Is Universal Health Coverage Revolutionary Enough?

India is a country with a massive dearth of high-quality medical facilities. Right from the shortage of good quality doctors to basic amenities that ought to be present in hospitals, India is behind on all fronts. Despite this,  medical tourism to India has surged in recent years, owing to its cheap and high-quality medical facilities. These facilities meet the requirements of the United Nations Universal Health Coverage criteria. This begs the question, is Universal Health Coverage good enough?


In today’s date, with new virus strains popping up around the world and wreaking havoc on the lives of the people and the world economy, revisiting the UHC definition is more important than ever.

Universal Health Coverage, a term defined by the World Health Organization (WHO), sets the minimum bar on the health coverage to which every person living on the planet should have access. It is also about ensuring a progressive expansion of coverage of health services and financial protection as more resources become available. It recognizes health as a fundamental right. Its main aim is to provide a minimum threshold so that all people in a community can get access to promotive, preventive, curative, rehabilitative, and palliative health services they need, of sufficient quality. It embodies three primary objectives:

  • Equity in access to health services – everyone who needs services should get them irrespective of their financial condition.
  • The quality of health services should be good enough to improve the health of those receiving services.
  • People should be protected against financial-risk, ensuring that the cost of using services does not put people at risk of financial harm.


According to the WHO definition, the UHC map looks like this:

fig.1 Nations by UHC. Green is best, red is worst


The importance of UHC is particularly felt during epidemics. The definition is controlled primarily by the more powerful countries in the UN. As a result, it tends to conform to their understanding of a sound healthcare system. In this article, we would discuss two countries that are prime examples of the failures of this definition, each in their own way. 


USA: The Uber Capitalist System

In countries like the US, where healthcare costs are steep, the government must provide every citizen with a basic health insurance plan. Given the high prices, patients are reluctant to visit a doctor for treatment. This could prove disastrous in epidemic scenarios.

In addition, the relationship between patients and insurance companies is parasitic. Exploiting the free market economy, these companies can go to an extreme, often highly unethical, lengths to increase profits. 


Ever since the Coronavirus outbreak, the UHC standards in the United States have come under severe scrutiny. Significant sections of the population have been demanding that all American citizens should have access to free treatment for the Coronavirus. In the present scenario, it would not be feasible for people with no health insurance to get treated. Given the proliferation rate of the virus, this presents a considerable problem. 


fig.2 Numbers of infected individuals in different countries


With the COVID-19 death toll rising beyond 40,000 in the USA, healthcare is going to be a significant talking point in the upcoming elections. The failure of the Trump administration to reduce the share of uninsured citizens and demonstrated commitment to undermining the Affordable Healthcare Act will likely come under fire from Democrats in the weeks to come. This time they would have a strong argument. After all, they face a crisis from an infectious disease outbreak that does not discriminate.


India’s Position on the Spectrum

India has one of the worst public healthcare systems in the world. Short-staffed and resource-deficient, the coronavirus spread presents a particularly difficult situation, due to the large population of the country and the paucity of medical professionals. The coronavirus outbreak has exposed massive weaknesses in the Indian healthcare system, with India performing very few tests daily (<40000 tests). In a country with a billion people, this number is not remotely sufficient. Countries like South Korea have done a better job with extensive testing and treatment.


However, the costs of medical treatment in India are far lower than Western counterparts, ensuring that everyone can at least have a chance at availing the required medical facilities. But the ground reality is that India does not have enough medical facilities to handle its population. The long queues in the government hospitals make it hard for patients to get treatment for minor ailments. At the same time, patients lying around in the hospital corridors don’t make the lives of the doctors and residents easy either. The doctors in our country are overworked. They do not have a work-life balance, with patients calling in at odd hours. It is imperative to provide all employees with the right working conditions to ensure optimal productivity. Being ambushed by patients and not having enough resources surely does not make for a pleasant work environment.


The Need for a Change

Bill Gates had pointed out in one of his talks in 2015 that we are not in a position to handle a wide-scale pandemic outbreak. Back then, he had discussed the devastating effects of Ebola in African countries, which didn’t spread so quickly. In 2019, the Coronavirus proved that the concerns raised by him were quite prudent. With the world struggling to mount a robust response to the virus, it is high time that we took UHC more seriously.


While the COVID 19 virus spreads, the one good thing is its low mortality rate. Further, it has been shown only to affect infants and the older section of the world’s population(Over 60 years of age). This gives us time to shift gears. All nations should put their differences aside and work towards a better contingency plan. At a time when Coronoavirus wreaks havoc around the world, the definition of the universal healthcare standard is more pertinent than ever. If we don’t act now, the next time a more deadly infection hits us, we may not have the time to respond.



  3. The next outbreak? We are not ready | Bill Gates

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