Why Future Generations Should Enjoy Universal Healthcare Coverage
Economic sustainability has been the main focus of the debate about universal healthcare coverage (UHC) for too long. Social and political sustainability should be considered as well, according to an article by Elio Borgonovi and Amelia Compagni (both in the Department of Policy Analysis and Public Management), which received an Elsevier Atlas Award, an acknowledgement to "research that could significantly impact people's lives around the world or has already done so" (Sustaining Universal Health Coverage: The Interaction of Social, Political, and Economic Sustainability, in Value in Health, Volume 16, Issue 1, Supplement, pp. S34-S38, doi:10.1016/j.jval.2012.10.006). The article has been selected across Elsevier's 1,800 journals by an external advisory board made up of individuals from international organizations and NGOs.
Borgonovi and Compagni suggest that universal healthcare coverage is a fundamental component of health care systems' social and political sustainability and observe that systems that provide UHC are not necessarily more expensive than those that don't: in the US total (public and private) expenditure in healthcare is 17% of the GDP and the system does not provide UHC; in Europe it varies between 9.2% and 12% of GDP and UHC is provided. "In our view, it remains the responsibility of policymakers", the authors write, "to achieve the sustainability of UHC in this broader conceptualization. (...). We propose that health policymakers should devise policies that act on the level of equity, diversity, interconnectedness, democracy, and political alignment within their health care system".
"There has been a real focus on economics in recent decades", Borgonovi commented in an interview published on the Atlas website. "Policy makers assume that getting the finances right means they will automatically reach political consensus and social equality, but we don't agree. The three factors – economic, political and social – are independent but also interconnected, and they all need to be considered".
The task ahead, according to Borgonovi and Compagni, implies the capability of policymakers to mobilize a variety of actors around these concepts, including various parts and tiers of government, the main political forces in a country, health care managers, professionals, technology producers, and citizens.
"Framing UHC as a matter of social and political sustainability of health care systems", the authors conclude, "has the potential to focus the efforts of these actors as if part of an interrelated sociopolitical system, the development and viability of which should be assured to future generations".