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Universal Healthcare Essays

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The government offers free healthcare services but not to everyone. According to the World Health Organization, universal health coverage is the most important aspect of eliminating socioeconomic disparities and a critical component of sustainable growth. In several countries, universal health coverage is sought by a mix of private and public...

The government offers free healthcare services but not to everyone. According to the World Health Organization, universal health coverage is the most important aspect of eliminating socioeconomic disparities and a critical component of sustainable growth. In several countries, universal health coverage is sought by a mix of private and public sector healthcare programs (Plianbangchang 2018). The government gives older people above 65 years of age free medical services; they also consider younger people suffering from disabilities and people who have renal issues. It definitely means that the government does not consider the other members of society, especially the working class. My essay will discuss the advantages and disadvantages of universal healthcare due to the government not offering free medical services to everyone.

Universal health care exemplifies nationwide healthcare programs in which all citizens have equal access to superior healthcare facilities regardless of individual or familial financial circumstances (Maruthappu, Ologunde, and Gunarajasingam 2013). Furthermore, universal health care encompasses social programs that include both nonmedical and medical services and infrastructure that is critical in promoting public health. Furthermore, universal health care (UHC) can significantly advance the trajectory of humanoid development. However, to achieve UHC, the government and the public health community must mobilize significant financial, technical, and human capital while still avoiding implementation challenges.

Many people will be glad and overwhelmed when they can walk into a hospital and feel optimistic that they will receive medical assistance regardless of their financial status (Jewell and McGiffert 2009). This will bring life to many citizens who were dying and suffering because they cannot afford to pay for medical bills, but the government has helped this group of people at the expense of the working-class group. UHC is also essential for a variety of reasons. First, preserving everyone’s mental and physical well-being is compatible with distributive justice ethics and proper behavior. The second explanation is related to the recognition of health as a fundamental human right. The ultimate aim is economic, in which UHC modifies market deficiencies related to health, such as the social benefits of sickness prevention and good health, which promote economic welfare at the macroeconomic level.

Furthermore, universal health care benefits society’s overall economic and social growth (LiPuma and Robichaud 2020). Based on primary healthcare, virtually every nation created its national health policies, which were later consolidated into the Global Plan for Health for All. Many countries worldwide have been captivated by the UHC concept application because they see it as a guiding force to assist governments in achieving the goal of good health for all individuals. Furthermore, as the number of sick people grows, governments worldwide have adopted UHC to provide sufficient care and treatment while also improving medical facilities. UHC is critical because it plays a vital role in reducing the rising prevalence of chronic non-communicable diseases, which necessitate long-term care and treatment that is prohibitively costly. In addition, ambulatory treatment and public hospitals are typically endorsed and promoted as essential components of national healthcare systems when the UHC approach is used.

The government’s strategic goal of universal health coverage is to ensure that everyone, regardless of socioeconomic status, has access to the health care they need without financial ruin or the possibility of poverty (Blattner, Price, and Holtkamp 2018). Specific patients, as well as the entire population, are served by UHC facilities. Many national governments worldwide see progress toward UHC as a driving value for the development of healthcare systems to provide a healthy population. Furthermore, the curative and preventive services provided by UHC protect both income and health. The explanation for this is that when we have healthy children in a society, they learn well without any health complications; however, when adults are well, they contribute both economically and socially (Burke, Normand, Barry, and Thomas 2016). Nonetheless, under the concept of universal healthcare, no cash payments will be made that exceeded a certain affordability level for the most unfortunate people. As a result, all governments must decide on the appropriate health services and devise strategies to ensure affordable, accessible, high quality, and effectiveness.

Insurance-based health funding is exceptionally vulnerable to profiteering by the private healthcare industry. UHC not only raises healthcare costs in a country noted for its fiscal prudence, but it also degrades existing public health services due to the increased likelihood of individuals opting for private healthcare (Zieff, Kerr, Moore, and Stoner 2020). As a result, the private sector maximizes its profits by focusing on more cost-effective issues while driving complex, inefficient, and chronic issues into already overburdened public health systems. Furthermore, regardless of the thrust and growth surrounding universal healthcare, we can conclude that the continued neglect of primary healthcare elements will still be the same. Furthermore, recent research indicates that a tax-based public health system improves health equity and comprehensiveness while remaining highly affordable in low and middle-income countries instead of insurance-based universal health coverage.

As much as the government opted for the introduction of universal health care, it is a time-consuming process since it must go through regulatory, taxation, and legislative mechanisms (Kumar, Braeken, Jurcut, Liyanage, and Ylianttila 2020). The majority of people in single-pay systems face financial distress by using healthcare services such as health promotion, support, prevention, palliative care, and recovery. Many people see UHC as a burden because of out-of-pocket expenses as well as catastrophic healthcare costs. The goal of achieving universal healthcare is challenging due to many challenges in healthcare systems, politics, and the economic-political climate. Furthermore, achieving universal health care is complicated by the presence of gross disparities in health status between developed and developing nations, rich and poor, female and male, and other classes.

The government’s free healthcare can make people irresponsible; people might decide not to take care of themselves and live irresponsible lives because the medical services are free (Plianbangchang 2018). The quality of service offered in the hospital will degrade because of the rising number of patients making the doctors and nurses work extra hours attending to patients. In several countries, universal health coverage is sought by a mix of private and public sector healthcare programs. Furthermore, many low- and middle-income countries’ healthcare programs are expanding rapidly in the private sector. The key cause is a shortage of infrastructure and doctors to meet all healthcare needs in the public sector. Nonetheless, almost half of the healthcare funding in low-income countries comes from their own pockets. However, with the anticipated increase in the general fraction of care provided by the private sector, the costs may be financially catastrophic for low-income individuals.

To summarize, the government should not offer free health services to everyone in society but to only the aged and the disabled people who are not in a position to work or earn enough money for paying their medical bills (Jewell and McGiffert 2009). Society should also support universal healthcare and not look down on the individuals using this medical cover as people who are not well off in society. As governments work to ensure that free health care is implemented, they can also strengthen the infrastructures of medical facilities to ensure that the number of patients who come for treatment is well cared for and that they access all of the available services to them.

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March 5, 2004

Rhetorical Argument

Thesis statement:  The federal government should enact a program of universal health care to better protect and serve all of its citizens.

I.    The uninsured constitute a larger and more diverse segment of our population than most people realize.

• The 2003 National Health Interview Survey showed that 42.3 million Americans (14.8%) were uninsured at the time of the survey.

B.   Most of the uninsured are not those living in poverty.

1.   The Kaiser Family Foundation’s Commission on Medicaid and the Uninsured found that over 80% of uninsured come from working families.

2.   2001 Census Bureau data showed that the largest increase in uninsured from 2000 to 2001 was among people who had incomes of $75,000 or more.

C.  Data from the Health Insurance Association of America shows that the uninsured population continues to grow and could reach 61 million by 2009.

II.   Lack of insurance leads to serious problems for those without it.

A.  The Institute of Medicine estimates that 18,000 American die prematurely each year because they are uninsured.

B.   According to Dr. W Light, a professor of health care policy and an expert on health care, 40% of bankruptcies in the US are the result of medical bills.

III. A universal health care program similar to the setup of the school system should be implemented by the federal government and would create unforeseen positive effects.

• Because one of the most voiced concerns about universal health care is a decline in quality of care, a system loosely modeled after the American school system should be put into effect.
• Because universal health care is such a large scale proposal, only the federal government has the adequate resources to implement such a large plan and guarantee equivalent services to all Americans.
• The implementation of universal health care would be beneficial to our citizens and system of care in less obvious ways.

1.   According to Dr. Mohammad Akhter of the American Journal of Public Health, if uninsured individuals obtained health insurance, their mortality rates would be reduced by 10-15%, their educational attainment would increase, and their annual earnings would rise by 10-30%.

2.   While the claim is made that universal health care would cause problems of inefficiency, this claim is not necessarily true.

a.   In his article in the American Journal of Public Health, Lawrence Brown – professor of health policy at Columbia University – has discarded claims that wait lists are prevalent in countries with universal health care systems.

b.   Universal health care would lessen the amount of paperwork needing to be done by doctor’s offices and hospitals so that staff and time could be better employed in treating patients.

Akhter, M.  (2003). APHA Policies on universal health care: Health for a few or health for all? American Journal of Public Health , 93(1), 99-101.

Brown, L. (2003). Comparing health systems in four countries: Lessons for the United States. American Journal of Public Health , 93(1), 52-56.

Centers for Disease Control National Health Interview Survey. (2004). Health Insurance Coverage: Estimates from the National Health Interview Survey, January – June 2003 .  Retrieved February 29, 2004, from http://www.cdc.gov/nchs/nhis.htm

Health Insurance Association of America.  (2000). The Changing Sources of Health Insurance . Washington, DC: Custer.

