Strengthening Health Systems of Developing Countries: Inclusion of Surgery in Universal Health Coverage
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Universal health coverage (UHC) has its roots in the Universal Declaration of Human Rights and has recently gained momentum. Out-of-pocket payments (OPP) remain a significant barrier to care. There is an increasing global prevalence of non-communicable diseases, many of which are surgically treatable. We sought to provide a comparative analysis of the inclusion of surgical care in operating plans for UHC in low- and middle-income countries (LMIC).
We systematically searched PubMed and Google Scholar using pre-defined criteria for articles published in English, Spanish, or French between January 1991 and November 2013. Keywords included “insurance,” “OPP,” “surgery,” “trauma,” “cancer,” and “congenital anomalies.” World Health Organization (WHO), World Bank, and Joint Learning Network for UHC websites were searched for supporting documents. Ministries of Health were contacted to provide further information on the inclusion of surgery.
We found 696 articles and selected 265 for full-text review based on our criteria. Some countries enumerated surgical conditions in detail (India, 947 conditions). Other countries mentioned surgery broadly. Obstetric care was most commonly covered (19 countries). Solid organ transplantation was least covered. Cancer care was mentioned broadly, often without specifying the therapeutic modality. No countries were identified where hospitals are required to provide emergency care regardless of insurance coverage. OPP varied greatly between countries. Eighty percent of countries had OPP of 60 % or more, making these services, even if partially covered, largely inaccessible.
While OPP, delivery, and utilization continue to represent challenges to health care access in many LMICs, the inclusion of surgery in many UHC policies sets an important precedent in addressing a growing global prevalence of surgically treatable conditions. Barriers to access, including inequalities in financial protection in the form of high OPP, remain a fundamental challenge to providing surgical care in LMICs.
KeywordsClub Foot Obstetric Care Health Information Technology Universal Health Coverage National Health Insurance Scheme
Conflicts of interest
All authors declare no conflicts of interest.
- 6.World Health Organization (2007) Everybody’s business—strengthening health systems to improve health outcomes: WHO’s framework for action. WHO, GenevaGoogle Scholar
- 8.WHO (2012) Global Health Observatory Data Repository. Out-of-pocket expenditure as a percentage of total expenditure on health. Available at http://apps.who.int/gho/data/node.imr.WHS7_150?lang=en. Accessed 13 Jun 2014
- 9.Debas HT, Gosselin R, McCord C, Thind A (2006) Surgery. In: Jamison DT, Breman JG, Measham AR et al (eds) Disease control priorities in developing countries, 2nd edn. World Bank, WashingtonGoogle Scholar
- 10.World Health Assembly (2005) Resolution 58.33: sustainable health financing, universal coverage and social health insurance. pp 139–140. http://www.who.int/providingforhealth/topics/WHA58_33-en.pdf. Accessed 13 Jun 2014
- 11.Taiwan National Health Insurance Administration (2012) The National Health Insurance Statistics. Taipei, pp 33–72. http://www.nhi.gov.tw/English/webdata/webdata.aspx?menu=11&menu_id=296&WD_ID=296&webdata_id=4456. Accessed 13 Jun 2014
- 12.Colombia Ministry of Health and Social Protection (2013) Anexo 2 resolucion 5521 del 2013. Available at http://pospopuli.minsalud.gov.co/LinkClick.aspx?fileticket=xGsc9LNQ7ko%3D&tabid=737&mid=1819. Accessed 13 Jun 2014
- 13.South Korea Ministry of Health (2013) List of covered treatments and servicesGoogle Scholar
- 14.Hanvoravongchai P (2013) UNICO study series 20: health financing reform in Thailand: toward universal coverage under fiscal constraints. UNICO, WashingtonGoogle Scholar
- 15.Couttolenc B, Dmytraczenko T (2013) UNICO studies series no. 2: Brazil’s primary care strategy. UNICO, WashingtonGoogle Scholar
- 16.Bitran R (2013) UNICO studies series 21: explicit health guarantees for Chileans: the AUGE benefits package. UNICO, WashingtonGoogle Scholar
- 17.Ramana GN, Chepkoech R, Watelign Workie N (2013) UNICO studies series 5: improving universal primary health care by Kenya: a case study of the health sector services fund. UNICO, WashingtonGoogle Scholar
- 19.Nagpal S (2013) UNICO studies series 13: expanding health coverage for vulnerable groups in India. UNICO, WashingtonGoogle Scholar
- 20.Nigeria National Health Insurance Scheme (2012) NHIS operational guidelines: benefit package. pp 350–359. doi: 10.4324/9780203403099_Nigeria
- 21.Joint learning network for universal health coverage. Mali. http://jointlearningnetwork.org/country/mali. Accessed 13 Jun 2014
- 22.Somanathan A, Dao HL, Van Tien T (2013) UNICO studies series 24: integrating the poor into universal health coverage in Vietnam. UNICO, WashingtonGoogle Scholar
- 23.Montenegro Torres F, Bernal Acevedo O (2013) UNICO studies series 15: Colombia case study: the subsidized regime of Colombia’s national health insurance system. UNICO, WashingtonGoogle Scholar
- 24.Harimurti P, Tandon A UNICO Studies series 8: the nuts & bolts of Jamkesmas Indonesia’ s government—financed health coverage program. p 8Google Scholar
- 25.Chakraborty S (2013) UNICO studies series 22: Philippines’ government sponsored health coverage program for poor households. UNICO, WashingtonGoogle Scholar
- 27.Durairaj V, D’Almeida S, Kirigia J (2010) Obstacles in the process of establishing a sustainable national health insurance scheme: insights from Ghana. p 1. http://www.who.int/health_financing/pb_e_10_01-ghana-nhis.pdf
- 29.The World Bank (2008) In: Gottret P, Schieber GJ, Waters HR (eds) Good practices in health financing: lessons from reforms in low- and middle-income countriesGoogle Scholar
- 30.Giuffrida A, Jakab M, Dale EM (2013) UNICO studies series 17: toward universal coverage in health: the case of the state guaranteed benefit package of the Kyrgyz Republic. UNICO, WashingtonGoogle Scholar
- 31.Health Service Delivery Profile Republic of Korea 2012 (2012, January 1) Retrieved February 10, 2014 from http://www.wpro.who.int/health_services/service_delivery_profile_republic_of_korea.pdf
- 32.2013 Joint learning network. Mutuelles, RwandaGoogle Scholar
- 34.Christian Health Association of Ghana (2011) Christian health association of Ghana 2011 Annual ReportGoogle Scholar
- 35.Frenk J (2007) Bridging the divide: global lessons from evidence-based health policy in Mexico. Salud Publica Mex 49(Suppl 1):S14–22. http://www.ncbi.nlm.nih.gov/pubmed/17469396
- 38.Frimpong JA, Helleringer S, Awoonor-Williams JK, Aguilar T, Phillips JF, Yeji F (2013) The complex association of health insurance and maternal health services in the context of a premium exemption for pregnant women: a case study in Northern Ghana. Health Policy Plan. doi: 10.1093/heapol/czt086 PubMedGoogle Scholar
- 40.Wang H, Switlick K, Connor C, Ortiz C, Zurita B (2009) Africa health insurance workshop—extending health insurance: how to make it work. BethesdaGoogle Scholar
- 41.UNICEF (2012) National health insurance in Asia and AfricaGoogle Scholar
- 48.Liu S, Chollet D (2006) Price and income elasticity of the demand for health insurance and health care services: a critical review of the literature. WashingtonGoogle Scholar