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.