Institute of Medicine . (2002). Care Without Coverage: Too Little, Too Late .  Washington, DC: Author.

Kaiser Commission on Medicaid and the Uninsured. (2003). Health Insurance Coverage in America: 2002 Data Update.   Washington, DC:  The Henry J. Kaiser Family Foundation.

Light, D.  (2003). Sick System. The Christian Century , 120(7), 9-10.

U.S. Census Bureau. (2002). Health Insurance Coverage: 2001 . Washington, DC: U.S. Government Printing Office.

                In the preamble to our Constitution, the promotion of “general welfare” of its citizens is set forth as an intrinsic goal of the United States of America; yet, this in an area in which our nation has fallen shamefully short. We are the richest nation in the world, and yet, we are the only industrialized country that doesn’t guarantee its citizens access to medical care.  If our country stands for justice and equity as we claim it does, then why is it that we turn a blind eye on so  many of our citizens in need of health coverage?  I’m sure that as not only Americans, but as human beings, every person in this room has a sense of justice and compassion for his fellow man and believes that everyone is entitled to basic human rights.  But many of our fellow citizens are being left out in the cold when it comes to health care – one of the most basic needs.  [Without health coverage, these individuals could die from something as simple as the flu.  And since 18-24 year-olds are consistently the least insured segment of the population, this problem should be one of personal concern to many of you in this room, especially as you prepare to leave school and live on your own.]  Therefore, I believe the federal government should enact a program of universal health care to better protect and serve all of its citizens.  In proving my point I will define the uninsured population of America, discuss the problems caused by lack of insurance, describe the policy of universal health care that I believe will best suit our nation, and delineate the less obvious benefits of universal healthcare.

To understand why our nation is in need of universal health care, you must first understand that:

1.     The survey also showed that 30.2% of 18-24 year-olds, consistently the least insured age group, were without insurance in 2003.

      a.    70% of uninsured have at least one full-time worker in their family

      b.     56% of uninsured workers worked full-time for the full-year in 2002.

1.     According to a report cited in the CQ Researcher, 2.2 million Americans lost their insurance during the 2001 recession and layoffs. [6]

2.     Medical professor and fellow of the Center of Bioethics at the University of Pennsylvania Dr. Donald W. Light claims that for each percent that health care costs rise, 300,000 people are dropped from coverage, and health care costs are currently rising at 8-10% a year. [2]

A.  The Institute of Medicine estimates that 18,000 Americans die prematurely each year because they are uninsured.

B.   According to Dr. Donald Light, a professor of health care policy and an expert on health care, 40% of bankruptcies in the US are the result of medical bills.

            * ConsumerHealth.com: typical doctor’s visit w/o insurance will cost $80-100

III. I will propose my plan for implementing universal health care and then address several of the prominent arguments against it.

• Federal government should create a universal health care system similar to the American public school system.
• Claims of opponents about the inadequacies of universal health care are false.

1.   Many claim it will lead to decreased quality of services.

      - My plan will avoid that, and it’s better than what millions of Americans are receiving now.

2.     People claim that the United States can’t afford universal health care.

a.   According to Dr. Donald Light, 24.1 percent of what employers and citizens pay goes to the complex billing, marketing, and administrative structures of the voluntary American system rather than to clinical services

b.     He also says that 16-20% of the $1.3 trillion spent annually on health care could be saved with a simplified universal system. (ER care)

3.     People claim that universal health care is inefficient.

1.     The American Journal of Public health discards claims that wait lists are prevalent in countries with universal health care systems. [10]

2.     Universal health care would lessen the amount of paperwork needing to be done by doctor’s offices and hospitals so that staff and time could be better employed in treating patients.

IV. The implementation of universal health care would be beneficial to our citizens in less obvious ways.

• According to Dr. Mohammad Akhter of the American Journal of Public Health, if uninsured individuals obtained health insurance, their mortality rates would be reduced by 10-15%, their educational attainment would increase, and their annual earnings would rise by 10-30%.
• Dr. Donald Light à raises productivity

1.     According to Dr. Light, the US ranks 72 nd in the world in health gain per $1 million spent, far below all other industrialized countries. [2]

• It would improve the health for our nation as a whole, thus raising our quality of life, and improving our country in the eyes of the world. (Would make us seem less hypocritical at times.)

                In the hopes that you, too, will support a universal health care system for our nation, I’ve discussed the uninsured as a population, talked about the problems associated with lack of insurance, proposed universal health care as a solution to these problems, and described the less obvious benefits of universal health care.  If our country is going to continue to act as a guardian of human rights throughout the world and chastise other nations for the inhumane treatment of their citizens, we must first improve the conditions of our citizens here at home.  The first step in achieving this goal is realizing that health care – like education – should be a right for all citizens, not just a privilege for some.

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Universal Health Care Essay Examples

Writing an essay about Universal Health Care can help you understand the issues and come up with solutions to improve healthcare for all. It's a hot topic that needs attention, so why not dive into it and make a difference with your words?

So, you want to write an essay about Universal Health Care, but you're not sure where to start? Don't worry, I've got your back. When choosing a topic for your essay, think about what aspect of Universal Health Care interests you the most. It could be the ethical implications, the economic impact, or the accessibility for all. Once you've found your focus, you can start brainstorming ideas for your essay.

Now, let's talk about the different types of essays you can write about Universal Health Care. If you're into debating and presenting different viewpoints, an argumentative essay might be right up your alley. For those who like to explore the causes and effects of an issue, a cause and effect essay could be a great choice. If you want to express your personal thoughts and feelings, an opinion essay might be the way to go. And if you're all about providing facts and information, an informative essay could be your best bet.

Let's say you're ready to dive into writing your essay. You might be wondering how to structure it and what to include. Well, let me give you a few examples. For a thesis statement on Universal Health Care, you could focus on topics like the impact of Universal Health Care on the economy, the ethical implications of providing healthcare for all, or the importance of accessibility to healthcare services. And when it comes to the , you could start by discussing the current state of healthcare and then lead into your thesis statement. Finally, for the , you could summarize your main points and reiterate the importance of Universal Health Care for the well-being of society. With these examples, you'll be well on your way to writing a stellar essay on Universal Health Care.

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The Debate Over Free Healthcare Ans Universal Healthcare in America

Having a healthier lifestyle, possible effect of changes in the aca on the market power of healthcare providers, health and social care, the negative effects of the current health care reform bill, investigation of the universal definition of health, patient satisfaction survey, the social determinants of health and its influence on indigenous people’s health in canada, health monitoring and disease prediction system, new medical policy & people's health, current developments in diagnostic methods of concussions, healthcare finance cost allocation, why and how healthcare marketing should develop patient personas, typical errors on the part of doctors, how to solve the problem of nursing turnover within the american healthcare system, impact of telemedicine in the health sector, the need to raise more awareness about mental health, enhancing healthcare access: a south african perspective, foundations of responsive caregiving: infants, toddlers, and twos, ecommerce on healthcare sector, relevant topics.

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Universal Healthcare in The United States Cause and Effect Essay

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Is Universal Healthcare right for America?

Universal healthcare, impacts on healthcare professionals and healthcare organisations, impacts on patients and families, critical analysis, significance to the practice of healthcare administration, recommendations.

Even with the introduction of Medicare program in the United States, the debate for and against universal and comprehensive healthcare still rages on in the country. Against the backdrop of the many discussions in the globe, the right to access medical care regardless of one’s socio-economic status in the society became one of the most important issues. Many governments are charged with the facilitation of access to all citizens.

However, for a long time, many healthcare systems have been run on a capitalistic arrangement where an individual in need pays for the services provided according to market rates. This system has, however, been accused of locking out millions of households from middle and low income earning categories, who are not able to afford proper medical care for some medical procedures.

For governments, a healthy nation directly relates to a healthy economy where there is enough human resources and reduced expenditure on health infrastructure. In many cases, the rich have been able to access modern healthcare facilities while poor families continue to lose their loved ones because of affordability and accessibility issues.

As a result, the reactions for many governments have resorted to the formulation of policies and guidelines to facilitate fast, affordable and easy access for all (Pozgar, 2012). A universal healthcare framework is one such model that has been adopted globally.

However, for effective implementation, there have been challenges for healthcare organisations, professionals, administrators and for patients. This paper looks at the impacts of universal healthcare on the different stakeholders in the sector and provides recommendations for future improvement.

Universal healthcare basically refers to the facilitation of basic healthcare services to residents of a particular region or country. Generally, this arrangement involves the provision of healthcare insurance and payment of healthcare costs by the government and other private institutions within an arrangement where the patients do not have to pay directly from their pockets.

