The impact of universal coverage schemes in the developing world: a review of the existing evidence

Although the concept of universal health coverage (UHC) is not new, over the last few years its importance and visibility have significantly increased. In 2005, the 58th World Health Assembly adopted a resolution encouraging countries to plan the transition to UHC in their health systems. In 2010, the World Health Organization devoted its World Health Report to a discussion of health care financing alternatives for achieving universal coverage. The current movement to promote UHC has been accompanied by other key actors in the field of global health such as the World Bank, the United Nations Children s Fund (UNICEF), the United States Agency for International Development, the Inter-American Development Bank, the Rockefeller Foundation, and the Bill and Melinda Gates Foundation, among others. UHC initiatives have sought to create awareness in and provide guidance to countries on how to improve the design and functioning of their health systems based on evidence of what works for achieving the goal of universal coverage. Meeting this goal is, however, challenging, because the available evidence rarely explores the causal link between the design features of these UHC schemes and the outcomes observed, and substantial heterogeneity exists regarding the robustness of the available evidence. Under these circumstances, providing meaningful guidance is not easy. This report contributes to the debate by systematically reviewing and synthesizing evidence concerning the impact of universal coverage schemes and combining it with a structured assessment of the robustness of such evidence. The review indicates that UHC interventions in low- and middle-income countries improve access to health care. It also shows, though less convincingly, that UHC often has a positive effect on financial protection, and that, in some cases it seems to have a positive impact on health status.