Universal health coverage: Two different approaches, but similar outcomes
SINGAPORE — They are two very different countries, yet Singapore and Bangladesh have made strides in introducing universal health coverage for their people, joining the list of countries that have provided such coverage regardless of their wealth, said World Health Organization (WHO) director-general Margaret Chan yesterday.
“The Bangladeshi story shatters the long-held assumption that countries must first reduce poverty, then better health will follow almost automatically. This is not true,” said Dr Chan during her keynote address at the Ministerial Meeting on Universal Health Coverage organised by the Ministry of Health. Driven by a commitment to equity, Dr Chan said the country aimed for universal coverage of its vast and very poor population with “a package of high-impact interventions”.
For example, Bangladesh trained and closely supervised a brigade of community health workers — mostly women — to compensate for a severe shortage of doctors and nurses. To prevent high charges from unregulated and largely unqualified healthcare providers, the Bangladeshi government then built and ran almost 12,000 strategically-located community clinics.
On the other hand, Singapore’s version of universal health coverage sought to balance the advantages of competition and other market forces with the need for state intervention to steer them in the right direction, said Dr Chan. “It balances freedom to choose providers, services and facilities with an obligatory health savings account ... the Medisave plan.”
She also lauded another “innovation” — MediShield Life — for embodying the principle of collective responsibility through the pooling of risk.
But Dr Chan noted that Singapore has some distinct advantages towards achieving universal health coverage. These include its smaller size, which makes it easier to extend health services to people, a tradition of cross-ministry collaboration, as well as the political stability and high level of public trust in the Government.
Universal health coverage, Dr Chan said, is unique, country-specific and context-specific.
“A rich country such as Singapore has done it beautifully; Bangladesh did it their way and it works for them. And the approach in both countries led to stunning reversals — reversals in excess mortality, morbidity,” she told the audience at the Grand Copthorne Waterfront Hotel.
In her speech, Dr Chan pointed out that economic decisions within a country will not automatically protect the poor or promote their health.
And with the widening income gap between the rich and poor globally, she felt that universal health coverage is one of the most powerful social equalisers among all policy options.
Dr Chan also noted that if there was a clash between health policies and the economic interests of sectors, such as trade or finance, “economic interests will trample health concerns nearly, nearly every time”.
However, she cited the implementation of the WHO Framework Convention on Tobacco Control as a notable exception, driven by overwhelming evidence of the health and economic costs of tobacco use.
Dr Chan said the health sector, when working in tandem with others, can reap huge benefits — “even tackling a powerful, devious and dangerous industry on multiple fronts, including through fiscal and regulatory measures”.
