Pandemic momentum for health systems financialisation: Under the cloaks of Universal Health Coverage

Abstract

Although a highly ambiguous and contested idea, Universal Health Coverage (UHC) is the hegemonic concept in international debates on health system reforms. States' difficulties to provide adequate and comprehensive response to people's health needs arising from the COVID-19 pandemic strengthened the impetus for UHC implementation. But while featured as the way to achieve justice in health, analyses of UHC-kind reform experiences since the 1990s show that it may be comprehended rather as a new facet of neoliberalism in the health policies' arena. Its insurance arrangements are aimed to finance packages of health goods and services for the poor, while states play mainly a role of public funds administrators, buying from public and private providers competing in the market. UHC contributes to health system fragmentation and segmentation, weakens public structures and opens new markets for corporations to capture public funds. COVID-19 pandemic subjected health systems to unforeseen stress, underscoring the crucial role that a well-funded public health system plays in people's lives. Assessing pandemic's challenges may be an opportunity to build more egalitarian health systems, based on dignity and not people's money. However, the unreflecting adoption of technocratic health paradigms and solutions may, instead, ultimately pave the way for further health financialisation and injustice.

Which UHC? Features for Equity and Universalism Comment on "Universal Health Coverage for Non-Communicable Diseases and Health Equity: Lessons From Australian Primary Healthcare"

“…The pandemic has exacerbated and exposed corruption around public funds in the response, and the negative consequences of underfunding public health systems. [12][13][14] It has exposed inequalities within and across countries that heighten risk and vulnerability, as well as powerful interests that have self-protected, further widening inequality and prejudice, triggering calls for explicit attention to equity. 12,13 As Arundathi Roy observed, pandemics offer a chance to break with the past, and "nothing could be worse than a return to normality. "…”

“…However, if this is the UHC that sustains the same narrow lens on reactive technocratic, biomedical and individual behavioural approaches, it is argued that the pandemic may deepen the financialisation and inequity in health systems. 14 Lopez Cabello 14 notes that the pandemic has widened public awareness of the critical role that universal, equitable public health systems play in our lives. We are thus in an important moment to challenge neoliberal, market-driven approaches to UHC, and to make clear the features that are essential for us to advance towards equitable, universal health systems.…”