The collision of Universal Health Coverage and COVID-19. Can we repair it?

The aspiration toward Universal Health Coverage (UHC) is more important in the context of the COVID-19 pandemic. All countries signed the targets of the Sustainable Development Goals and the commitments in the UN General Assembly to pursue the goal of UHC, which in practical terms means that people and communities receive the health services they need and have. Essential financial protection. In other words, people can access high-quality preventive and therapeutic health services and safe and effective medicines, including vaccines, without incurring catastrophic expenses.
However, Universal Health Coverage is now more difficult to achieve. Since March 2020, the COVID-19 pandemic has highlighted the vulnerability of health systems. The health crisis has deepened the gaps in public health and the asymmetries in the capacity of services so that patients with COVID-19 or those with other diseases receive accessible, quality medical care and that the population receives the vaccine against COVID-19. 19.

Disruptions of health services and disparities in Latin America
The adverse results are tangible. The reduction of essential services, the fatality figures for COVID-19, excess mortality, and vaccination coverage indicate significant disparities in Latin America. From May to July 2020, the World Health Organization and the Pan American Health Organization (PAHO) surveyed Ministries of Health on perceived interruptions in essential health services. Almost all countries reported disruptions to health services.
The leading causes of the disruptions were demand and supply factors. Redeployment of clinical staff to provide care for COVID-19 cases, redeployment of clinics and hospitals, or ICU services solely for COVID-19 are supply disruptions. In terms of demand, the population stopped attending services due to fear of contagion and community distrust and in part due to social distancing policies.
Reports indicate significant disruption of essential services. A reduction in vaccines for children, pregnant women, and older adults, lower numbers of cervical and breast cancer detections, an increase in patients with uncompensated diabetes and hypertension, and delays in elective surgeries are reported. Mortality is also an important indicator—case fatality from COVID-19 ranges from 9% in Peru to 0.9% in Barbados. By 2020, excess mortality in Ecuador, Mexico and Peru were more significant than 50%. In part, the population’s poor health and socio-economic conditions are factors that influence excess mortality. Finally, the vaccination coverage figures also indicate deep disparities, ranging from 0.5% in Haiti to 85.6% in Chile of people who have received the total number of recommended doses.

The pandemic slowed the reduction in out-of-pocket spending.
Between 2000 and 2018, out-of-pocket spending, as a percentage of health spending in Latin America and the Caribbean (LAC), fell from 38.37% to 30.1%, indicating progress in financial protection policies in health. A good example is Chile since, between 2015 and 2020, its out-of-pocket spending fell from 35.5% to 26.9%. However, the countries of the region need to invest more in health. In LAC, health spending represents an average of 3.3% of the gross domestic product (GDP), still below the OECD countries, which spend 6.6% of GDP.
The pandemic has required significant economic resources for its attention, creating high contrasts in the offer of services. The health crisis encouraged all countries to implement specific measures to financially protect the population and reduce the spread of the disease. COVID-19 tests, outpatient and hospital medical care for cases with this condition, and vaccines are the public sector’s responsibility. They are accessible to the entire population and without the need for co-payments. From this perspective, the CUS is fulfilling its task.
At the same time, the UHC was diminished because the prioritization of spending to attend to the pandemic affected the supply of essential services and made it necessary for people to absorb the expenses to listen to their health. For example, in Mexico, out-of-pocket spending increased by 40% between 2018 and 2020, it increased from 42.7% to almost 60%, due to the reduction in the supply of health services in the public sector. The most detailed analysis indicates that the poorest population was the most affected.

The CUS is vital to building resilient and equitable health systems
The population must have the certainty of exercising their right to health. The need to increase access to essential services that make it possible to overcome health care inequalities and provide financial protection, mainly to the most fragile, is visible.
The need to continue the response to the pandemic, attend to essential services simultaneously, and protect the population financially is clear. For this, from the health system’s perspective, it is necessary to strengthen governance, financing, provision of services, and generation of resources.
From a service provision perspective, it is critical to continue innovating and adapting services to the changing context of the pandemic. The strengthening of coordination strategies between the different levels of health care and the acceleration of the digitization of health services are essential actions.

It is also advisable to consider establishing packages of essential health services as a viable alternative. Knowing the burden of disease in countries is the first step. It is necessary to identify cost-effective interventions, the selection of which is now essential since fiscal space is reduced due to the health crisis. Who must also establish the criteria to decide how to implement the interventions that allow closing the gaps in essential services that have deepened during the pandemic and, on the other hand, not neglecting the response to the health crisis.
Indeed, keeping UHC on the policy agenda is a priority. It is essential to have an effective health system that significantly reduces the transmission of infectious diseases and duly attends to the primary health needs of the population. In simpler words, and answering the initial question, we can affirm that it is possible to repair the collision between Universal Health Coverage and the COVID-19 pandemic.