What is much harder to provide is solid comparative evidence of the extent to which countries’ health systems manage to achieve this goal.
In 2013, Adam Wagstaff argued in a blog that UHC can, in fact, be regarded as old wine in a new bottle, as the idea also drew on earlier attempts in the 90’s to measure equity in the finance and delivery of healthcare systems in high income countries, most of which often subscribed to egalitarian goals.In this lecture, Eddy examines in more detail the extent to which this is true by comparing the original concepts to the latest measures of UHC and why they required adaptation. As well as:
  • The notion of payment according to ability to pay was replaced by the notion of financial protection and measures of progressivity were turned into measures of impoverishment or catastrophic spending.
  • The ethical premise of “equal treatment for equal need, irrespective of ability to pay” evolved into measures that are trying to get at the depth of coverage that can be adjusted for inequality.
  • The (arbitrary) combination of both dimensions into one index of Universal Health Coverage is discussed based on recent data from the WB HEFPI database.

All of these developments are illustrated with examples from the old and new approaches in order to draw some lessons that were learned. To the extent possible, the implications of the COVID-19 pandemic for the attainment of UHC goals will also be discussed.

Eddy van Doorslaer

Holds a joint appointment as Professor of Health Economics at the Erasmus School of Economics and the Erasmus School of Health Policy and Management, both at Erasmus University Rotterdam. He studied econometrics in Antwerp (B), and health economics in York (UK), and obtained his PhD at Maastricht University (NL). He has taught and researched in health economics for almost 40 years and has published extensively on the measurement and explanation of inequalities in health and inequities in health care. He was elected as a member of the Netherlands Royal Academy of Science in 2014 and has acted as a consultant for many international organisations like the World Bank, WHO and the OECD and served as an Editor of the two main journals in health economics (JHE and HE) for many years. He was also a visiting professor at the University of British Columbia in Vancouver (1996-97), the University of Technology in Sydney (2004-5) and at the University of Cape Town (2014) and Stellenbosch (since 2016). Current research interests include the examination of causal mechanisms underlying the socioeconomic gradient in health, both early and late in the life cycle, and equity and efficiency in the provision of health and long term care.