One of the characteristic-wise of defining a system directed towards this collection of goals is the system that is directed towards achieving Universal Health Coverage. Universal Health Coverage is usually defined as having a number of elements. The first is that all individuals and communities receive the health services they need without suffering financial problems or hardship. Note, health care doesn't need to be free, it means without suffering financial hardship. As we will see in the course in relation to the United States and China, the high cost of medical services can cause the financial hardship to large portions of the population. Reducing out-of-pocket payments is therefore important in achieving Universal Health Coverage. It's important ensuring that everyone has access to the services that address the most significant causes of disease and death. But in addition, Universal Health Coverage also means ensuring that the quality of those services is good enough to improve the health of the people who receive them. The reference to good enough refers to ensuring both the people receive recommended care, and ensuring they're not provided with unnecessary care. Universal Health Coverage can be characterized in this slide as being directed to three dimensions simultaneously. The first dimension is the proportion of costs covered, what's the amount of the out-of-pocket payments incurred by those seeking health care? Secondly, what is the range of services that are available? Thirdly, what is the proportion of the population covered by the health care system? Universal Health Coverage is not an absolute, it does no domain achieving the ultimate goal of full coverage for the whole population with no out-of-pocket payments immediately. There is no achieving the goal of moving on to the next problem. Universal Health Care is an effort to define a set of goals towards which a system may move. It is a dynamic process of moving a health system towards these goals. Over time, the needs of the population will change, and that will result in the continual problem of realigning the health system on each of these dimensions around this new problem. For example, nearly all health systems are in the process of responding to increases in the number of chronic non-communicable diseases. These diseases require different kinds of care, have call for re-invention of universal health care system to meet these challenges. Universal Health Coverage, as a goal for health system, does impose a set of governance requirements on that system. In other words, we're interested in the continuing process by which health systems adopt a form of governance that enables them to respond to these new needs. We're not interested in whether or not health system achieves any particular goal at a particular time, rather it is the movement towards the composite set of goals that are included in the Universal Health Coverage that is important. It's significant because if we do not think of healthcare systems as being directed towards a set of goals included in the definition of Universal Health Coverage, we end up in a quagmire of complexity. Here offer one definition of healthcare that's relevant to the United States, but it does begin to capture the complexity of the health care system. It's along definition, but I want to read it to you because it provides some useful background. A healthcare system is a collection of institutions and actors who provide health care. Immediately, we're in a degree of circularity, health system provides health care. Then it goes on to identify who does that? That is, doctors, nurses, hospitals, pharmacies, traditional healers. The organizations that supply specialist inputs to provide, for example, training schools, manufacturers of products, the financial intermediaries, planners, and regulators who control fund and influence the providers. For example, insurers, government agencies, and regulatory bodies. The organizations that offer preventive services, and the financial flows that finance the provision of health care. This circular definition of healthcare end us up in endless repetition of complexity of relationships between the range of stakeholders and the range of outputs. The focus on Universal Health Coverage and on the movement towards the goals embedded in Universal Health Coverage allows us to identify the characteristics of systems which move towards those goals, and the characteristics of systems which either fail to achieve the movement towards those goals, or which achieve movement towards those goals more slowly than others. Comparative analysis of health systems involves an analysis of the interaction between the elements of healthcare systems and the outcomes produced by those systems. It is through this approach to comparative analysis that should be encouraged to imagine how all of the stakeholders interacting ways that produced these outcomes. In the next part of the lecture, we will consider what we mean by improving health in particular, what we mean by population health, and how we measure it.
