A new Chatham House report indicates that by dedicating one per cent of GDP, countries of all kinds all over the world can deliver universal health care for their citizens.
Throughout recent history, even in the midst or aftermath of economic crises, political leaders have launched successful universal health reforms, bringing huge benefits to their populations and considerable political benefits for themselves.
New Chatham House research shows that such reforms have typically cost around one per cent of GDP in public financing. Today's leaders, facing multiple troubles and in need of powerful political propositions, should take note.
Universal health coverage (UHC) is achieved when everybody receives the health services they need without suffering financial hardship.
In reality, no country has reached this goal yet. But some are making much faster progress than others.
The key determinant of success is to create a publicly financed health system, where healthy and wealthy members of society subsidize the sick and the poor. Therefore, the need for UHC reforms is greatest in health systems that are mostly financed by out-of-pocket payments - especially in South Asia and Sub-Saharan Africa.
Born out of crisis
Over the last two years, The Chatham House Commission for Universal Health, co-chaired by Helen Clark (former prime minister of New Zealand) and Jakaya Kikwete (former President of Tanzania) has been researching the tendency for political leaders to launch universal health reforms in response to national crises.
The Commission found that this has happened in all regions and at all income levels, occurring in response to, or in the aftermath of wars (in the UK, France, Japan and Ukraine); following natural disasters (in Turkey) and health emergencies (China after the SARS epidemic); and also following political upheavals - for example in many Latin American countries, as democratic governments replaced repressive dictators, many of them during the 1980s.
Interestingly, many UHC reforms have also emerged from economic and financial crises, when one would have thought that sufficient public financing would not be available. This was the case in New Zealand, Thailand, Uruguay, and Cyprus.
Common lessons
Despite the varying contexts and the different crises involved, common lessons can be learned from successful post-crisis universal health reforms:
Firstly, political leaders prioritized reaching full population coverage rapidly, by providing a universal entitlement to a comprehensive package of publicly-financed health services.
Unsurprisingly, given their huge popularity, political leaders have promoted these reforms as flagship policy, with a view to winning votes and retaining power.
To finance this, governments typically increased public health financing by around one per cent of Gross Domestic Product (GDP) to expand the supply and quality of services and generate additional demand by removing financial barriers to services. This made the universal entitlement to services a reality rather than an aspiration.
However, it should be noted that while this appears sufficient to launch successful UHC reforms, additional public financing will be needed in the longer term to meet the growing health needs of ageing populations.
Governments have tended to concentrate additional public spending on improving primary care services and strengthening health systems in areas such as human resources, essential medicines, infrastructure, information systems and governance.
Furthermore, to improve financial access for everyone, leaders removed or drastically reduced user fees so that health services in the agreed package were provided free at the point of delivery.
Unsurprisingly, given their huge popularity, political leaders have promoted these reforms as flagship policy, with a view to winning votes and retaining power.
Because UHC is so popular in reducing people's fears about health costs, it has proven extremely resilient to changes of government.
UHC has also played an important role in non-democratic countries such as China, where reforms were launched in response to mounting political pressure following the SARS epidemic.
Additionally, because UHC is so popular in reducing people's fears about health costs, it has proven extremely resilient to changes of government, even when parties initially opposed to the reforms assumed power: once in place, universal health coverage proves difficult to dismantle, creating lasting political legacies.
Of all these findings, perhaps the most significant is that the cost of launching popular, truly universal health reforms appears to be around one per cent of GDP in public financing: this is what it took for the UK's post war government to launch the NHS in 1948.
Political commitment
The policy message for today's leaders, assailed by multiple crises from climate change to the cost of living, is clear. Launching universal health reforms is perfectly feasible and affordable, even in the aftermath of a financial crisis. All that it requires is the political commitment to dedicate an additional one per cent of GDP to public health financing.
As Dr Tedros, The Director General of WHO says: 'UHC is a political choice'. It is one our Commission encourages leaders without such provision to make.
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Not only will it improve the health and welfare of citizens and stimulate economic growth, it can deliver huge societal and political benefits. This will be true at anytime, but especially in times of crisis and political turmoil, where leaders are looking for quick wins.
Universal health coverage has proven near universally popular in countries where it has taken root.
This could therefore be a huge political opportunity for leaders in countries who even now appear very far from offering universal health coverage.
This includes both those where campaigning for elections is underway, such as the United States, or those where recent election results have weakened powerful political parties, like those in India and South Africa.
Universal health coverage has proven near universally popular in countries where it has taken root, and represents a powerful tool for those with the will to use it.
Given global trends it appears inevitable that at least some of these countries will take big steps towards universal health coverage in the coming years. Today's crises ought to provide a catalyst not to wait, and to do it now.
