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Universal health coverage and user charges

Published online by Cambridge University Press:  20 August 2013

Peter C. Smith
Peter C. Smith*
Affiliation:
Centre for Health Policy, Imperial College Business School, London, UK
*
*Correspondence to: Professor Peter Smith, Centre for Health Policy, Imperial College, SW7 2AZ London, UK. Email: peter.smith@imperial.ac.uk
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Abstract

There has been an explosion of interest in the concept of ‘universal health coverage’, fuelled by publication of the World Health Report 2010. This paper argues that the system of user charges for health services is a fundamental determinant of levels of coverage. A charge can lead to a loss of utility in two ways. Citizens who are deterred from using services by the charge will suffer an adverse health impact. And citizens who use the service will suffer a loss of wealth. The role of social health insurance is threefold: to reduce households’ financial risk associated with sickness; to promote enhanced access to needed health services; and to contribute to societal equity objectives, through an implicit financial transfer from rich to poor and healthy to sick. In principle, an optimal user charge policy can ensure that the social health insurance funds are used to best effect in pursuit of these objectives. This paper calls for a fundamental rethink of attitudes and policy towards user charges.

Type
Debate
Information
Health Economics, Policy and Law , Volume 8 , Issue 4 , October 2013 , pp. 529 - 535
Copyright
Copyright © Cambridge University Press 2013 

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References

Canadian Institute for Health Information (2013), Lifetime Distributional Effects of Publicly Financed Health Care in Canada, Ottawa: CIHI.Google Scholar
Chernew, M., Rosen, A. B.Fendrick, A. M. (2007), ‘Value-based insurance design’, Health Affairs, 26(2): 198–203.Google Scholar
OECD (2009), Achieving Better Value for Money in Health Care, Paris: OECD.Google Scholar
Richards, M. (2008), Improving Access to Medicines for NHS Patients: A Report for the Secretary of State for Health by Professor Mike Richards, London: Department of Health.Google Scholar
Rothschild, M.Stiglitz, J. E. (1976), ‘Equilibrium in competitive insurance markets: an essay on the economics of imperfect information’, Quarterly Journal of Economics, 90: 630–649.Google Scholar
Rumbold, R., Alakeson, V.Smith, P. (2012), Rationing Health Care: Is it Time to Set Out More Clearly What is Funded by the NHS?, London: Nuffield Trust.Google Scholar
Schreyögg, J., Stargardt, T., Velasco-Garrido, M.Busse, R. (2005), ‘Defining the “Health Benefit Basket” in nine European countries: evidence from the European Union Health BASKET Project’, European Journal of Health Economics, 6(Supplement 1): 2–10.Google Scholar
Smith, P. (2005), ‘User charges and priority setting in health care: balancing equity and efficiency’, Journal of Health Economics, 24: 1018–1029.Google Scholar
Smith, P. (2013), ‘Incorporating financial protection into decision rules for publicly financed healthcare treatments’, Health Economics, 22(2): 180–193.Google Scholar
Thomson, S., Schang, L.Chernew, M. E. (2013), ‘Value-based cost sharing in the United States and elsewhere can increase patients’ use of high-value goods and services’, Health Affairs, 32: 704–712.Google Scholar
World Bank (1993), World Development Report 1993, Washington, DC: World Bank.Google Scholar
World Health Organization (2010), World Health Report 2010: Health Systems Financing: the Path to Universal Coverage, Geneva: World Health Organization.Google Scholar