RESUMO
BACKGROUND: When today's efforts to achieve universal health coverage are mainly directed towards low-income settings, it is perhaps easy to forget that countries considered to have universal, comprehensive and high-performing health systems have also undergone this journey. In this article, the aim is to provide a century-long perspective to illustrate Sweden's long and ongoing journey towards universal health coverage and equal access to healthcare. METHODS: The focus is on macro-level policy. A document analysis is divided into three broad eras (1919-1955; 1955-1989; 1989-) and synthesises seven points in time when policies relevant to overarching goals and regulation of universal health coverage and equal access were proposed and/or implemented. The development is analysed and concluded in relation to two egalitarian goals in the context of health: equality of access and equal treatment for equal need. RESULTS: Over the past century, macro-level policy evolved from the concept of creating access for the neediest and those reliant on wages for their survival to a mandatory insurance with equal right to healthcare for all. However, universal health coverage was not achieved until 1955, and individuals had to rely on their personal financial resources to cover the cost at the time of care utilization until the 1970s. It was not until 1983 that legislation explicitly stated that access to healthcare should be equal for the entire population (horizontal equity), while a vertical equity-principle was not added until 1997. Subsequently, ideas of free choice and privatization have gained significance. For instance, they aim to increase service access, addressing the Swedish health system's Achilles' heel in this regard. However, the principle of equal access for all is now being challenged by the emergence of private health insurance, which offers quicker access to services. It can be concluded that there is no perpetual Swedish healthcare model and various dimensions of access have been the focus of policy discussion. The discussion on access barriers has shifted from financial to personal and organizational ones. Today, Sweden still ranks high in terms of affordability and equity in international comparisons: although not as well as a decade ago. Whether this marks the beginning of a new trend intertwined with a decline in Sweden's welfare 'exceptionalism', or is a temporary decline remains to be assessed in the future.
Assuntos
Política de Saúde , Acessibilidade aos Serviços de Saúde , Cobertura Universal do Seguro de Saúde , Suécia , Cobertura Universal do Seguro de Saúde/tendências , Cobertura Universal do Seguro de Saúde/história , Humanos , Acessibilidade aos Serviços de Saúde/tendências , Política de Saúde/história , Política de Saúde/tendências , História do Século XX , História do Século XXIRESUMO
Although it is not generally done, it is useful to compare the history of the evolution of universal health coverage (UHC) in Canada and Sweden. The majority of citizens in both countries have shared, and continue to share, a commitment to a strong form of single-tier universality in the design of their respective UHC systems. In the postwar era, they also share a remarkably similar timeline in the emergence and entrenchment of single-tier UHC, despite the political and social differences between the two countries. At the same time, UHC was initially designed, implemented, and managed by social democratic governments that held power for long periods of time, creating a path dependency for single-tier Medicare that was difficult for future governments of different ideological persuasions to alter.
Assuntos
Atenção à Saúde/história , Política , Seguridade Social/história , Medicina Estatal/história , Cobertura Universal do Seguro de Saúde/história , Canadá , Atenção à Saúde/estatística & dados numéricos , História do Século XX , História do Século XXI , Mudança Social/história , Seguridade Social/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Suécia , Cobertura Universal do Seguro de Saúde/estatística & dados numéricosRESUMO
We examine the efforts of the International Labour Organisation (ILO) to extend medical care under social security, through international conventions, advocacy and technical assistance. We consider the challenges faced by the ILO in advancing global health coverage through its labourist, social security model. The narrative begins in the interwar period, with the early conventions on sickness insurance, then discusses the rights-based universalistic vision expressed in the Philadelphia Declaration (1944). We characterize the ILO's postwar research and technical assistance as "progressive gradualism" then show how from the late-1970s the ILO became increasingly marginalized, though it retained an advisory role within the now dominant "co-operative pluralistic" model.
