How to finance universal access to healthcare

Recognizing that everyone should have access to essential healthcare services is only the beginning. The next challenge is deciding how the necessary resources are raised, managed and used. Drawing on my experience in the sector, I, Magín Eduardo Blasi Blanchard, propose separating each function clearly.

Pooling the risk of illness

A family can plan many everyday expenses, but it cannot reasonably anticipate every cost of cancer, intensive care or a complex chronic illness. Health-financing systems therefore need mechanisms that spread risk across many people.

The WHO distinguishes three functions: revenue raising, pooling funds and risks, and purchasing services. They are not interchangeable. Revenue raising determines where the money comes from; pooling distributes risk; purchasing defines which services are contracted, from whom and under what terms.

A financial design that protects everyone

My hypothesis is that a sustainable model can combine tax revenue, mandatory contributions and other prepaid sources according to each country's context. The essential condition is that inability to pay does not exclude people from necessary care, and that funds redistribute resources among people with different incomes and health risks.

Excessive fragmentation can restrict that redistribution. At the same time, institutional architecture must fit the capacities and needs of each society: there is no single universal formula.

Finance care, not unnecessary complexity

Administration, audit and oversight perform important roles. Yet their costs must be measured and duplication that adds no value should be removed. The goal is not to eliminate necessary controls, but to simplify procedures and free resources for effective services.

Technology can automate billing, coordination and information analysis, although it also requires investment, oversight and data protection.

From financing to purchasing services

Raising more money is not enough if it is allocated without clear criteria. We must define benefits, protect vulnerable groups and establish contracting mechanisms that reward appropriate, high-quality care.

Financing universal access requires sufficient resources, pooled risk and responsible purchasing.

Reference

The WHO summarizes its health-financing principles in this topic guide.