Global Health: Introduction to Universal Health Care Systems Around the World

Experts agree that access to quality health care is the best way to improve global health. But health-care options vary greatly depending on where you are in the world. Universal health coverage (UHC) is the ability of all people to go to a doctor for preventive care or when they are sick, and then to pay for the care they receive.

Universal Health Coverage: A Global Goal

International organizations such as the United Nations, the World Health Organization, and the World Bank are urging countries to provide UHC by 2030, going so far as to include a specific target to achieve UHC in the UN Sustainable Development Goals. The World Bank tracks countries’ advancement toward UHC with a measurement called the UHC service coverage index.

Data from that index shows that in countries with functioning national health-care systems and higher gross national incomes, which score high on the index, health outcomes are broadly similar, with high life expectancy and low infant mortality rates. In fact, twenty-five years of life expectancy separate citizens of countries at the bottom of the index from those at the top. However, even before the COVID-19 pandemic, the goal to extend UHC to an additional one billion people was not being met.

The Spectrum of Health-Care Delivery

Around the world, health-care systems differ widely. Countries adopt different systems to provide health care to their citizens, with different levels of government and private sector involvement. The spectrum of ways in which health care is delivered around the world can be gathered into four general categories:

1. Universal coverage with single-payer system: Everyone is covered by a national health-care plan that is fully funded by the government. In many countries with socialized health care, such as Cuba and the United Kingdom, the government provides care through publicly run hospitals and clinics.
2. Universal coverage with multi-payer system: A national health insurance system administered by competing insurers usually exists alongside a private insurance option for high-income people. In countries such as France, Germany, and Japan, people are required to have health insurance, which is mostly publicly funded.
3. Multi-payer system with no universal coverage: A mix of health-care programs exists, although health insurance is not required. The government allows private insurance companies more autonomy, which has given rise to advanced medical technology along with high costs and no guarantee of health coverage. The United States has a multi-payer system without universal coverage.
4. No coverage at all: Requires individuals to pay for health care completely out of pocket.

Health Care Spending and Insurance Data

The following data points highlight the differences in health-care financing between specific countries and the global average:

• Global Average Health Spending: 9 percent of gross domestic product (GDP).
• France, Germany, and Japan: These countries spend around 11 percent of their gross domestic product (GDP) on health care.
• Germany Insurance Split: While nearly 90 percent of the population has primary coverage through public health insurance, about 10 percent has private insurance.

Advancing Global Health Education

The Global Health Pathway engages trainees to become equitable, sustainable partners in global health clinical practice, as well as cultivate skills and knowledge relevant to decreasing health inequities and disparities locally and internationally. The course is a mixture of concepts, implementation, and research skill, and will focus on participants developing shared language around global health practice, knowledge in diseases relevant to populations worldwide, and practical skills in global health projects. The pathway highlights didactics and practical training for sustainable global health practice, led by local and international global health experts.