Within a national establishment, universal healthcare may therefore involve the taxation of all citizens, combined with health insurance coverage that eventually caters for the costs of medical care when required. The government is also charged with the facilitation of universal care through policy formulation, regulation and providing mandate to all care providers.

In some forms of arrangement, popularly referred to as ‘single payer health insurance’, the government is only involved in financing of healthcare, while healthcare institutions are charged with service delivery.

Under the Affordable Care Act of 2010, the United States’ government has adopted the concept of universal healthcare that came into force in 2014 (Murray & Frenk, 2010). It is notable that by the time of adoption, the US was the only developed nation that did not have this kind of arrangement for its citizens.

However, the program did not come into the societal limelight recently as the legislation process may suggest. Calls for universal health coverage began in the early 1900’s, but legislation and adoption has seemingly dragged on, because the adoption of universal healthcare has its own challenges across the board that has led to intense debates.

Effective implementation of universal healthcare has numerous impacts on health professionals and organisations as outlined in the following section.

The impact of universal healthcare on professionals and organisations in the sector are numerous. However, major impacts will be felt in the areas of financing, facility capacity building, personnel workload and regulatory requirements. First, funding is important for the success of any healthcare institution, be it for profit or not for profit.

Within the universal healthcare framework, there might be cash flow problems for hospitals that have to provide care and seek compensation from the insurance companies or the government depending on the arrangement. In most cases, the process of cost reimbursement may take some time.

Without proper management of finances within healthcare institutions, therefore, there might be many risks attached to insufficient supplies and late payment of health workers.

Secondly, capacity development plans for many healthcare organisations will remain highly effected. Universal healthcare improves access for the previously ‘locked out’ populations. As a result, there is a likelihood of increased numbers for the out and in-patient hospital sections. To be able to take care of this boom, hospitals will have to increase their capacity without compromising on the quality of care.

This may present a bigger challenge if financial management in the hospitals is not effectively enhanced. However, there are also opportunities for hospitals if the numbers are going to translate into improved financial performance hence increased expansion. The healthcare professionals like nurses may also expect improved pay structures.

On the other hand, increased number of patients is likely to result in issues of personnel workload. When the already overburdened healthcare professionals receive large number of patients in the wards and clinics, there is a need for increased personnel. Just like in the expansion of space and facilities, this is another area that is likely to negatively impact healthcare professionals and organisations if not effectively planned.

Lastly, regulatory requirements of the new healthcare act have new professions for access to quality care that may require change within healthcare organisations. The healthcare professionals will also need to acquaint themselves with the new requirements. For instance, every organisation must understand the procedures for claims and reimbursements for the different medical insurance plans.

Even though universal healthcare holds a big promise to patients and their families, the impact on the new system for this category must be noted. Generally, issues of access, quality, taxation and technical knowledge are most critical for this group of stakeholders. On a positive note, the impact of universal healthcare on access can be tremendous provided organisations effectively align to the required changes.

Patients from all forms of social and economic backgrounds will be provided with easy access to modern care facilities that they could not previously afford. This is a good step in the right direction for the US, since all citizens and particularly from the poor families will be assured of their right to live a healthy life.

For many families who have had to spend the little money they have on seeking treatment for chronic illnesses like heart disease, diabetes and cancer, this provides a lifeline for economic and social empowerment.

However, increased access raises an issue of quality of care within the participating healthcare organisations. In the event that poor management in such organisation results in overstretched capacity, the quality of care might be compromised at the expense of patients and their families. Any slight negative impact on quality of care may be against the main aim of universal healthcare in the country that many families have yearned for.

Another issue raised by the opponents of this program is that of taxation. The impact of facilitating this program on national economy may be damaging if not properly managed. Generally, when the government chooses to increase taxation to help in the funding of this program, families already living in tough economic times may be adversely affected.

Lastly, the issue of technical knowledge required for decision making is very important for the patients and the families. Many poor families may not have the literacy levels required to select the suitable medical plans for their households. Given that private and profit making institutions are involved in the program, the impact on choice of medical cover may be negative if proper guidance is not provided for families.

However, the mentioned impacts may not necessarily mean that universal healthcare may not be viable for the United States. There are numerous case examples that may be used to indicate the benefits of this program and how the many challenges associated to it may be overcome.

As stated earlier, many governments have strived to provide universal healthcare access to their citizens globally. The Netherlands, Germany and Singapore are examples of developed nations that have successful universal healthcare programs for their citizens (Hooe, Considine & Sethi, 2013).

The Asian nation can however be a better case for highlighting the importance of universal care programs. With a fast growing population, the economic powerhouse in the Asian continent still recorded higher rates of infant mortality and other deaths associated with venerable diseases like malaria. The rural populace in the country, mostly low-income earners, were the most affected.

However, the adoption of a single pay health insurance system for its population, the country has made enormous gains in the healthcare sector that may be a model for many countries.

As a result of the comprehensive medical care implemented by the government in collaboration with healthcare organisations and professionals, the life expectancy rates in the country have significantly improved similarly to the declining infant mortality rates. From this case, it is easy to connect the healthy population with the country’s booming economy.

Universal healthcare can only be achieved with proper management as already pointed out in the discussions. The implementation of universal healthcare programs provides challenges as well as opportunities for healthcare administrators. Universal healthcare has great implications for healthcare administration practice.

First, there is need for effective change management that should begin from administrative levels (Shi & Singh, 2012). For all departments and personnel to effectively implement universal care and take advantages of growth opportunities presented by it, administrators must be ready to initiate change.

Secondly, risk management is an essential part of health organisations’ success in the new universal care system. For administrators, the challenge for effective risk management is of great significance to performance, because the financial inflexibility that may be brought within the transitional period has far reaching implications for growth.

Third, quality assurance has been identified as another area of challenge for the universal healthcare program implementation. Administrators are also required to effectively co-ordinate departments and cross functional activities to ensure that success for all mentioned areas is attained. The benefits of universal healthcare present huge opportunities for administrators in the sector.

Most importantly, administrators are presented with the opportunity to attain the goal of providing healthcare to all individuals regardless of their cultural, social or economic backgrounds. In addition, administrators also have an opportunity to collaborate with their counterparts in other organisations to ensure that they comply with the requirements of the new system.

Having examined the benefits of universal healthcare, it is easy to conclude that the US needs the system. Given the success story noted from the selected case, the challenges identified may be eliminated in many ways. First, there is need for training of all administrators and personnel on the legal, economic and social implications of the newly implemented system.

Training will also help professionals provide guidance and advice to the illiterate individuals who may not be able to choose suitable healthcare plans for their families.

Secondly, the government and other sector stakeholders should engage in frequent policy restructuring to ensure smooth implementation, because universal healthcare relies on particular regional and institutional factors like geographical and demographic dynamics (Savedoff, de Ferranti, Smith & Fan, 2012).

The mode and nature of care for different individuals should also be clearly defined to avoid cases of congestion in hospitals. Next, it is important that healthcare organisations plan for financial risk protection through access to other sources of financing while reimbursements are forthcoming.

In this way, operations are likely to run without hitches pegged on capacity and resource availability. Lastly, community sensitisation programs should continue to be carried out to ensure that all citizens are aware of their rights of access and the available avenues for doing so.

Hooe, B. S., Considine, P. T., & Sethi, M. K. (2013). National healthcare systems: A worldview . New York: Springer.

Murray, C. J., & Frenk, J. (2010). Ranking 37th—measuring the performance of the US health care system. New England Journal of Medicine, 362 (2), 98-99.

Pozgar, G. (2012). Legal aspects of health care administration . Sudbury, MA: Jones & Bartlett Publishers.

Savedoff, W. D., de Ferranti, D., Smith, A. L., & Fan, V. (2012). Political and economic aspects of the transition to universal health coverage. The Lancet, 380 (9845), 924-932.

Shi, L., & Singh, D. A. (2012). Essentials of the US health care system . Sudbury, MA: Jones & Bartlett Publishers.

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IvyPanda. (2019, June 21). Universal Healthcare in The United States. https://ivypanda.com/essays/universal-healthcare/

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Should the U.S. Government Provide Universal Health Care?

• History of Universal Health Care

27.5 million non-elderly Americans did not have health insurance in 2021, a decline from 28.9 million uninsured Americans in 2019. The largest group of Americans, almost 155 million non-elderly people, were covered by employer-sponsored health insurance. Less than 1% of Americans over 65 were uninsured, thanks to Medicaid, a government provided insurance for people over 65 years old.

