**3. Universal health coverage**

The 2030 Agenda for Sustainable Development was endorsed by the UN General Assembly in 2015 [26]. The 2030 Agenda emphasizes the significance of strengthening comprehensive and coherent methods to ensure that "no one is left behind" in obtaining universal health coverage (UHC). The agenda includes 17 sustainable development goals (SDGs) that must be accomplished [26].

### *Toward Universal Health Coverage: The Role of Health Insurance System DOI: http://dx.doi.org/10.5772/intechopen.106431*

Universal health coverage (UHC) articulates that everyone should have access to high-quality medical care that meets their requirements without experiencing economic difficulties. It asserts that a wide range of essential services is provided to the public in a way that is well connected with other social goals [17, 27].

Universal health coverage (UHC) as devoted to by the United Nations affiliate in the SDGs, can contribute to health equity if it is appropriately premeditated and realized [28, 29]. To achieve the overarching goal of good health and wellbeing for all people as well as other important healthcare targets in the SDGs, such as mortality reduction and the prevention of premature mortality from noncommunicable diseases. It is imperative that the two unmistakable goals of UHC; achieving equitable access to high-quality essential healthcare services and ensuring social financial risk protection be met [12].

WHO Report of 2019 called for all health systems to move toward universal coverage, defined as "access to adequate healthcare for all at an affordable price" [28]. Everyone wants access to high-quality, reasonable healthcare. The goal of UHC is to ensure that everyone has access to the medical services they require without facing financial hardship. Universal health coverage (UHC) seeks to improve health and community development, prevent disease from pushing people below the poverty line, and provide people the chance to live longer, healthier lives [15, 29, 30].


The objectives of UHC are to make sure that everyone has access to high-quality healthcare, to protect everyone from risks to the public's health, and to prevent

#### **Table 2.**

*Summary of universal health coverage.*

#### **Figure 1.**

*Relationship among health system functions, healthcare financing policy, and universal health coverage as health system goal. Source: Kutzin, Joseph. Health financing for universal coverage and health system performance: concepts and implications for policy. Bulletin of the World Health Organization 2013;91:602-611.*

everyone from falling into poverty because of illness, whether from out-of-pocket medical expenses or from lost income when a family member becomes ill. To reduce extreme poverty by 2030 and increase shared prosperity in lower- and mediumincome countries (LMICs), where the majority of the world's poor reside, it will be crucial to provide universal access with quality and without financial obstacles (**Table 2**) [16, 31, 32].

Universal health coverage ranges of comprehensive services, including prevention, promotion, treatment, rehabilitation, and palliative care would progressively expand to reduce the unmet health needs, as no or few countries can afford to instantly finance a full set of services to all people [11, 12, 33]. UHC encompasses different health system components, including service delivery, financing policy, information system, infrastructure, health workforce, drug supply management, and governance (**Figure 1**) [11].

### *Toward Universal Health Coverage: The Role of Health Insurance System DOI: http://dx.doi.org/10.5772/intechopen.106431*

The road to UHC is not easy; each nation already has some systems in place, and in order to progress to UHC, each nation must strengthen those systems [11, 33]. Nevertheless, each nation must make progress in at least three different areas in order to meet the UHC objective: the first is the percentage of persons covered by pooled funds, the second is the range of accessible, and the third is cost-sharing from aggregated funds (**Figure 2**) [33].

Government ought to make important policy decisions as they proceed along these dimensions in order to improve effectiveness, be fair, and address other issues [10]. These decisions entail balancing how much of the population is addressed, the scope and types of care provided, and the cost covered by the aggregated money to achieve complete coverage in each dimension. Coverage along all three dimensions is achieved through risk pooling, health insurance, and/or government-financed provision of services (the blue cube within the UHC cube) [9].

Access to healthcare is used to measure whether people are receiving the services they need or not. It includes the physical availability and accessibility, economic affordability, and psycho-social acceptability of health services by the people. Accessible services also increase responsiveness, decrease health inequality, and improve health outcomes [31, 34]. According to WHO, about one-third of the world's population is without the access to medicines they need, mostly in Asia and Africa [4, 35].

**Figure 2.** *Three dimensions to consider when moving toward universal coverage. Source: WHO (2010).*

Globally, millions of people suffer and die due to lack of money to pay for healthcare while others suffer by paying more catastrophic payments. Accordingly, World Health Organization (WHO) recommends moving away from direct, out-of-pocket payments to using prepaid mechanisms to raise funds for health [12]. Every year, 100 million people are pushed into poverty because they have had to pay directly for their healthcare [19, 36, 37].

Today, a key element of national health strategy in numerous middle-income countries is achieving financial protection from risks related to family OOP expenditures on healthcare [38]. Financial risk protection represents the trade-off between funding essential requirements like schooling, nourishment, and housing on the one hand and paying for necessary health services on the other [4, 15]. A key goal of health insurance during era of universal health coverage is to reduce financial risks caused by high out-of-pocket health spending as the result of households' catastrophic healthcare payments that consume a large portion of their overall budget, eventually pushing them into poverty where they must take out loans or sell assets to pay for healthcare [4, 7, 37].
