The Impact of Universal Coverage UHC Schemes in the Developing World: A Review of the Existing Evidence

UNICO Studies Series 25

The Impact of Universal Coverage UHC Schemes in the Developing World: A Review of the Existing Evidence, Ursula Giedion, Eduardo Andrés Alfonso, Yadira Díaz,

The World Bank, Washington DC, January 2013

 “…….UHC initiatives have sought to create awareness in and provide guidance to countries on how to improve the design and functioning of their health systems based on evidence of what works for achieving the goal of universal coverage. Meeting this goal is, however, challenging, because the available evidence rarely explores the causal link between the design features of these UHC schemes and the outcomes observed, and substantial heterogeneity exists regarding the robustness of the available evidence. Under these circumstances, providing meaningful guidance is not easy.

This report contributes to the debate by systematically reviewing and synthesizing evidence concerning the impact of universal coverage schemes and combining it with a structured assessment of the robustness of such evidence.

The review indicates that UHC interventions in low- and middle-income countries improve access to health care. It also shows, though less convincingly, that UHC often has a positive effect on financial protection, and that, in some cases it seems to have a positive impact on health status.

The review also shows that the effect of UHC schemes on access, financial protection, and health status varies across contexts, UHC scheme design, and UHC scheme implementation processes.

Regarding UHC design features, the review shows that there are several common features across countries and regions, such as the coexistence of  UHC schemes, heterogeneity in design and organization, a widespread effort to include the poor in the schemes, and the prevalence of mixed financing sources (contributions plus taxes). Yet, in a majority of cases, evidence is scarce and inconclusive on the impact of specific UHC design features on their intended outcomes.

A closer look at UHC schemes and available evidence reveals the following four lessons, all of which have implications for both policy and future UHC research.

First, affordability is important but may not be enough. ……”