The United States is the only nation among the 37 OECD (Organization for Economic Co-operation and Development) nations that does not have universal health care either in practice or by constitutional right. Read more background…

Pro & Con Arguments

Pro 1 The United States already has universal health care for some. The government should expand the system to protect everyone. A national health insurance is a universal health care that “uses public insurance to pay for private-practice care. Every citizen pays into the national insurance plan. Administrative costs are lower because there is one insurance company. The government also has a lot of leverage to force medical costs down,” according to economic expert Kimberly Amadeo. Canada, Taiwan, and South Korea all have national health insurance. In the United States, Medicare, Medicaid, and TRICARE function similarly. [ 178 ] Medicare is the “federal health insurance program for: people who are 65 or older, certain younger people with disabilities, [and] people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).” Patients pay a monthly premium for Medicare Part B (general health coverage). The 2023 standard Part B monthly premium is $164.90. Patients also contribute to drug costs via Medicare Part D. Most people do not pay a premium for Medicare Part A (“inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care”). More than 65.3 million people were enrolled in Medicare according to Feb. 2023 government data. [ 180 ] [ 181 ] Medicaid “provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.” More than 84.8 million people were enrolled in Medicaid as of Nov. 2022. [ 181 ] [ 182 ] [ 183 ] The Children’s Health Insurance Program (CHIP), often lumped in with Medicaid in these discussions, is a “low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP covers pregnant women. Each state offers CHIP coverage, and works closely with its state Medicaid program.” CHIP covers more than 6.9 million patients. [ 181 ] [ 182 ] [ 183 ] TRICARE is the “military health system that provides care to almost 10 million active-duty service members, retired personnel, and their families.” Active-duty military members pay $0 for health insurance, while retired members and their families paid a premium up to $1,165 per month (for a member and family) in 2021. [ 184 ] The United States already successfully maintains universal health care for almost 36% of the U.S. population, according to U.S. Census data released in Sep. 2022. As the Baby Boomer generation continues to age and more of the generation becomes eligible for Medicare, estimates suggest about 73.5 million people will use Medcare and about 47% of American health care costs will be paid for by public health services by 2027. [ 185 ] [ 186 ] If the government can successfully provide universal health care for 36% to almost 50% of the population, then the government can provide univeral health care for the rest of the population who are just as in need and deserving of leading healthy lives. Read More

Pro 2 Universal health care would lower costs and prevent medical bankruptcy. A June 2022 study found the United States could have saved $105.6 billion in COVID-19 (coronavirus) hospitalization costs with single-payer universal health care during the pandemic. That potential savings is on top of the estimated $438 billion the researchers estimated could be saved annually with universal health care in a non-pandemic year. [ 198 ] “Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households,” conclude researchers from the Yale School of Public Health and colleagues. [ 201 ] According to the National Bankruptcy Forum, medical debt is the number one reason people file for bankruptcy in the United States. In 2017, about 33% of all Americans with medical bills reported that they “were unable to pay for basic necessities like food, heat, or housing.” If all Americans were provided health care under a single-payer system medical bankruptcy would no longer exist, because the government, not private citizens, would pay all medical bills. [ 131 ] Further, prescription drug costs would drop between 4% and 31%, according to five cost estimates gathered by New York Times reporters. 24% of people taking prescription drugs reported difficulty affording the drugs, according to a Kaiser Family Foundation (KFF) poll. 58% of people whose drugs cost more than $100 a month, 49% of people in fair or poor health, 35% of those with annual incomes of less than $40,000, and 35% of those taking four or more drugs monthly all reported affordability issues. [ 197 ] [ 199 ] [ 200 ] Additionally, 30% of people aged 50 to 64 reported cost issues because they generally take more drugs than younger people but are not old enough to qualify for Medicare drug benefits. With 79% of Americans saying prescription drug costs are “unreasonable,” and 70% reporting lowering prescription drug costs as their highest healthcare priority, lowering the cost of prescription drugs would lead to more drug-compliance and lives not only bettered, but saved as a result. [ 197 ] [ 199 ] [ 200 ] Read More

Pro 3 Universal health care would improve individual and national health outcomes. Since 2020, the COVID-19 pandemic has underscored the public health, economic and moral repercussions of widespread dependence on employer-sponsored insurance, the most common source of coverage for working-age Americans…. Business closures and restrictions led to unemployment for more than 9 million individuals following the emergence of COVID-19. Consequently, many Americans lost their healthcare precisely at a time when COVID-19 sharply heightened the need for medical services,” argue researchers from the Yale School of Public Health and colleagues. The researchers estimated more than 131,000 COVID-19 (coronavirus) deaths and almost 78,000 non-COVID-19 deaths could have been prevented with universal health care in 2020 alone. [ 198 ] Another study finds a change to “single-payer health care would… save more than 68,000 lives and 1.73 million life-years every year compared with the status quo.” [ 201 ] Meanwhile, more people would be able to access much-needed health care. A Jan. 2021 study concludes that universal health care would increase outpatient visits by 7% to 10% and hospital visits by 0% to 3%, which are modest increases when compared to saved and lengthened lives. [ 202 ] Other studies find that universal health coverage is linked to longer life expectancy, lower child mortality rates, higher smoking cessation rates, lower depression rates, and a higher general sense of well-being, with more people reporting being in “excellent health.” Further, universal health care leads to appropriate use of health care facilities, including lower rates of emergency room visits for non-emergencies and a higher use of preventative doctors’ visits to manage chronic conditions. [ 203 ] [ 204 ] [ 205 ] An American Hospital Association report argues, the “high rate of uninsured [patients] puts stress on the broader health care system. People without insurance put off needed care and rely more heavily on hospital emergency departments, resulting in scarce resources being directed to treat conditions that often could have been prevented or managed in a lower-cost setting. Being uninsured also has serious financial implications for individuals, communities and the health care system.” [ 205 ] Read More

Con 1 Universal health care for everyone in the United States promises only government inefficiency and health care that ignores the realities of the country and the free market. In addition to providing universal health care for the elderly, low-income individuals, children in need, and military members (and their families), the United States has the Affordable Care Act (the ACA, formerly known as the Patient Protection and Affordable Care Act), or Obamacare, which ensures that Americans can access affordable health care. the ACA allows Americans to chose the coverage appropriate to their health conditions and incomes. [ 187 ] Veterans’ Affairs, which serves former military members, is an example of a single-payer health care provider, and one that has repeatedly failed its patients. For example, a computer error at the Spokane VA hospital “failed to deliver more than 11,000 orders for specialty care, lab work and other services – without alerting health care providers the orders had been lost.” [ 188 ] [ 189 ] Elizabeth Hovde, Policy Analyst and Director of the Centers for Health Care and Worker Rights, argues, “The VA system is not only costly with inconsistent medical care results, it’s an American example of a single-payer, government-run system. We should run from the attempts in our state to decrease competition in the health care system and increase government dependency, leaving our health care at the mercy of a monopolistic system that does not need to be timely or responsive to patients. Policymakers should give veterans meaningful choices among private providers, clinics and hospitals, so vets can choose their own doctors and directly access quality care that meets their needs. Best of all, when the routine break-downs of a government-run system threaten to harm them again, as happened in Spokane, veterans can take their well-earned health benefit and find help elsewhere.” [ 188 ] [ 189 ] Further, the challenges of universal health care implementation are vastly different in the U.S. than in other countries, making the current patchwork of health care options the best fit for the country. As researchers summarize, “Though the majority of post-industrial Westernized nations employ a universal healthcare model, few—if any—of these nations are as geographically large, populous, or ethnically/racially diverse as the U.S. Different regions in the U.S. are defined by distinct cultural identities, citizens have unique religious and political values, and the populace spans the socio–economic spectrum. Moreover, heterogenous climates and population densities confer different health needs and challenges across the U.S. Thus, critics of universal healthcare in the U.S. argue that implementation would not be as feasible—organizationally or financially—as other developed nations.” [ 190 ] And, such a system in the United States would hinder medical innovation and entrepreneurship. “Government control is a large driver of America’s health care problems. Bureaucrats can’t revolutionize health care – only entrepreneurs can. By empowering health care entrepreneurs, we can create an American health care system that is more affordable, accessible, and productive for all,” explains Wayne Winegarden, Senior Fellow in Business and Economics, and Director of the Center for Medical Economics and Innovation at Pacific Research Institute. [ 190 ] [ 191 ] Read More

