Bilqis, an 18 year-old woman from a rural village in Pakistan, traveled 150 miles in August this year to the capital to receive life-saving heart surgery after 15 years. Her family had delayed the operation because they were too poor to cover the exorbitant costs; when her situation worsened, they were forced to borrow money from a loan shark. This sunk them all into lifelong debt that would sometimes force them to go without food in order to make ends meet.
Bilqis’ story is sadly not unique.
The World Health Organization estimates that every year 150 million people suffer severe financial hardship because they have to pay out of their own pockets at the time they receive care, and 100 million are pushed into poverty as a result. These statistics, intimidating in themselves, probably mask a problem that cuts far deeper into families and societies across the world.
As world leaders gather in New York to launch a new set of development goals that they hope will improve the lives of millions, a new constituency has joined the health debate. More than 250 prominent economists – Joseph Stiglitz, Larry Summers and Linah Mohohlo – have signed the Economists’ Declaration on Universal Health Coverage, which calls on world leaders to implement universal health coverage.
High health costs that families have to pay directly from their own pockets are not just a problem for the poor. A well-off family that suddenly has to cope with the high costs of treatment for a loved one with a chronic condition will inevitably have to sell off their assets over time. Patients requiring expensive therapy, such as for cancer, are devastated financially even if they have the means to pay initially.
Among developed nations, the United States is unique in its failure to provide financial risk protection to all its citizens, which leads to many falling into, or deeper, into poverty when someone gets sick.
When implemented correctly, universal health coverage reduces poverty, increases economic growth and effectively tackles both infectious and non-communicable diseases, all while building resilience to shocks.
The Economist Declaration on Universal Health Coverage, convened by The Rockefeller Foundation, highlights the enormous economic benefits of investing in health, which are estimated to be more than 10 times greater than the cost. These investments also ensure that families and indeed countries are more resilient to potential shocks. The Ebola outbreak, which killed more than 11,000 people, decimated health systems and cost three times the annual cost of investing in building a universal health service in the Ebola affected countries - Liberia, Sierra Leone and Guinea. Ebola highlighted that the world’s global health system is only as strong as its weakest part.
How universal health coverage is paid for differs around the world and impacts overall access and the health services available. Insurance can work for those in the formally employed sector, and private insurance with high premiums may have a protecting effect for a specific and usually small segment of the population. Most social health insurance plans, where governments underwrite premiums on behalf of poor patients, provide coverage only for a basic set of services and usually do not cover catastrophic costs. Similarly, revenue funded systems also tend to provide only basic health services in many low and middle income countries, which in Brazil led to public protest and subsequent reform.
To protect people from the risk of financial ruin when they need more specialist health services (for example, cancer treatment), universal health coverage must also be supported by social protection schemes to protect the poor against catastrophic health shocks. Without it, the health system is undermined, as people will still suffer financial stress or fall into poverty while accessing services.
Bilqis’s heart surgery was a success but her family have now been unfairly thrust into poverty for saving her life. When the grand speeches of the UN General Assembly end, what will be telling is how much governments decide to invest in improving their health systems and providing people with social protection to mitigate the risk of out-of-pocket expenses.
The economists’ support adds momentum to the overwhelming evidence that providing quality health services free at the point of delivery would help end poverty, boost growth and save lives.Now its up to governments to translate economic sense into health system reform.
