Universal Health Protection 5
2.1.1. Legal health coverage
The Universal Declaration of Human Rights 1948 states that “Everyone, as a member of society, has the right to social security and is entitled to realization, through national effort
and international co-operation and in accordance with the organization and resources of each State, of the economic, social and cultural rights indispensable for his dignity and the
free development of his personality” Art. 22.
ILO Recommendation No. 202 reaffirms the human right to social security, including health protection. It emphasizes the need to translate this right to protection into
entitlements to benefits as prescribed by national law para. I. 3b as a key principle for social protection provision. The related national legislation should specify:
the population covered; qualifying conditions to access health benefits; and
complaint and appeal procedures. Figure 2.2 shows historical developments in legal health coverage of the population in
various countries. It refers to the percentage of the population covered as stipulated by law in national health systems, social health insurance or other forms of health protection.
Although it appears that in a number of countries, legal health coverage has increased to reach nearly 100 per cent, no conclusions can be drawn about whether individuals can
effectively access health care in case of ill health based on this graph. For effective access, the design of health schemes or systems and their implementation play an important role.
Thus, even with statutory coverage of 100 per cent of the population, universal coverage in a meaningful sense may not be achieved if the legislation is not sufficiently implemented.
Figure 2.2. Legal health coverage as a percentage of total population, selected OECD countries and others Selected countries
Source: ILO, 2011b.
10 20
30 40
50 60
70 80
90 100
1 9
2 1
9 2
9 1
9 3
7 1
9 4
5 1
9 5
3 1
9 5
9 1
9 6
4 1
9 6
9 1
9 7
4 1
9 7
9 1
9 8
4 1
9 8
9 1
9 9
4 1
9 9
9 2
4 2
9
P e
rc e
n ta
g e
o f
th e
p o
p u
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c o
ve re
d
Austria France
Germany Greece
Portugal Spain
United States Chile
Austria, France,
Germany
Spain, Greece Portugal
Rwanda, Ghana
6 Universal Health Protection
To be meaningful, legal health coverage needs to result in effective access for all residents of a country, regardless of the financing subsystem to which they belong. However, this
does not preclude national health policies from focusing temporarily on priority groups such as the most vulnerable when extending social protection in health. Frequently,
vulnerable population groups do not have equal access to necessary health care. This is often due to gaps in legislation, and particularly concerns the following categories:
the poor; workers in the informal economy and their families;
women; persons with special needs, such as persons living with HIVAIDS PLHIV; and
ethnic minorities and migrants.
2.1.2. Effective access to health care
Despite legal coverage, the sick are often not in a position to access necessary quality health care without risk of poverty and financial hardship. This is not solely dependent on
the existence of legislation or affiliation to a scheme or system; it depends also on a range of issues such as gaps in the implementation of legislation as well as social, economic and
other factors.
In order to ensure adequate protection in terms of effective and equitable access to health care, affordability and financial protection in addition to availability of quality services
must be guaranteed by the removal of financial barriers such as out-of-pocket payments OOP. Furthermore, there must be sufficient funding for quality service delivery, and
excellence in governance and management of health systems and schemes. An overview of key aspects to be assessed is provided in figure 2.3.
Figure 2.3. Dimensions of effective access to health care
Source: ILO, 2013a.
A ff
o rd
a b
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f in
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c ia
l
p ro
te c
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n
Non-existence of financial barriers to access services
Financial contribution in relation to ability to pay
Absence of catastrophic health- care costs
Absence of impoverishment due to health-care costs and inability
to generate income
A v
a il
a b
il it
y a
n d
q u
a li
ty
Excellence of social health protection at the systemic,
organizational and managerial level e.g. use of funds,
efficiency, management capacity, legislation and enforcement,
decision-making process Excellence of the service delivery
system e.g. responsiveness, provider behaviour, medical
interventions, infrastructure, staff, equipment
Availability of a set of essential services
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