Con 2 Universal health care would raise costs for the federal government and, in turn, taxpayers. Medicare-for-all, a recent universal health care proposal championed by Senator Bernie Sanders (I-VT), would cost an estimated $30 to $40 trillion over ten years. The cost would be the largest single increase to the federal budget ever. [ 192 ] The Congressional Budget Office (CBO) estimates that by 2030 federal health care subsidies will increase by $1.5 to $3.0 trillion. The CBO concludes, “Because the single-payer options that CBO examined would greatly increase federal subsidies for health care, the government would need to implement new financing mechanisms—such as raising existing taxes or introducing new ones, reducing certain spending, or issuing federal debt. As an example, if the government required employers to make contributions toward the cost of health insurance under a single-payer system that would be similar to their contributions under current law, it would have to impose new taxes.” [ 193 ] Despite claims by many, the cost of Medicare for All, or any other universal health care option, could not be financed solely by increased taxes on the wealthy. “[T]axes on the middle class would have to rise in order to pay for it. Those taxes could be imposed directly on workers, indirectly through taxes on employers or consumption, or through a combination of direct or indirect taxes. There is simply not enough available revenue from high earners and businesses to cover the full cost of eliminating premiums, ending all cost-sharing, and expanding coverage to all Americans and for (virtually) all health services,” says the Committee for a Responsible Federal Budget. [ 195 ] An analysis of the Sanders plan “estimates that the average annual cost of the plan would be approximately $2.5 trillion per year creating an average of over a $1 trillion per year financing shortfall. To fund the program, payroll and income taxes would have to increase from a combined 8.4 percent in the Sanders plan to 20 percent while also retaining all remaining tax increases on capital gains, increased marginal tax rates, the estate tax and eliminating tax expenditures…. Overall, over 70 percent of working privately insured households would pay more under a fully funded single payer plan than they do for health insurance today.” [ 196 ] Read More

Con 3 Universal health care would increase wait times for basic care and make Americans’ health worse. The Congressional Budget Office explains, “A single-payer system with little cost sharing for medical services would lead to increased demand for care in the United States because more people would have health insurance and because those already covered would use more services. The extent to which the supply of care would be adequate to meet that increased demand would depend on various factors, such as the payment rates for providers and any measures taken to increase supply. If coverage was nearly universal, cost sharing was very limited, and the payment rates were reduced compared with current law, the demand for medical care would probably exceed the supply of care–with increased wait times for appointments or elective surgeries, greater wait times at doctors’ offices and other facilities, or the need to travel greater distances to receive medical care. Some demand for care might be unmet.” [ 207 ] As an example of lengthy wait times associated with universal coverage, in 2017 Canadians were on waiting lists for an estimated 1,040,791 procedures, and the median wait time for arthroplastic surgery was 20–52 weeks. Similarly, average waiting time for elective hospital-based care in the United Kingdom is 46 days, while some patients wait over a year. Increased wait times in the U.S. would likely occur—at least in the short term—as a result of a steep rise in the number of primary and emergency care visits (due to eliminating the financial barrier to seek care), as well as general wastefulness, inefficiency, and disorganization that is often associated with bureaucratic, government-run agencies. [ 17 ] [ 190 ] Joshua W. Axene of Axene Health Partners, LLC “wonder[s] if Americans really could function under a system that is budget based and would likely have increased waiting times. In America we have created a healthcare culture that pays providers predominantly on a Fee for Service basis (FFS) and allows people to get what they want, when they want it and generally from whoever they want. American healthcare culture always wants the best thing available and has a ‘more is better’ mentality. Under a government sponsored socialized healthcare system, choice would become more limited, timing mandated, and supply and demand would be controlled through the constraints of a healthcare budget…. As much as Americans believe that they are crockpots and can be patient, we are more like microwaves and want things fast and on our own terms. Extended waiting lines will not work in the American system and would decrease the quality of our system as a whole.” [ 206 ] Read More

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• Read an example of the persuasive rhetorical mode.

Universal Health Care Coverage for the United States

The United States is the only modernized Western nation that does not offer publicly funded health care to all its citizens; the costs of health care for the uninsured in the United States are prohibitive, and the practices of insurance companies are often more interested in profit margins than providing health care. These conditions are incompatible with US ideals and standards, and it is time for the US government to provide universal health care coverage for all its citizens. Like education, health care should be considered a fundamental right of all US citizens, not simply a privilege for the upper and middle classes.

One of the most common arguments against providing universal health care coverage (UHC) is that it will cost too much money. In other words, UHC would raise taxes too much. While providing health care for all US citizens would cost a lot of money for every tax-paying citizen, citizens need to examine exactly how much money it would cost, and more important, how much money is “too much” when it comes to opening up health care for all. Those who have health insurance already pay too much money, and those without coverage are charged unfathomable amounts. The cost of publicly funded health care versus the cost of current insurance premiums is unclear. In fact, some Americans, especially those in lower income brackets, could stand to pay less than their current premiums.

However, even if UHC would cost Americans a bit more money each year, we ought to reflect on what type of country we would like to live in, and what types of morals we represent if we are more willing to deny health care to others on the basis of saving a couple hundred dollars per year. In a system that privileges capitalism and rugged individualism, little room remains for compassion and love. It is time that Americans realize the amorality of US hospitals forced to turn away the sick and poor. UHC is a health care system that aligns more closely with the core values that so many Americans espouse and respect, and it is time to realize its potential.

Another common argument against UHC in the United States is that other comparable national health care systems, like that of England, France, or Canada, are bankrupt or rife with problems. UHC opponents claim that sick patients in these countries often wait in long lines or long wait lists for basic health care. Opponents also commonly accuse these systems of being unable to pay for themselves, racking up huge deficits year after year. A fair amount of truth lies in these claims, but Americans must remember to put those problems in context with the problems of the current US system as well. It is true that people often wait to see a doctor in countries with UHC, but we in the United States wait as well, and we often schedule appointments weeks in advance, only to have onerous waits in the doctor’s “waiting rooms.”

Critical and urgent care abroad is always treated urgently, much the same as it is treated in the United States. The main difference there, however, is cost. Even health insurance policy holders are not safe from the costs of health care in the United States. Each day an American acquires a form of cancer, and the only effective treatment might be considered “experimental” by an insurance company and thus is not covered. Without medical coverage, the patient must pay for the treatment out of pocket. But these costs may be so prohibitive that the patient will either opt for a less effective, but covered, treatment; opt for no treatment at all; or attempt to pay the costs of treatment and experience unimaginable financial consequences. Medical bills in these cases can easily rise into the hundreds of thousands of dollars, which is enough to force even wealthy families out of their homes and into perpetual debt. Even though each American could someday face this unfortunate situation, many still choose to take the financial risk. Instead of gambling with health and financial welfare, US citizens should press their representatives to set up UHC, where their coverage will be guaranteed and affordable.

Despite the opponents’ claims against UHC, a universal system will save lives and encourage the health of all Americans. Why has public education been so easily accepted, but not public health care? It is time for Americans to start thinking socially about health in the same ways they think about education and police services: as rights of US citizens.

Online Persuasive Essay Alternatives

Martin Luther King Jr. writes persuasively about civil disobedience in Letter from Birmingham Jail :

• http://www.stanford.edu/group/King/frequentdocs/birmingham.pdf
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Michael Levin argues The Case for Torture :

• http://people.brandeis.edu/~teuber/torture.html

Alan Dershowitz argues The Case for Torture Warrants :

• http://blogs.reuters.com/great-debate/2011/09/07/the-case-for-torture-warrants/

Alisa Solomon argues The Case against Torture :

• http://www.villagevoice.com/2001-11-27/news/the-case-against-torture/1

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Best Practices in Achieving Universal Health Coverage: A Scoping Review

Jalil koohpayehzadeh.

1 Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Community and Family Medicine Department, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

Saber Azami-Aghdash

2 Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran

Naser Derakhshani

3 Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran

Aziz Rezapour

Riaz alaei kalajahi.

4 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

Javad Sajjadi Khasraghi

Mahdi nikoomanesh.

5 Student Research Committee, School of Health Management and Information Sciences Branch, Iran University of Medical Sciences, Tehran, Iran

Hamideh Sabetrohani

Samira soleimanpour.

6 Department of Medical Librarianship and Information Sciences, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran

Background: The Universal Health Coverage (UHC) is a very important and effective policy in the health system of countries worldwide. Using the experiences and learning from the best practices of successful countries in the UHC can be very helpful. Therefore, the aim of the present study is to provide a scoping review of successful global interventions and practices in achieving UHC.

Methods: This is a scoping review study that has been conducted using the Arkesy and O'Malley framework. To gather information, Embase, PubMed, The Cochrane Library, Scopus, Scientific Information Database, and MagIran were searched using relevant keywords from 2000 to 2019. Studies about different reforms in health systems and case studies, which have examined successful interventions and reforms on the path to UHC, were included. Articles and abstracts presented at conferences and congresses were excluded. Framework Analysis was also used to analyze the data.

