HEALTH SYSTEM AND UNIVERSAL HEALTH COVERAGE: A NARRATIVE REVIEW OF FOUR COUNTRIES

Background: Universal health coverage (UHC) is the stated political agenda for sustainable development. Coverage of services and financial risk protection are important performance indicators. The present review aimed to describe the health system, financing structure and level of achievement for UHC in 4 purposively chosen countries, including India, Germany, the United Kingdom and the United States of America. Methods: This study used a narrative review methodology. Firstly, a targeted review of published evidence was undertaken by using selected keywords in PubMed and Google Scholar. Secondly, websites of key international organizations involved in supporting global and country-level work on UHC were searched for additional papers. Thirdly, a review of global databases and repositories of performance dashboards was undertaken to determine country-level UHC performance based on set indicators. Results: Overall, the present review shows wide heterogeneity in the selected countries in terms of the extent of financing, patterns of financing, and density of the health workforce. The UHC performance index varies from 64% to 88%. More than 5% of people undergoing hospitalization in India are pushed below poverty due to health care expenditures. Conclusion: The key lessons for adequate financing, enhancing the role of pre-payment and reducing out-of-pocket payments, developing a robust health workforce, as well as focusing on strategies to make the health systems efficient and equitable are important key recommendations.