In our previous module, we discussed the role of universal health coverage in disasters in health and human security. In this module, module three, we're going to discuss the role of universal health coverage. More generally, we're going to introduce some definitions and concepts, and we're going to look at the role of universal health coverage specifically in the context of aging. So for this module, we're going to have nine lessons. We'll start with an overview of the basic concepts of universal health coverage, what it is and how it works. Then we'll give some definitions and a couple of lessons about financial risk protection and how we define it and measure it. Then we'll discuss some methods for measuring the quality and extent of universal health coverage. We'll talk about equity in universal health coverage and then we'll go on to discuss specifically the problem of aging. There'll be some examples from Japan and Bangladesh, which are two countries with very different situations in the path of the aging problem. And then we'll discuss a couple of different policy directions for dealing with aging and for strengthening universal health coverage in the future. So this lesson is going to be an introduction to the concept of universal health coverage and some basic principles underlying it. So universal health coverage is not a complicated concept. It's a very simple one, that many countries have implemented effectively. And this is a common definition that's used to describe what universal health coverage is. So in essence, UHC is a system which ensures that everyone who needs health services is able to access them without undue financial hardship. It's a very simple definition, but setting up a system that can ensure this is a challenge. And there are very many different ways to do that, and they depend on the particular situation of the particular country. So some countries that are commonly used as examples of countries with effective universal health coverage systems. The UK, with its national health system, Japan's universal health coverage system and Germany and France and Canada are other good examples of universal health coverage systems. But many countries in the world have not achieved universal health coverage. And our goal in this lecture series is to understand how to measure it, how to talk about its progress, and how to make that progress happen. Okay. So first let's discuss some basic concepts of universal health coverage. So universal health coverage ensures access to health services for all people. We can measure access in many ways. We can talk about the availability that is, the health services actually there for people to use and they are able to use it. We can talk about quality, which is the level of service provided to people. Do they receive an adequate service from the coverage system and also obviously access to health services depends on proximity. You need to be near enough to a health service to use it, and many countries with large rural areas such as Australia, or many parts of Africa have particular challenges in this regard. Once we have talked about access, we can then move on to talking about effective coverage. So we don't just want people to have access to these services. We want them to have effective services. Now effective coverage can be described in terms of the timeliness of that service, and also in terms of its quality. So these are two concepts that we'll talk about in more detail today. Two other concepts, which are particularly important for the second part of the definition of universal health coverage are financial risk protection and equity. So financial risk protection is the aspect of the universal health coverage system, which ensures that everyone is protected against financial hardship. We need to define financial hardship, we need to measure it, and we need to prevent it. And equity is the aspect of universal health coverage, which actually ensures that it is universal. That is, that people can get what they need at a price that is affordable to them. So we'll talk about those concepts in later lessons as well. So first let's discuss the basic dimensions of universal health coverage using this tool that's been made available to us by the WHO. So typically when we talk about the aspects of universal health coverage that we want to assess, or describe we divide it up into three dimensions. And this diagram shows those dimensions. So in the center of this diagram you have the current pooled funds, which is the amount of money available in a country or in a national system to guarantee access to care. And then you can see around this cube of pooled funds there is a larger cube, which measures the dimensions of universal health coverage. So, the first dimension is the population. So who is covered by the universal health system, is everyone covered or only some proportion of the population. Then we have services. Which services are covered? So the services which a universal healthcare system can cover given its available funds may vary according to the particular system that is in place. And finally, we have to consider the direct costs. That is the proportion of the costs of the health service that are covered by the universal health coverage system. And as you can see from this diagram, for a fixed pool of funds, You will need to balance the level of effectiveness on each of these dimensions to ensure that you have a functioning system. For example, the UK National Health Service covers 100% of the cost. So its vertical dimension, the direct cost dimension is 100% covered. However, in order to make that happen it also has to exclude some services. For example, for many years it was not possible for a woman under 25 to get access to a cervical smear. However, it also covered everyone in the population. In Japan, the whole population is covered. So that dimension is 100%, but many services are not covered. And in the direct costs axis about only 70% of costs are covered. So some proportion of the costs are paid for by individuals. So these three dimensions can vary and move around depending upon the particular definition and structure of the system. This slide shows three hypothetical examples of universal health coverage systems in place and how we can measure their effectiveness. These three examples, situation A, B and C, can be imagined as three different countries with three different universal health coverage systems. For all three situations, the green bar measures the proportion of the population who are in need of the service who could receive it, who have access to it. The orange bar measures the proportion of the population who actually receive the service, which can be less than the proportion covered. And the blue bar records the proportion who received the service and suffered no financial hardship. So in Situation A and B and C, we can see that 100% of the population are theoretically covered by this universal health coverage system. In Situation A however, only 80% of people covered by this system received the service. So 20% for some reason, are not. And then only 70% of the population receive the service and suffer no financial hardship. So about 12% of people who access the service are experiencing some kind of financial hardship, perhaps because of direct costs. In Situation B, the same proportion of people have access to the service, and the same proportion 80%, actually receive the service. But only 40% receive the service and suffer no financial hardship. This could be for example, because of high direct costs or because of poverty in the country, which makes those direct costs quite unattainable for a large proportion of the population, or it could be because of inequity. In Situation C the same proportion of people are covered that is 100% of the population theoretically have access, but only 40% receive the service. That is 60% don't access the service at all for some reason. And then of the population, 40% receive the service and suffer no financial hardship. So everyone who receives the service, receives it at no financial cost to themselves. However, very few people actually receive the service. This could be because the direct costs have some initial barrier, which is then repaid and which poor people can't handle. Or it could again, be because of inequality of some form. But in all three situations, we can see that the goal of the service, the ability of the service to deliver. And the ability of the service to protect against financial hardship differ according to the system that is in place. And our goal in future lessons will be to look at how to measure these things, and how to improve these aspects of a universal health coverage system. So to measure the way that universal health systems work, We need to establish indicators. So we have on the one hand, indicators of financial hardship, which enable us to assess the way in which it's protecting people from financial harm. And then we have indicators of service coverage, which tell us how well service is working for the people. And those indicators can further be broken down into prevention and promotion, and treatment, and we'll talk about those indicators in subsequent lessons. So just to review, we can define universal health coverage in terms of its access, its coverage, its protection against financial risk and equity. We measure the broad success of the system in terms of three dimensions, which are population, services coverage, and direct costs. And we establish some tracking areas for indicators that we wish to observe and measure to assess the quality of the universal health coverage system. And we'll talk about some more of these definitions in detail in the next lesson.