Results: Out of 4257 articles, 57 finally included in the study. The results showed that of the 40 countries that had successful interventions, most were Asian. The interventions were financial protection (40 interventions that were categorized into 14 items), service coverage (31 interventions categorized into 7 items), population coverage (36 interventions categorized into 9 items), and quality (18 interventions categorized into 7 items), respectively. Also, the positive results of interventions on the way to achieving UHC were financial protection (14 interventions), service coverage (7 interventions), population coverage (9 interventions), and quality (7 interventions), respectively.

Conclusion: This study provides a comprehensive and clear view of successful interventions in achieving the UHC. Therefore, with consideration to lessons learned from successful interventions, policymakers can design appropriate interventions for their country.

What is “already known” in this topic

The UHC approach has been highly considered by countries in the last two decades, and these countries have taken many steps with success or failure in the road of achieving UHC. Accordingly, reviewing and learning from the successful interventions of other countries and learning from these experiences in the field of UHC can be very useful.

What this article adds

This study provides the comprehensive and clear view of successful interventions performed in most countries at different income levels, which seek to achieve the UHC. Reporting these successful interventions can be a model and guide for other countries to avoid the costs and recurring mistakes.

Introduction

The UHC has been introduced by the World Health Organization (WHO) as a viable approach and a way for countries to access equitable health services and ultimately a healthy community ( 1 , 2 ). The UHC can be accepted as a very important and effective policy in the health system of countries, which can improve the quality of people's lives to an acceptable level by providing equitable quality health services to all people everywhere without any financial pressure ( 3 - 11 ). Thus, achieving UHC can have a significant impact on health promotion, easier access to health care for those in need, and improved public health, especially for the poor ( 12 , 13 ).

Given the importance of achieving UHC for high- and middle-income countries, the number of countries trying to achieve this has increased in the last 2 decades ( 14 , 15 ). In addition, nowadays, countries by increasing their knowledge and awareness of strategies and applying the experiences of successful countries as well as acquiring the necessary capabilities to meet their urgent needs, are trying to take the path of achieving UHC ( 16 - 18 ). Like other high-income countries that have achieved UHC, low- and middle-income countries, with taking into account the structure and resources that they have on the path to UHC undertake measures, such as mobilizing resources, fulfilling the political commitments necessary to implement health-related policies, and implementing effective reforms and interventions in macronational policies ( 1 , 19 - 21 ). The UHC can be one of the most challenging political processes that require the support of various stakeholders, including health system policymakers ( 4 ). Although all countries pursue the same goal of achieving UHC, the path and duration of achieving this goal depend on the structure and resources of the countries as well as the specific effective factors of each country ( 4 ).

Given the specific circumstances of each country, there is no uniform way of achieving UHC, and countries act based on their structural strengths and weaknesses. ( 4 , 22 - 24 ). To achieve UHC, countries need to identify their strategic issue. For example, in the field of stewardship, financing, resources generation, and service provision, each country based on its health system needs, identifies effective factors, such as prioritizing health system reforms according to its own factors, such as prioritizing health system reforms ( 25 ), considering organizational structure and its capacity ( 26 - 28 ), having national and political commitment ( 29 - 32 ), economic growth ( 33 - 35 ), financial protection ( 36 - 39 ), health insurance coverage ( 15 , 34 , 40 ), prevention of catastrophic costs ( 41 , 42 ), reduction of out-of-pocket payments ( 41 , 43 - 49 ), health insurance prepayment ( 40 , 50 - 53 ), national policies for human resources training ( 25 - 27 ) and geographical distribution of services ( 54 - 57 ), and given its weaknesses or strengths in these functions, to reform and strengthen its health system on the path to UHC.

On the path to UHC, it is crucial to consider the functions of the health system and reform these functions based on the specific circumstances of the countries. In this regard, using the experiences of other countries and learning from the best practices in successful countries in the field of UHC can be highly useful. The definition of the best practices in this study is to paying attention to the experiences and successful interventions of countries’ health systems in the achievement of UHC.Therefore, the purpose of the present study was to review the successful global interventions and practices to achieve UHC in the form of a scoping review.

- Identify successful financial protection interventions, reforms, and practices in achieving UHC

- Identify interventions, improvements, and successful service coverage practices in achieving UHC

- Identify successful population coverage interventions, reforms, and practices in achieving UHC

- Identify successful interventions, reforms, and practices in the quality of health services in achieving UHC

This was is a scoping review study conducted in 2019 based on the book "A Systematic Review to Support Evidence-Based Medicine" ( 58 ).

Information Sources

Required information was searched in the Embase, PubMed, the Cochrane Library, Scopus, Scientific Information Database, and MagIran from January 2000 until the end of January 2019. The keywords of Universal health coverage, Universal health care coverage, Universal health care coverage, Universal coverage, UHC, Strength,* Transform,* interventions, improve,* program,* innovations, initiative, Financing, "Service delivery", Stewardship, and "Resource generation" were used in the search. Some specialized journals, Google Scholar, and the references of included articles were reviewed manually. The databases of the European Association for Gray Literature Exploitation and the Health Care Management Information Consortium as well as the WHO and World Bank sites were also searched ( Table 1 ).

Eligibility Criteria

Inclusion criteria: All observational (descriptive studies about different reforms in health systems) and intervention studies, especially case studies, which have examined successful interventions and reforms of countries on the path to UHC and published between 2000 and 2019, were included in the study.

Exclusion Criteria: Articles and abstracts presented at conferences and congresses as well as studies that did not report successful interventions were excluded.

Review Process:

In this study, the Arkesy and O'Malley frameworks for scoping review were used. This framework is the first methodological framework for conducting scoping review research published in 2005 ( 59 ). The framework consists of 6 steps: (1) identification of the research question; (2) identification of relevant studies, (3) study selection; (4) Data charting; (5) data analysis and reporting the results; and (6) consultation exercise. The study also used the (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) PRISMA framework to report the results ( 60 , 61 ).

The study process was such that initially the titles of all articles were reviewed and articles that were incompatible with the aims of the study were excluded. Subsequently, abstracts and full-texts of the articles were studied, respectively, and studies that did not meet the inclusion criteria and had poor correlation with study aims were identified and excluded. Data were extracted according to a researcher-made data extraction form, and entered into the designed table. At first, as a pilot for data extraction form, the data of 5 papers were extracted and the deficiencies of the original form were eliminated. The whole process of systematic review was performed by 2 researchers independently and disputes were referred to a third researcher.

Given that it was necessary to study the full-text of the included studies to extract data, this was done by the research team in 2 stages. However, in the third and fourth stages of the Arkesy and O'Malley frameworks, after the initial extraction of the data from the selected studies, the research team reexamined the data in 2 sessions carefully and, finally, the studies were rescreened by the research team to include precisely relevant and high-quality studies. Endnote X9 software was also used to organize study titles and abstracts as well as identify duplicates.

Data Analysis

The framework analysis was used to analyze the data, which is a hierarchical approach used to classify and organize data based on key themes, concepts, and emerging classes. Data were extracted by 2 researchers and entered in to data extraction table. The steps for analyzing and coding the data were (1) familiarity with the text of articles (immersion in article results); (2) identifying and extracting primary themes (identifying and extracting more articles relevant to primary themes); (3) placing articles in determined themes, (4) reviewing and completing the results of each theme with the use of results of the articles and ensuring the reliability of the themes and the results extracted in each theme (in cases of disagreement between the 2 coders, the dispute was referred to the third researcher). Textual data were analyzed manually and categorized into dimensions of UHC (financial protection, population coverage, service coverage, and quality) using the framework analysis method ( 62 , 63 ). In case of disagreement between researchers, the study was reviewed by a third person who was an expert, and with the authors' consensus, the proper function was selected.

Of the 4257 articles found, 1328 were excluded as duplicate papers and 2616 were excluded in title and abstract reviews. Also, of the 313 articles entered the full-text review phase, 256 were excluded because of lack of appropriate information and lack of reporting of the required information as well as rescreening of the full-text. Finally, 57 articles were included in the study ( Fig. 1 ).

Flow diagram of the searches and Inclusion process.

The results of included studies are summarized in supplementary file1 ( Appendix 1 ).

Country of Study

Studies published on successful interventions to achieve UHC were conducted in 40 countries. Most studies were in Asia, with 14 countries, and the least in European countries with 4 studies. Most studies were conducted in Thailand (6 studies), China (6 studies), Mexico (6 studies), and Brazil (6 studies). Among these countries, 5 achieved to UHC, 11 were at the border of achieving, and others were on the path to UHC. Also, according to the latest World Bank classification in 2019-2020 ( 64 ), 9 studies were conducted in low-income countries (LICs), 13 in lower-middle income countries (LMIC), 18 in upper-middle income countries (UMIC) and 9 studies in High-Income Countries (HIC), and 8 in more than 1 country ( Fig. 2 ).