Assuntos
Saúde Global/história , Sindicatos/história , Cobertura Universal do Seguro de Saúde/história , História do Século XX , História do Século XXI , Humanos , Previdência Social/históriaRESUMO
Abstract We examine the efforts of the International Labour Organisation (ILO) to extend medical care under social security, through international conventions, advocacy and technical assistance. We consider the challenges faced by the ILO in advancing global health coverage through its labourist, social security model. The narrative begins in the interwar period, with the early conventions on sickness insurance, then discusses the rights-based universalistic vision expressed in the Philadelphia Declaration (1944). We characterize the ILO's postwar research and technical assistance as "progressive gradualism" then show how from the late-1970s the ILO became increasingly marginalized, though it retained an advisory role within the now dominant "co-operative pluralistic" model.
Resumo Analisamos os esforços da Organização Internacional do Trabalho (OIT) em ampliar o cuidado médico sob seguridade social, via convenções, amparo e assistência técnica internacionais. Consideramos os desafios da OIT no desenvolvimento da cobertura global de saúde por meio do modelo trabalhista e de seguridade social. A narrativa inicia no período entreguerras, com as primeiras convenções sobre seguro saúde, depois discute a visão universalista baseada em direitos da Declaração da Filadélfia (1944). Classificamos a pesquisa e a assistência da OIT no pós-guerra como "gradualismo progressivo" e mostramos como, a partir do final da década de 1970, a OIT foi marginalizada, embora mantivesse um papel de conselheira dentro do atual modelo "pluralista cooperativo" dominante.
Assuntos
Humanos , História do Século XX , História do Século XXI , Saúde Global/história , Cobertura Universal do Seguro de Saúde/história , Sindicatos/história , Previdência Social/históriaRESUMO
OBJECTIVES: To analyze the fundamentals of the global health agenda from 1944 to 2018, especially regarding Universal Health Coverage, in order to unveil its relations with capital accumulation in health services and to contribute to world social mobilization to change this tendency. METHODS: A historical study was carried out based on a purposeful selection of primary sources on the global health agenda from multilateral organizations and secondary sources about the changes of capitalism from the study period. RESULTS: The global health agenda changed from the state responsibility for health to an insurance healthcare system based on markets. The medical-industrial complex pressured national economies, broke postwar pacts, and urged economic globalization. The neoliberal, neoclassical, and neo-institutional discourse that promoted a new state-market relationship eased the new capital accumulation in healthcare into financial and cognitive capitalism. CONCLUSIONS: Understanding these relationships allows us to provide elements for social mobilization geared to transform the healthcare sector toward a new vision of health with a nature-society relationship that contributes to socially constructing human and environmental health, rather than gaining profits based on illness and chronic suffering.
Assuntos
Atenção à Saúde/economia , Saúde Global/economia , Saúde Global/história , Serviços de Saúde/economia , Política , Cobertura Universal do Seguro de Saúde/economia , Cobertura Universal do Seguro de Saúde/história , Cobertura Universal do Seguro de Saúde/legislação & jurisprudência , Atenção à Saúde/história , Atenção à Saúde/legislação & jurisprudência , Atenção à Saúde/estatística & dados numéricos , Saúde Global/legislação & jurisprudência , Saúde Global/estatística & dados numéricos , Serviços de Saúde/história , Serviços de Saúde/legislação & jurisprudência , Serviços de Saúde/estatística & dados numéricos , História do Século XX , História do Século XXI , Humanos , Cobertura Universal do Seguro de Saúde/estatística & dados numéricosRESUMO
The new Imperial era, Reiwa, started in May, 2019. After World War II, Reiwa is the third Imperial era following Showa and Heisei. In each era, we had specific healthcare problems in cardiovascular medicine and implemented preventive strategies against them. Furthermore, nationwide healthcare policies such as a universal healthcare insurance system (kaihoken) and health check-up system largely contribute to overcoming these problems. Here, we summarize the specific issues in cardiovascular medicine and nationwide strategies policies against them in each era. We also describe what we should do in the new Imperial era from the cardiovascular viewpoint.
