Health financing policies during the COVID-19 pandemic and implications for universal health care: a case study of 15 countries
Issued Date
2023-12-01
Resource Type
eISSN
2214109X
Scopus ID
2-s2.0-85176457535
Journal Title
The Lancet Global Health
Volume
11
Issue
12
Start Page
e1964
End Page
e1977
Rights Holder(s)
SCOPUS
Bibliographic Citation
The Lancet Global Health Vol.11 No.12 (2023) , e1964-e1977
Suggested Citation
De Foo C., Verma M., Tan S.Y., Hamer J., van der Mark N., Pholpark A., Hanvoravongchai P., Cheh P.L.J., Marthias T., Mahendradhata Y., Putri L.P., Hafidz F., Giang K.B., Khuc T.H.H., Van Minh H., Wu S., Caamal-Olvera C.G., Orive G., Wang H., Nachuk S., Lim J., de Oliveira Cruz V., Yates R., Legido-Quigley H. Health financing policies during the COVID-19 pandemic and implications for universal health care: a case study of 15 countries. The Lancet Global Health Vol.11 No.12 (2023) , e1964-e1977. e1977. doi:10.1016/S2214-109X(23)00448-5 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/91187
Title
Health financing policies during the COVID-19 pandemic and implications for universal health care: a case study of 15 countries
Author's Affiliation
The George Institute, UK
Duke-NUS Medical School
Hanoi School of Public Health
Hanoi Medical University
Universitas Gadjah Mada
National Health Foundation, Thailand
Universidad del Pais Vasco
University of Melbourne
Universidad Autónoma de Nuevo León
Bill & Melinda Gates Foundation
Chatham House
National University of Singapore
University of Toronto
Mahidol University
Faculty of Medicine, Chulalongkorn University
WHO
Duke-NUS Medical School
Hanoi School of Public Health
Hanoi Medical University
Universitas Gadjah Mada
National Health Foundation, Thailand
Universidad del Pais Vasco
University of Melbourne
Universidad Autónoma de Nuevo León
Bill & Melinda Gates Foundation
Chatham House
National University of Singapore
University of Toronto
Mahidol University
Faculty of Medicine, Chulalongkorn University
WHO
Other Contributor(s)
Abstract
Background: The COVID-19 pandemic was a health emergency requiring rapid fiscal resource mobilisation to support national responses. The use of effective health financing mechanisms and policies, or lack thereof, affected the impact of the pandemic on the population, particularly vulnerable groups and individuals. We provide an overview and illustrative examples of health financing policies adopted in 15 countries during the pandemic, develop a framework for resilient health financing, and use this pandemic to argue a case to move towards universal health coverage (UHC). Methods: In this case study, we examined the national health financing policy responses of 15 countries, which were purposefully selected countries to represent all WHO regions and have a range of income levels, UHC index scores, and health system typologies. We did a systematic literature review of peer-reviewed articles, policy documents, technical reports, and publicly available data on policy measures undertaken in response to the pandemic and complemented the data obtained with 61 in-depth interviews with health systems and health financing experts. We did a thematic analysis of our data and organised key themes into a conceptual framework for resilient health financing. Findings: Resilient health financing for health emergencies is characterised by two main phases: (1) absorb and recover, where health systems are required to absorb the initial and subsequent shocks brought about by the pandemic and restabilise from them; and (2) sustain, where health systems need to expand and maintain fiscal space for health to move towards UHC while building on resilient health financing structures that can better prepare health systems for future health emergencies. We observed that five key financing policies were implemented across the countries—namely, use of extra-budgetary funds for a swift initial response, repurposing of existing funds, efficient fund disbursement mechanisms to ensure rapid channelisation to the intended personnel and general population, mobilisation of the private sector to mitigate the gaps in public settings, and expansion of service coverage to enhance the protection of vulnerable groups. Accountability and monitoring are needed at every stage to ensure efficient and accountable movement and use of funds, which can be achieved through strong governance and coordination, information technology, and community engagement. Interpretation: Our findings suggest that health systems need to leverage the COVID-19 pandemic as a window of opportunity to make health financing policies robust and need to politically commit to public financing mechanisms that work to prepare for future emergencies and as a lever for UHC. Funding: Bill & Melinda Gates Foundation.