Barbara Fienieg & Corinne Hinlopen
‘Act with Ambition!’ is this year’s slogan for Universal Health Coverage (UHC) Day. The aim of UHC is nothing short of ambitious: guaranteeing access to essential – and affordable – health services for all. It is one of the ambitious Sustainable Development Goals (SDGs), or Agenda2030, which nearly every country worldwide has agreed to a year ago. Wemos, too, believes UHC is something that should be attained.
Health is regarded as a public good. As a goal in itself, a human right, and as a prerequisite for advancement and development in areas like education and employment. The aim of UHC is that rich and poor, regardless of country or region of origin, get access to necessary health services. Health care should be accessible both geographically and financially. Last year on World UHC Day, Cordaid stressed that having to walk 27 kilometers to a clinic for a prenatal visit is unacceptable. Preventive basic healthcare should be free, or affordable at the very least.
Countries and international organizations like the World Health Organization (WHO) and the World Bank are in theory on the same page when it comes to the definition of financial accessibility. Financial access to health means that essential health services (which includes medication) may not lead to financial hazard. Households should not have to deal with financial difficulties or additional financial burden caused by health expenses. In 2015, WHO and the World Bank expressed concerns about the fact that 400 million people still don’t have access to essential health services, and that 6% of the population in low- and middle-income countries is being driven further into extreme poverty due to health expenditure.
Realizing financial access to health is a huge challenge for governments worldwide. We still have a long way to go. So how do we determine whether we are taking steps in the right direction? Should we be happy with increasingly more people getting health insurance? Until recently, the Inter-Agency Expert Group (IAEG), which monitors the progress indicators of the SDGs, indeed used health insurance as a criterion for access to health. However, WHO and many NGOs pressed for an alternative, since having health insurance does not automatically mean one is protected from financial setbacks. Also, in some countries, health insurance actually widens the gap between rich and poor. A few weeks ago, fortunately, the IAEG backs the proposal for a new indicator.
There are concerns about financial access to health in the Netherlands, too. In 2013, TNS NIPO reported that three-quarters of Dutch medical specialists and general practitioners had experienced that patients in their practices refrained from health care because of high costs. According to the Dutch Practitioners Association, 94% of general practitioners had had the same experience. This can only mean one thing: the health system in its current state causes financial problems for many. The deductible excess is increasing, and patients don’t pursue their practitioner’s referral to second-line care and won’t take prescriptions because these have to be paid from their deductible excess. Also, increasingly more people don’t visit their physiotherapist or dentist anymore because of their deductible excess. Unfortunately, this often leads to deteriorating health complaints – which not only cause more anguish, but are also more expensive to treat.
Since the Dutch general elections are coming up in March 2017, health care is currently a pivotal topic. For Wemos, this year’s UHC Day slogan is therefore also a message to Dutch political parties preparing for the elections: ‘Act with ambition!’. Access to essential health services should be a reality for all – in the Netherlands as well as in other parts of the world. Together with our partners of the Health Systems Advocacy Partnership we look forward to UHC plans, and all the more to their realization. Now is the time for ambition, for health for all!
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