Assuntos
Cardiologia/tendências , Política de Saúde/tendências , Insuficiência Cardíaca/terapia , Assistência de Saúde Universal , Cobertura Universal do Seguro de Saúde/tendências , Cardiologia/história , Previsões , Política de Saúde/história , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/história , História do Século XX , História do Século XXI , Humanos , Japão/epidemiologia , Formulação de Políticas , Fatores de Tempo , Cobertura Universal do Seguro de Saúde/históriaRESUMO
OBJECTIVES: This study has analyzed the policy-making requirements related to basic health insurance package at the national level with a systematic view. RESULTS: All the documents presented since the enactment of universal health insurance in Iran from 1994 to 2017 were included applying Scott method for assuring meaningfulness, authenticity, credibility and representativeness. Then, content analysis was conducted applying MAXQDA10. The legal and policy requirements related to basic health insurance package were summarized into three main themes and 11 subthemes. The main themes include three kinds of requirements at three level of third party insurer, health care provider and citizen/population that contains 5 (financing insurance package, organizational structure, tariffing and purchasing the benefit packages and integration of policies and precedents), 4 (determining the necessities, provision of services, rules relating to implementation and covered services) and 2 (expanded coverage of population and insurance premiums) sub themes respectively. According to the results, Iranian policy makers should notice three axes of third party insurers, health providers and population of the country to prepare an appropriate basic benefit package based on local needs for all the people that can access with no financial barriers in order to be sure of achieving UHC.
Assuntos
Países em Desenvolvimento/economia , Cobertura Universal do Seguro de Saúde/legislação & jurisprudência , Pessoal Administrativo , Países em Desenvolvimento/história , Pessoal de Saúde , Política de Saúde/legislação & jurisprudência , Serviços de Saúde/normas , História do Século XX , História do Século XXI , Humanos , Seguro Saúde/história , Seguro Saúde/legislação & jurisprudência , Seguro Saúde/normas , Irã (Geográfico) , Formulação de Políticas , Cobertura Universal do Seguro de Saúde/históriaRESUMO
Current interest in a single-payer approach to universal health care coverage in the United States has also triggered interest in alternative multipayer approaches to the same goal.An analysis of experiences in Germany, the Netherlands, Switzerland, and Israel shows how the founding of each system required a distinctive political settlement and how the subsequent timing, content, and course of the reforms were shaped by political circumstances and adjustments to the founding bargain in each nation.Although none of these systems is directly transferable to the United States, certain parallels with the American context suggest that a multipayer approach might offer a model for universal coverage that is more politically feasible than a single-payer scheme but also that issues associated with risk selection and other potential inequities would remain.
Assuntos
Seguro Saúde/história , Seguro Saúde/organização & administração , Política , Europa (Continente) , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Seguro Saúde/legislação & jurisprudência , Israel , Sistema de Fonte Pagadora Única/organização & administração , Previdência Social/história , Estados Unidos , Cobertura Universal do Seguro de Saúde/história , Cobertura Universal do Seguro de Saúde/organização & administraçãoRESUMO
Ghana has made significant stride towards universal health coverage (UHC) by implementing the National Health Insurance Scheme (NHIS) in 2003. This paper investigates the progress of UHC indicators in Ghana from 1995 to 2015 and makes future predictions up to 2030 to assess the probability of achieving UHC targets. National representative surveys of Ghana were used to assess health service coverage and financial risk protection. The analyses estimated the coverage of 13 prevention and four treatment service indicators at the national level and across wealth quintiles. In addition, we calculated catastrophic health payments and impoverishment to assess financial hardship and used a Bayesian regression model to estimate trends and future projections as well as the probabilities of achieving UHC targets by 2030. Wealth-based inequalities and regional disparities were also assessed. At the national level, 14 out of the 17 health service indicators are projected to reach the target of 80% coverage by 2030. Across wealth quintiles, inequalities were observed amongst most indicators with richer groups obtaining more coverage than their poorer counterparts. Subnational analysis revealed while all regions will achieve the 80% coverage target with high probabilities for the prevention services, the same cannot be applied to the treatment services. In 2015, the proportion of households that suffered catastrophic health payments and impoverishment at a threshold of 25% non-food expenditure were 1.9% (95%CrI: 0.9-3.5) and 0.4% (95%CrI: 0.2-0.8), respectively. These are projected to reduce to 0.4% (95% CrI: 0.1-1.3) and 0.2% (0.0-0.5) respectively by 2030. Inequality measures and subnational assessment revealed that catastrophic expenditure experienced by wealth quintiles and regions are not equal. Significant improvements were seen in both health service coverage and financial risk protection over the years. However, inequalities across wealth quintiles and regions continue to be cause of concerns. Further efforts are needed to narrow these gaps.
