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Brief analytical summaries or syntheses #10

World Health Report 2010
Health systems financing: The path to universal coverage


The 2010 World Health Report presents practical guidance on ways to finance health care. It describes different options for changing healthcare financing systems in order to move towards universal coverage and maintain gains that have been achieved to date. The report draws on evidence and lessons from a number of different countries.


Promoting and protecting health is essential to human welfare and sustained economic and social development. This was recognized more than 30 years ago by the Alma-Ata Declaration signatories, who noted that Health for All would contribute both to a better quality of life and also to global peace and security. In this context, timely access to health services is critical. This cannot be achieved, except for a small minority of the population, without a well-functioning health financing system. Recognizing this, member states of the World Health Organization (WHO) committed in 2005 to develop their health financing systems so that all people have access to services and do not suffer financial hardship paying for them. This goal was defined as universal health coverage.

As the world grapples with economic slowdown, globalization of diseases as well as economies, and growing demands for chronic care that are linked partly to ageing populations, the need for universal health coverage, and a strategy for financing it, has never been greater.

Analysis and results

Three fundamental interrelated problems restrict countries from moving closer to universal coverage: 1) the availability of resources; 2) over-reliance on direct payments at the time people need care; and 3) inefficient and inequitable use of resources.

The report proposes measures to deal with each of these problems.

  1. The availability of resources

    1. Increase the efficiency of revenue collection
    2. Reprioritize government budgets
    3. Innovative financing
    4. Development assistance for health

  2. Over-reliance on direct payments at the time people need care

    1. Subsidize the portion of the population too poor to contribute via income taxes or insurance premiums.
    2. Make contributions compulsory, otherwise the rich and healthy will opt out.
    3. Pools that protect the health needs of a small number of people are not viable in the long run (a few episodes of expensive illness will wipe them out). Multiple pools, each with their own administrations and information systems, are also inefficient and make it difficult to achieve equity.

  3. Inefficient and inequitable use of resources

    1. Reduce unnecessary expenditures on medicines (could save countries up to 5% of their health expenditure).
    2. Get the most out of technologies and health services.
    3. Motivate health workers.
    4. Improve hospital efficiency with attention to size of hospital and length of stay.
    5. Get care right the first time by reducing medical errors.
    6. Eliminate waste and corruption.
    7. Critically assess what services are needed.


No country starts from scratch in the way it finances health care. All have some form of system in place, and must build on it according to their values, constraints and opportunities. This process should be informed by national and international experience.

The first key message of this report is that there is no magic bullet to achieving universal access. Nevertheless, a wide range of experiences from around the world suggests that countries can move forward faster than they have done in the past or take actions to protect the gains that have been made. It is possible to raise additional funds and to diversify funding sources. It is possible to move away from direct payments towards prepayment and pooling and to become more efficient and equitable in the use of resources.

Implications and recommendations

Inequalities in access to care

Governments must be aware that free public services may be captured by the rich, who use them more than the poor even though their need may be less. In some countries, only the richest people have access to an adequate level of services, while in others, only the poorest are excluded. Some groups of people slip through the gaps in most systems, and patterns of exclusion from services vary. Particular attention must be paid to the difficulties women and ethnic and migrant groups face in accessing services, and to the special problems experienced by indigenous populations. At a conservative estimate, 20% to 40% of health resources are being wasted and could be channeled towards universal coverage.

Facilitating and supporting change

All countries can do more to raise funds for health or diversify their sources of funding, to reduce the reliance on direct payments by promoting prepayment and pooling, and to use funds more efficiently and equitably, provided the political will exists. Simply choosing from a menu of options, or importing what has worked in other settings, will not be sufficient. Health financing strategy needs to be home grown, pushing towards universal coverage out of existing terrain. It is imperative, therefore, that countries develop their capacities to analyze and understand the strengths and weaknesses of the system in place so that they can adapt health financing policies accordingly, implement them, and monitor and modify them over time.


World Health Report 2010
Health systems financing: The path to universal coverage