How Many Countries Have Universal Health Care?

UHC (Universal Health Care) can be defined as providing all people access to comprehensive, quality healthcare services without financial hardship. Countries implement UHC differently, depending on their political ideology, economic development, healthcare needs and healthcare system design – but their systems should generally provide free or nearly free care for citizens and residents funded either from government funds or compulsory insurance sources.

International recognition of Universal Healthcare Coverage is increasing. To advance UHC, technical solutions must be supplemented by pragmatic policies tailored to local political economy context. This multicountry study of 11 countries shows that while UHC may present challenges, its achievement remains feasible and achievable for countries equipped with sufficient leadership, policies environment and capacity to implement and sustain them.

The 11 countries utilized an incremental approach to expand health coverage gradually, initiating reforms when they were both politically feasible and financially sustainable. For instance, Brazil’s commitment to universal coverage stemmed from its democratic movement during periods of slow economic growth, while Thailand made significant strides due to the Asian financial crisis. Success on UHC depended heavily on efforts to gain political support from various interest groups while building institutional and technical capacity needed to manage cost pressures and secure long-term gains over time.

Though the principles of universal healthcare coverage (UHC) are widely acknowledged, its implementation remains challenging for low-income countries. Countries must address obstacles to expanding coverage and ensure access to affordable primary healthcare and essential medications including mental health treatments at an affordable cost; as well as reduce inequalities caused by high out-of-pocket spending by poorest people disproportionately affected.

At present, only 72 countries worldwide provide some form of universal healthcare, with many adopting systems that provide free or near-free coverage for citizens and residents. Examples of such countries include Cuba, the UK’s National Health Service as well as Norway and Australia that employ government-funded systems wherein some patients pay directly while others do so indirectly through taxes or social insurance contributions.

Countries studied mostly funded their reforms through general taxes and cross-subsidized their healthcare systems by targeting higher risk groups – with some additional support from donor governments. They implemented policies designed to manage costs, such as conducting cost-effectiveness and impact evaluations for new technologies and pharmaceutical products; setting clear standards to guide benefit package design; and consolidating and streamlining insurance schemes to reduce red tape and promote equity. They also established strong governance arrangements to make accountability a top priority, such as by separating purchaser and provider functions; creating capacities for strategic goal setting and quality assessment; and mitigating interest group pressures. Such arrangements were essential in ensuring long-term sustainability for their policies as well as preventing backsliding on UHC gains.