Assuntos
Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/tendências , Gana/epidemiologia , Gastos em Saúde , Serviços de Saúde , Indicadores Básicos de Saúde , História do Século XX , História do Século XXI , Humanos , Programas Nacionais de Saúde , Vigilância em Saúde Pública , Fatores Socioeconômicos , Cobertura Universal do Seguro de Saúde/economia , Cobertura Universal do Seguro de Saúde/históriaRESUMO
Sri Lanka has been lauded for providing good health coverage at a low cost despite having a modest per capita income. This article identifies the unique historical factors that enabled Sri Lanka to achieve near universal coverage, but it also discusses how this achievement is now being undermined by inadequate government investment in health services, the burdens of non-communicable diseases, and the growing privatisation of health services. In doing so, the article highlights the challenges of achieving and maintaining universal health coverage in a relatively low income country with a health system designed to treat infectious diseases and provide child and maternal health services as the country undergoes an epidemiological transition from infectious to non-communicable diseases. Using updated information on developments in the Sri Lankan health system, this article argues, in contrast with earlier publications, that Sri Lanka is no longer providing good health at a low cost. It shows that Sri Lanka's low investment in health is detrimental and not an asset to achieving good health. The article also questions the possibilities of providing coverage for noncommunicable diseases at a low cost. The article has four main sections. The first details Sri Lanka's accomplishments in moving toward universal health coverage. The second identifies the factors enabling Sri Lanka to do so. The third describes the equity and access challenges the health system now confronts. The fourth assesses what the Sri Lankan experience suggests about the requirements for universal health coverage when providing health services for treating non-communicable diseases becomes an important consideration.
Assuntos
Pobreza , Cobertura Universal do Seguro de Saúde , Doença Crônica , Atenção à Saúde , Acessibilidade aos Serviços de Saúde , História do Século XX , Humanos , Sri Lanka , Cobertura Universal do Seguro de Saúde/históriaRESUMO
Recently, the World Health Organization launched its Universal Health Coverage initiative with the aim to improve access to quality health care on a global level, without causing financial hardship to the patients. In this paper, we will identify and analyze the ideological similarities between this influential initiative and the work of one of the founders of the WHO-Andrija Stampar (1888-1958)-whose social medicine was built of various normative, sociological and philosophical elements. Our aim is to demonstrate the crucial role of carefully erected and thought-out ideology for the success of public health programs.
Assuntos
Atenção à Saúde/história , Saúde Pública/história , Medicina Social/história , Croácia , História do Século XX , Humanos , Faculdades de Saúde Pública/história , Cobertura Universal do Seguro de Saúde/história , Organização Mundial da Saúde/história , IugosláviaRESUMO
With increasing adoption of universal health coverage (UHC), the health for all agenda is resurgent around the world. However, after a promising start the first time in 1978, the health for all agenda fizzled over the next decade. This commentary discusses the origin of the health for all agenda in the 1970s and the influence of global politico-economic forces in shaping that agenda, its demise and the resurgence in the form of UHC in the twenty-first century. We discuss UHC's focus on finances and the increasing role of market economy in health care, and the opportunities and risks UHC poses. We conclude by saying that UHC's greater focus on finances is prudent, but in order to achieve its promise, UHC needs to regulate the market based provision of healthcare, and incorporate more of the people and community centered ethos of its earlier iteration from 40 years ago.