Countries’ successful interventions on the path to UHC with different condition and suc-cessful interventions in achieving UHC in countries based on the World Bank’s latest classification.

Trend of Publications Year

The time trend of the studies’ publication shows that most of the studies, except for 2, were published after the announcement of UHC as a global, international health policy for all countries by the WHO in 2008, and most of studies (n = 15 studies) were published in 2018 ( Fig. 3 ).

The time trend of interventional studies' publication on the path to UHC

Interventions According to the Dimensions of UHC

According to the type of interventions in each of the UHC dimension, interventions were categorized into different parts as follows: financial protection (40 interventions categorized into 14 items), service coverage (31 interventions categorized into 7 items), population coverage (36 interventions categorized into 9 items), and quality (18 interventions categorized into 7 items). The most and the least interventions were financial protection and quality, respectively ( Fig. 4 ).

Successful interventions in achieving UHC in countries

Successful Results of Interventions

According to the type of successful results gained from interventions in countries in each of the UHC dimension, results were categorized into different items as follows: financial protection (n = 14 items), service coverage (n = 7 items), population coverage (n = 9 items), and quality (n = 7 items) ( Fig. 5 ).

Achieving positive results on the way to achieving UHC

Out of 4257 articles found, finally 57 were included in the study. These articles examined successful interventions in 40 countries on the path to UHC. Most studies were conducted in Asia and the least in Europe.

Results were categorized into different items: financial protection (n = 14 items), service coverage (n = 7 items), population coverage (n = 9 items), and quality (n = 7 items). Most of the interventions were done in LMICs. The results show that most of the interventions in the field of service coverage are targeted specific groups, such as children, adolescents, women, and as specific patients.

The results of the reviewing the time trend of study publication revealed that most studies (except for 2) were published after announcing the UHC as a national and international policy for countries by the WHO in 2008 ( 3 , 65 ). Also, the time trend of articles publication indicates the importance and great attention of countries to international health-related policies. Considering the many efforts being made in this area, again the high importance of this issue and its repeated mention by the WHO and the commitment of countries to achieve UHC by 2030, demonstrates the feasibility of conducting interventional studies and publication of very important and modeling articles for other countries. Therefore, published articles in this field need to address the performed intervention in more detail so that other countries do not make repeated and costly mistakes when using model countries' experiences ( 3 , 6 , 66 , 67 ).

Most of the interventions were done in LMICs and UMICs. Few studies were conducted in high or LICs. One of the possible reasons could be that the HICs are fully achieved UHC and need for no major interventions. In LICs, also, the low interventions could be due to their low income and their inability to finance the structural and basic interventions and to develop major infrastructure. However, evidence suggests that LICs have also taken substantial measures and successful interventions to achieve UHC, given the importance of health and its impact on their economies and sustainable development. However, valuable interventions in countries, such as Nepal ( 68 , 69 ), Uganda ( 70 , 71 ), Rwanda ( 72 ), Tanzania ( 56 , 73 ), Ethiopia ( 74 ), Afghanistan ( 75 ), and Madagascar, ( 76 ) have been conducted and positive results have been reported. In addition to published studies in this area, it should be noted that many successful interventions may have taken place before the announcement of this global policy in 2008, which has not been published with the aim of UHC, and these studies are likely to be lost.

Each country, taking into account its own needs and specific circumstances, undertakes specific interventions to achieve UHC. Considering the economic conditions of countries, the results of the present study show that most of the interventions have been performed in the field of financing or financial protection functions. Thus, most interventions in these countries have focused on the insurance system and targeted the poor people or specific groups of society ( 69 , 72 , 77 - 81 ).

Also, one of the issues that mostly reformed by countries is the payment and premium systems ( 76 , 82 - 84 ). Similarly, a study by Elio Borgonovi and Emilia Compagni (2013) indicates that social, economic, and political sustainability are key drivers of health interventions and reforms in achieving UHC ( 85 ). Also, in many studies, social health insurance (SHI) ( 86 ), premium ( 50 , 51 , 87 ), cost containment ( 88 ), national health insurance system ( 89 - 91 ), tax revenue ( 92 , 93 ), risk-pooling mechanisms ( 4 , 92 ) and strategic purchasing ( 94 ) are crucial factors in the financial protection function of achieving UHC, such that positive reform interventions in these areas can draw countries one step closer to achieving their original goal.

That is why financing function or the financial protec tion dimension and interventions in them can be considered as an essential component of achieving UHC. The results of the study showed that successful interventions in the countries under study have positive results such as reduction in the intensity of care and a decrease in length of hospital stay ( 82 , 95 ), elimination of costs of services that cause overuse of health services ( 76 ), allocating a large percentage of income to health ( 79 ), reducing out-of-pocket payments ( 96 ), and so on.

The results show that most of the interventions in the field of service coverage are targeted specific groups, such as children, adolescents, women, and specific patients, which could be due to the high vulnerability of women and children under 5 years old and the financial inability of these groups in LMICs. Also, designing dedicated and fully customized service packages can be much more efficient and effective than comprehensive service packages designed for the population of a country without considering the specific needs of different groups. With regard to specific diseases, special conditions, such as chronicity, being erodible, and cost consuming, can lead to catastrophic expenditure; for this reason, people with specific illnesses are covered by free services. Interventions in service coverage show that most interventions are in areas such as modifying or creating service packages based on people's needs at all levels of service provision or for different age groups and specific diseases, and also implementing fundamental interventions in primary health care or community-based health care. Interventions in this area have been in line with the findings of studies that have identified service packages as a major and very effective factor in achieving UHC ( 15 , 88 , 97 - 100 ).

The study showed that most of the interventions in the field of population coverage were related to the coverage expansion in specific groups or diseases ( 69 , 73 , 76 , 79 , 80 , 101 - 106 ). Countries are also trying to cover poor households and individuals by implementing mandatory or voluntary insurance programs to cover more population ( 15 , 79 , 81 , 107 , 108 ) . Thailand, for example, with the aim of covering its population considering socioeconomic conditions, by implementing a 30 Bahat health plan, could increase its insured population from 40% to 95% within 4 years, which is also considered one of the most successful interventions in this field ( 109 ). China has also been able to cover its entire population by implementing urban and rural health insurance plans ( 77 , 78 ).

Studying the results of interventions in different countries showed that most of the interventions targeted financial protection and most of the published results also were in this area. This could be due to the importance of financing and reimbursement in the health system and financial protection of citizens against illness, as interventions in this area can reflect an early impact and can be better monitored and evaluated. However, results from the quality dimension are less reported. One of the reasons may be that interventions in this field are new and, on the other hand, the long-term impact of quality improvement interventions can be effective in publishing less studies in this area. Delays in the considering of the quality of health services by the WHO as the fourth dimension could also be another reason for the low publication of quality interventions and their effects on UHC.

The results of the present study show that quality interventions with 18 cases had the least report. However, studies on UHC have identified the quality of care and regulatory mechanisms for quality as one of the most influential factors in achieving UHC ( 36 , 55 , 110 - 112 ). One of the reasons for low interventions in this dimension could be the overemphasis of countries on the quantity of services provided and coverage of the majority of the population. It can also be attributed to the late introduction of this dimension and its recognition as the hidden dimension of UHC. While implementing programs related to other dimensions of public health coverage, countries need to take into account the quality and its monitoring, so that the interventions can be more efficient and effective. However, given the importance of quality in health, countries have taken important interventions, such as training and using experienced nurses ( 103 ), using information technology to reduce medical errors and filling the gap in access to health services ( 113 ), maintaining quality of service by licensing qualified individuals and hospitals accreditation ( 16 , 114 ), and improving patient safety ( 34 ). However, the results of interventions in the quality dimension indicate maintaining and enhancing the quality of health care for service receivers through the implementation of quality standards and increasing users' satisfaction with services and eliminating the inequality in accessing quality health services in some countries ( 84 , 115 , 116 ).

One of the limitations of this study was the use of only English and Farsi languages to search and collect studies and documentation based on the authors' familiarity with these 2 languages. However, reports and documentation of successful interventions in countries may have been published and documented in other languages than have not been reviewed in this study. It should be noted that the present study examined only successful interventions that had good and significant results for countries. The reader should note that also some countries on the path to achieving UHC have had unsuccessful and costly interventions that can be used as a model to learn from failures and that only focusing on successful patterns cannot be effective.

