Universal Health Coverage: Why health insurance schemes are leaving the poor behind

Universal Health Coverage (UHC) has risen to the top of the global health agenda. At its core, Universal Health Coverage is about the right to health. . According to the World Health Organization every year 100 million people are pushed into poverty because they have to pay in cash for medicines and treatment – that’s the equivalent of three people every second. Everyone – whether rich or poor – should get the health care they need without suffering financial hardship. Unfortunately, in the name of Universal Health Coverage, some donors and developing country governments are promoting health insurance schemes that exclude the majority of people and leave the poor behind. These schemes may also reinforce inequality - by prioritising people who are formally employed and excluding the most poor and marginalised who cannot afford to pay premiums, especially women. However, a number of developing countries are rejecting this model and prioritisinged general government spending for health – on its own or pooled with formal sector payroll taxes – to successfully scale up health coverage. Funding through progressive taxation and international aid is the key to achieving Universal Health Coverage. Even the poorest countries can raise more revenue for health through taxes. Oxfam estimates that improving tax collection in 52 developing countries could raise an additional $269bn – enough to double health budgets in these countries. Urgent action on global tax evasion and avoidance is needed to ensure that countries can generate and retain more of their own resources for health. Donors and governments should abandon unworkable insurance schemes and focus on financing that delivers universal and equitable health care for all.