The Many Paths Towards Universal Health Coverage: WHO Video Review

This post was written by Niniola Soleye.

Universal health care (UHC) is a hot topic in global health right now. The United Nations, World Health Organization (WHO), and World Bank have all endorsed UHC. Further, UHC has played a prominent role in discussions on the Sustainable Development Goals, which will build on the Millennium Development Goals and support the post-2015 development agenda. The WHO put together a video to explain UHC and show how some countries are providing universal access to basic health care services.

As Dr. Margaret Chan, Director General of the WHO said in the video, “Universal health coverage is the most powerful concept that public health has to offer.” The key to UHC is that it allows for equity within a health system. It guarantees health care to all members of a population and overcomes the challenges of unavailable or unaffordable services, which is often the case in modern health care settings.

The video highlights UHC in six countries – China, Oman, Mexico, Rwanda, Thailand, and Turkey. It shows how each country is addressing their health care system and making progress towards UHC.

I found it very interesting to see the differences between each country. It really drove home the point that there is no single UHC approach or model that will work for every country. The journey towards UHC is unique and varied. For example, in China the emphasis is on how to cover as many people as possible. In Oman, the focus is on access because their population, while small, is widely dispersed throughout the country. Mexico, Thailand, and Turkey are working on expanding the type and quality of services provided, while Rwanda has increased coverage from 7% to 97% in the last decade.

The main takeaways from the ten-minute video are the importance and benefits of UHC, the challenges in implementing it, and the various models that allow countries to work towards providing basic primary care to everyone.

Perspective: A Day in the Life of Another Country’s Healthcare System

I will be the first one to admit that my job teaching English to privileged Korean children at a private academy has almost nothing to do with public health. While I have maintained most of my international-health related activities (and even added some new ones since being here), my income-generating activities are not typically health-related. There are times, however – and more than I originally expected, to be sure – when my public health knowledge and training comes in handy. For example, we have a lot of debate classes, and obesity, fast food, and eating disorders are frequent topics. It can be really enriching to bring my professional training into the classroom and engage my students beyond the textbook.

And then I occasionally get responses to writing assignments like these.
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If your first instinct is that this is just a witty response from a smart-ass middle school student, think again. I got two more with the same response.

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Teacher, what?

By and large, South Korea’s healthcare system comes very highly reviewed. The government provides universal health coverage through the compulsory National Health Insurance scheme, which covers basic services – half of the premium is paid by the individual and the other half by that person’s employer. Experts and pundits love to list it as one of the examples that America’s own expensive and oh-so-broken system should aspire to be, as South Korea only spends about 7% of its GDP on health care (compared to our whopping 17%). Koreans, of course, take great pride in their healthcare system. A prime example can be found on the popular blog Ask a Korean, where the author writes about this very same topic.

Part of the reason why the Korean did not follow the [American healthcare debate] was because the entire thing was so moronic: to the Korean, it is obvious that a country should guarantee its citizens a health insurance, and the cheapest way to achieve that is a single-payer system like Korea’s. Scores of advanced and semi-advanced countries in the world manage to do this without turning their country into Russia. (Unless, of course, if their country is Russia.) There is no point in watching a debate where the other side is arguing the sky isn’t blue.

What has been strange for us to understand was not Koreans’ views on healthcare, but on accessing it. We noticed very early on that our Korean coworkers go to the hospital for everything – and by that, I mean everything. Have a stomachache? Time to go to the hospital. Sore throat? Going to the hospital. Cold? Hospital. Fever? Flu? Twitch under your eye? You get the idea. During our first few weeks, I was always very concerned to hear that someone had gone to the hospital, but now I don’t even bat an eye.

Coming from a country where healthcare is so expensive that people wait until they are at death’s door to get treated (and then, by necessity, have to go to the hospital), I found a system with the opposite problem to be somewhat fascinating. I asked one of my friends here, who is a neurologist at a local hospital, about it, and he explained some of the reasons behind this tendency:

  1. Many Koreans think that bigger is better, which means if they go to a hospital for a simple cold, they feel like they get better service than they would get from a small clinic.
  2. Also, many Koreans feel that they need to see someone who works at a reputable facility, graduated from a prestigious university, or has multiple advanced degrees to be satisfied, even for minor ailments.
  3. Third, he explained, Korea is still a hierarchical society, which means that upper-class individuals go to upscale hospitals for treatment to get the medical treatment they feel that they deserve according to your socioeconomic status.

In a system where a procedure costs the same amount no matter where you go, these reasons make sense, particularly in a culture that is as socially competitive as this one. Of course, every healthcare system has its own issues, and Korea is no exception. Because the price for a given procedure is the same everywhere and, as a result, larger hospitals have people lined up out the door to get their runny noses looked at, providers are pressured to see as many patients as possible in the shortest amount of time to minimize wait time and maximize profit. Absolutely everyone knows that this is a terrible idea, leading to stories like the one I read in the local English-language paper about a small colonoscopy clinic in Seoul that was seeing hundreds of patients per day – and not properly cleaning their instruments because they were so rushed. Also, much like the U.S., Korea is starting to see its healthcare costs rise and must come up with a way to continue to finance them, lest they become sustainable. Still, as Americans prepare themselves for the upcoming changes that the landmark healthcare reform will bring over the next few years, it is interesting to put the uproar into perspective.

Not all of the write-up books that I received were so drastic in their responses to the runny nose question. Two of my best students also gave me slightly more sensible answers.

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