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WHAT CAN BE DONE
THE HIGH ROAD: RECLAIMING
THE PUBLIC INTEREST
Governments must take back control of public policy and ensure that the
design, financing and delivery of public services policy are done in the public
interest, so they can meet their inequality-busting potential. There are
countries around the world offering good examples and hope that the high road
is possible. For governments to take this road, mobilized citizens must weigh
in on policy choices that, to date, have been dominated by vested interests.
Universal Health Coverage
The growing momentum around Universal Health Coverage (UHC) – under which
all people should get the healthcare they need without suffering financial
hardship – has the potential to vastly improve access to healthcare and drive
down inequality.
In 2013, Margaret Chan, described UHC as ‘the single most powerful concept
that public health has to offer’. 454 At the World Bank, President Jim Yong Kim has
been unequivocal that UHC is critical to fighting inequality, saying it is ‘central
to reaching the [World Bank] global goals to end extreme poverty by 2030 and
boost shared prosperity.’ 455
Some governments are already taking action. China, Thailand, South Africa
and Mexico are among the emerging economies that are rapidly scaling up
public investment in healthcare. Many low-income countries have introduced
free healthcare policies for some or all of their citizens as a first step towards
UHC, for example by removing fees for maternal and child-health services. The
countries making most progress towards UHC have prioritized public financing
of healthcare from general taxation, rather than relying on insurance premiums
or out-of-pocket payments by individuals. Every step on this road is a step
that can reduce economic inequality significantly, giving everyone access
to healthcare.
Before Thailand’s Universal Coverage Scheme was introduced in 2002 nearly
a third of the population had no health coverage; 456 most of them were
employed informally and were too poor to pay insurance premiums. The Thai
government moved to finance coverage from general tax revenues, and in just
10 years reduced the proportion of the population without health coverage to
less than four percent. 457 This was a progressive reform; in the first year, the
amount of money the poorest were spending each month on healthcare costs
was more than halved. 458 The percentage of households forced into poverty
through excessive health payments dropped from 7.1 percent in 2000 to
2.9 percent in 2009. 459 Infant and maternal mortality rates plummeted.
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