Assuntos
Saúde Global , Política de Saúde/história , Justiça Social , Cobertura Universal do Seguro de Saúde/história , Economia , História do Século XX , História do Século XXI , Humanos , Política , Atenção Primária à SaúdeRESUMO
The UN Sustainable Development Goals of 2015 have restored universal health coverage (UHC) to prominence in the international health agenda. Can understanding the past illuminate the prospects for UHC in the present? This article traces an earlier history of UHC as an objective of international health politics. Its focus is the efforts of the International Labor Organization (ILO), whose Philadelphia Declaration (1944) announced the goal of universal social security, including medical coverage and care. After World War II, the ILO attempted to enshrine this in an international convention, which nation states would ratify. However, by 1952 these efforts had failed, and the final convention was so diluted that universalism was unobtainable. Our analysis first explains the consolidation of ideas about social security and health care, tracing transnational policy linkages among experts whose world view transcended narrow loyalties. We then show how UHC goals became marginalized, through the opposition of employers and organized medicine, and of certain nation states, both rich and poor. We conclude with reflections on how these findings might help us in thinking about the challenges of advancing UHC today.
Assuntos
Política de Saúde , Cobertura do Seguro/tendências , Internacionalidade , Objetivos Organizacionais , Política , Cobertura Universal do Seguro de Saúde/tendências , História do Século XX , Humanos , Sindicatos/história , Cobertura Universal do Seguro de Saúde/históriaAssuntos
Acessibilidade aos Serviços de Saúde/história , Planos de Sistemas de Saúde/história , Marketing de Serviços de Saúde/história , Programas Nacionais de Saúde/história , Socialismo/história , Cobertura Universal do Seguro de Saúde/história , Cobertura Universal do Seguro de Saúde/tendências , Previsões , Acessibilidade aos Serviços de Saúde/tendências , Planos de Sistemas de Saúde/tendências , História do Século XX , História do Século XXI , Marketing de Serviços de Saúde/tendências , Programas Nacionais de Saúde/tendências , Setor Privado/história , Setor Privado/tendências , Federação Russa , Socialismo/tendênciasAssuntos
Conflitos Armados/história , Direitos Humanos/história , Saúde Pública/história , Qualidade da Assistência à Saúde/história , Cobertura Universal do Seguro de Saúde/história , Conflitos Armados/tendências , Previsões , História do Século XX , História do Século XXI , Direitos Humanos/tendências , Humanos , Saúde Pública/tendências , Qualidade da Assistência à Saúde/tendências , Federação Russa , Cobertura Universal do Seguro de Saúde/tendênciasRESUMO
High-quality primary health care (PHC) services are associated with better health outcomes and positive health equity. Providing PHC services to all inhabitants is one of the Chinese government's health care objectives. However, an imbalance between people's increasing health needs and effective health service utilization exists in China. The objective of this review is to identify evidence for PHC development in China and to summarize the challenges as a reference for the future improvement of China's PHC system. Literature searches related to China's PHC were performed in PubMed, Web of Science, China National Knowledge Infrastructure, and Wan-fang databases. Related data were collected from the China Statistical Yearbook on Health and Family Planning 2003-2016, the China National Health Accounts Report 2015, and An Analysis Report of National Health Services Survey in China, 2013. The PHC network and the population's health have improved in China in recent years, with general practitioners as "gatekeepers" who have gradually taken the initiative to offer health services to residents. The limitation of input and shortages of resources and skilled health care providers may restrict the sustainable development of China's PHC system. Therefore, policy support from the government is necessary.