The course starts from the premise that Universal Coverage is not an end in itself, but a means — a means to better health, financial protection, and user satisfaction. Moreover, there are many possible paths towards Universal Coverage. A country’s starting point – defined by its existing patterns of financing, service delivery and financial protection mechanisms, as well as each country’s economic, political and social situation – determines which directions are feasible.
Participants will consider where their countries are relative to national coverage goals, considering the various dimensions of coverage – the percent of the population covered, the level of benefits covered, and the extent to which health care costs are covered, for different groups in the population. The course will emphasize that what really matters is not coverage “in principle” or “on paper,” but the actual, effective availability of health services, taking into account the costs to users and payers, and service quality and effectiveness. Affordability is always a concern and a constraint, and is affected by current and future resource availability. New policies and programs aimed at achieving universal coverage may generate future entitlements and expectations that can easily overwhelm the system. New entitlements must be matched by availability of services – whether provided by the private, non-profit or public sectors. Prevention and health promotion are important – the healthier the population, the more feasible it is to expand towards UHC.
The Flagship framework takes participants beyond the design of health systems financing, to also consider important ethical and political issues, and the different interests of the stakeholders affected by health policies (e.g. health care providers, patient groups, international drug companies, private sector entrepreneurs, etc). Most importantly, the Flagship approach focuses attention on implementation issues, such as organization and management, regulation, the design of payment systems, incentives for behavioral change, and the capabilities that need to be in place for successful implementation of different policy options.
The course methodology will use case studies specifically related to Universal Coverage. Group work sessions will give participants the opportunity to apply the course concepts and content to the specific situation in their own countries; and to interact with and draw on the experiences of other participants/countries and the Harvard and WBI faculty. Participants should end the course with a clearer sense of their options, constraints, opportunities and priorities in considering the next major steps towards Universal Coverage.
Topics/themes that will be discussed/analyzed during the course include:
- Why the focus on Universal Coverage?
- What UC involves and its relationship with ultimate outcomes
- Different possible pathways to Universal Coverage
- The Flagship framework – enhanced to include the health system “building blocks” applied to the analysis of pathways to Universal Coverage
- Ethics and the political economy of Universal Coverage
- Intermediate outcomes: quality, efficiency and access
- Financing options for Universal Coverage
- Paying and reimbursing providers
- Expanding coverage and the design of benefit packages
- Setting priorities and controlling expenses
- The importance of health promotion and prevention in making UHC feasible
- Improving performance in the public sector to expand coverage
- Universal Coverage and the private sector: contracting and regulation
- Leadership for implementing change