Financing mechanisms The ILO concept of health protection

12 Universal Health Protection A recent reform example regarding legal coverage relates to the USA where the Patient Protection and Affordable Care Act A.C.A., 2010: “Obamacare” extends existing legal coverage to some 14 percent of the population that is currently not covered and will have access to an affordable insurance policy. Another 6 percent of the population will have to buy new private insurance policies that meet the criteria of the A.C.A. Lizza 2013. Figure 3.2. Legal health coverage from public, private or national health-care schemes and systems: Global figures, latest available year percentages Source: OECD Health Statistics database; national sources for non-OECD countries Health coverage is closely correlated with levels of wealth, as might be expected: wealthier countries reach higher average levels of coverage than less well-off countries. According to ILO estimates, in some of the poorest countries of the world no more than 10 per cent of the population are covered while the remaining 90 per cent have to pay for health care without any risk pooling through health protection, often in the form of OOP ILO, 2010a. Generally, at the global level, GDP per capita and coverage are positively related. Figure 3.3 shows this relation: higher levels of GDP are linked to higher coverage rates. Universal Health Protection 13 Figure 3.3. Health coverage and per capita GDP, latest available data Source: ILO, based on ILO, LABORSTA and UN; UNDATA, 2013. Gaps in health coverage are particularly concentrated in developing countries. In particular, they frequently affect vulnerable groups such as the poor, workers in the informal sector, migrants and women ILO, 2012b. They are frequently an indication of fragmented legislation and rights-based approaches on health systems that are characterized by inadequate coordination of various financing mechanisms such as microinsurance, social insurance, private insurance and others.

3.1.2. Funding and financing

National levels of health expenditure define the availability of quality services, medicines, infrastructure and other elements. Health care will be delivered only at low quality if at all where funding is insufficient. Inadequate financing mechanisms that impose large amounts of expenditure on private households also impact negatively on the accessibility of necessary health care by creating financial barriers. Thus, minimum requirements for health funding and financing include meeting at least the key principles of providing access to at least essential health-care services, and fairness in health financing. What is the situation at the global level? National health expenditure varies widely across countries. Those that spend the most on health care are situated in the Americas and Europe. In 2012, the United States spent more than 18 per cent of its GDP on health, while the Netherlands spent 12 per cent figure 3.4. Those countries that spend the least on health are largely situated in sub-Saharan Africa: for instance, health expenditure in the Congo amounts to about 3 per cent of GDP. 5 000 10 000 15 000 20 000 25 000 30 000 35 000 40 000 20 40 60 80 100 G D P p e r cap it a in c u rr e n t U S Population coverage