Despite the issues raised in achieving UHC and necessity of interventions in the dimensions of UHC, and in light of the results, it should be made clear that in addition to providing the countries with the appropriate technical conditions on this path, the financial resources and political commitment of officials in all disciplines are essential, as the continuity and sustainability of this policy will achieve UHC. The results show that each country, depending on their particular economic, social and political circumstances have selected appropriate intervention mechanisms and tools for achieving UHC and have intervened. Each country has also been able to achieve significant progress in this area by identifying its weaknesses and prioritizing the most important ones for intervention, have achieved remarkable success in this regard, and have taken a step forward. Therefore, lessons learned from successful interventions in these countries can be highly efficient and effective through localizing and combining with target country' features.

Implications for Research and Policy

The present study provides a comprehensive and clear view of successful interventions performed in most countries at different income levels that seek to achieve UHC, and summarizing and reporting these successful interventions can be a model and guide for other countries to avoid the costs and mistakes. The results showed that countries have paid little attention to the quality of services. Therefore, more attention is needed to design and implement comprehensive interventions and policies to improve the quality of services in achieving UHC. Valid interventions with strong methodology and the use of control groups are recommended for future studies. Specific methodological evaluation of interventions is also recommended for future studies.

Conflict of Interests

The authors declare that they have no competing interests.

Acknowledgment

We are grateful to the experts for their contribution, time, and invaluable comments. Also, we are very grateful to Iran University of Medical Sciences for providing financing support.

Appendix 1.

Characterized of studies included and summarized in the study.

Cite this article as : Koohpayehzadeh J, Azami-Aghdash S, Derakhshani N, Rezapour A, Alaei Kalajahi R, Sajjadi Khasraghi J, Nikoomanesh M, Sabetrohani H, Soleimanpour S. Best Practices in Achieving Universal Health Coverage: A Scoping Review. Med J Islam Repub Iran. 2021 (30 Dec);35:191. https://doi.org/10.47176/mjiri.35.191

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Dylan Scott answers 9 key questions about universal health care around the world

Vox policy reporter Dylan Scott traveled to Taiwan, Australia, and the Netherlands to see their health systems.

by Lauren Katz

Vox policy reporter Dylan Scott traveled the world last fall to explore what the US can learn from other countries’ health systems , visiting Taiwan, Australia, and the Netherlands. His trips were the foundation for Everybody Covered , a Vox series on health care that also reported on health systems in the United Kingdom and Maryland .

Dylan did a Reddit Ask Me Anything session on Wednesday, January 29, discussing everything from how countries pay for universal health care to what it will take to achieve further health care reform in America. Here’s a roundup of some of the most interesting questions and answers, lightly edited for clarity.

1) How do countries pay for public health insurance?

Icantnotthink: Where does the payment for public health care come from in other countries?

Dylan: Most of these countries use some mix of 1) payroll taxes for individuals, 2) employer contributions, and 3) general government revenue and progressive/sin taxes. To be honest, there isn’t one model to follow. Each country had its own health funding plan that has since been reformed to meet the needs of their current system, just as the US would. But other countries are looking for health care dollars in many of the same places Medicare-for-all supporters think we should here.

2) When it comes to covering everyone, is a country’s population density important?

Verybalnduser: How important would you say a country’s population density is to keeping total cost down?

Dylan Scott: It’s a huge asset. Taiwan has been able to keep its overall spending low — people on the left would say their single-payer program is actually underfunded — and cost sharing low for patients in large part because its urbanized nature makes it easier for a smaller workforce to meet the needs of its patient population. The Netherlands has been very innovative in delivery reforms, meant to keep costs in check, something that’s clearly been aided by its density. Australia , on the other hand, even with a universal public insurance plan, has still struggled with access in its more rural areas.

3) Is there a lot of paperwork in a single-payer system?

ZenBacle: How much paperwork do patients in single-payer systems have to fill out? And how much time do those patients have to spend fighting with health care providers to get them to honor their coverage?

Dylan Scott: One of the benefits of single-payer is there’s a lot less administration. We visited a hospital in Taipei, Taiwan, and while all the clinic lobbies were full, the cashier’s desk was basically empty. One survey finding that stuck out to me showed the doctors in the Netherlands (with private insurance) are more annoyed about paperwork than their peers in more socialized systems. So while I wouldn’t want to try to quantify it off the top of my head, there seems to be less of a paperwork headache.

The Pandemic Playbook Vox explores the successes — and setbacks — in six nations as they fought Covid-19.

• Taiwan’s single-payer success story — and its lessons for America
• Two sisters. Two different journeys through Australia’s health care system.
• The Netherlands has universal health insurance — and it’s all private
• The answer to America’s health care cost problem might be in Maryland
• In the UK’s health system, rationing isn’t a dirty word

4) Between Taiwan, Australia, and the Netherlands, which policy would translate most easily to the US?

Doctor_YOOOOU: Which of these universal health care systems is “closest” in terms of the amount of reform required to the United States?

Dylan: This is a tricky one — no country looks much like the US status quo. The Netherlands does have a lot of the same features as Obamacare (ban on preexisting conditions, individual mandate, government assistance to cover the costs), but it’s available to everybody and it’s stricter. The mandate penalty is harsher, the government rules on cost sharing are more stringent, and the government actually helps set prices and an overall budget for health care. So it’s much more involved than the US government is in administering that private health insurance. And almost all of the insurers are nonprofits.

So we’re talking about huge changes to move the US system to something that looks more like the Dutch — and that’s one I’d name as closest (along with Japan) to what we have right now.

5) Do solutions exist within the US that can be applied to the rest of the country?

Blakestonefeather: You traveled the world to explore what the US can learn, but did you also travel the US to learn if the US can learn? [In other words,] what are the barriers we in America face to learning/being able to learn?

Dylan Scott: We actually did one story in the US, on Maryland’s unique system for paying hospitals . (Every insurer — private, Medicare and Medicaid — pays the same rates for the same services.)

But there is a huge challenge in translating policies from abroad to the US. Taiwan and Australia have about the same population as Texas, but Taiwan’s is contained to a tiny island off the coast of China and Australia is a continent. The Netherlands is one of the most densely populated countries in the world; the United States is one of the least.

Then you’ve got political differences; Princeton economist Uwe Reinhardt famously didn’t believe single-payer could work in the US, not because it’s not a good idea but because the government was too beholden to corporate interests. The recent failure of surprise billing legislation in Congress in the face of industry opposition is certainly a warning sign to any aspiring reformers.

So the dissatisfying answer to “so what can the US learn from these other countries’ successes?” is: It’s complicated. But my hope for this series is it would speak to the kinds of values and strategies, if less the specific policies, that are necessary to achieve universal health care.

• 9 things Americans need to learn from the rest of the world’s health care systems

6) What does the American health care system get right?

taksark: What’s something good about the American health care system that could be kept and improved on in a better version?

Dylan Scott: The geographic immensity of the US has forced a lot of experimentation with telemedicine, and that is both a necessity and an area where other countries have tried to draw from what the US has done. I heard a lot from doctors about coming to the US to learn the latest on best practices for delivering care.

I think the US is still seen as a leader in innovative medicine — the question is why can’t we give more people access to it?

7) Besides America, what other countries have private health insurance?

To_Much_Too_Soon: How many other countries besides America have private health insurance?

Dylan: The US relies much more on private health insurance than any other country I’m aware of. About half of US citizens depend on private insurance as their primary coverage, and about 8 percent of our GDP is private health spending; most other developed economies don’t top 4 percent of GDP for private spending.

There are countries like the Netherlands with universal private insurance. But their private insurance is a lot different than ours: Almost all of the insurers are nonprofits, the government sets rules about premiums and cost sharing, there is a global budget for health care costs, etc.

Some countries with single-payer programs, like Australia, allow private insurance as a supplement — so you can get more choice in doctor or can skip the line for surgery. But no developed economy I know of is so dependent on private insurance as the US and with comparatively few regulations about its benefits.

8) What surprised you the most throughout your reporting?

JoseyGunner: What shocked you the most during your travels?

Dylan Scott: I was surprised how often people I talked to were shocked by the worst parts of US health care. The uninsured rates, the deductibles we have to pay, the very idea of a surprise medical bill — all of it was unfathomable to many of the people I met.

9) What are the biggest hurdles to any future health reforms in the US?

Flogopickles: What do you see as America’s biggest hurdle to achieving any sort of movement in affordable care for our citizens?

Dylan Scott: The status quo is powerful for two reasons: One, it’s good enough for enough people that big change feels like a risky proposition to a lot of the population and, two, health industry interests are so influential in Washington, DC. Overcoming those two things — people’s inherent aversion to risk in health care and the power of industry to constrain policymaking, especially price constraints for medical care — are the biggest hurdles to any future health reforms.

Join the conversation

• Read Dylan Scott’s full Reddit AMA

• Sign up for VoxCare, Vox’s health policy newsletter

• Join Vox’s health policy Facebook group

• Listen to the Impact episode about Taiwan’s single-payer system

• Health Care

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