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[GEEF 2018 Plenary Session] For Universal Health Coverage: Increasing Accessibility for All
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Universal Health Coverage (UHC) aims to ensure everyone the essential access to quality healthcare without having to suffer financial difficulties. However, rising cost of healthcare is pushing more people to poverty and poses a serious challenge for governments trying to implement UHC. By addressing key policy issues, fair pharmaceutical pricing, and integration of technology, infrastructure, and medicine, six panelists discussed different ways to achieve UHC while maintaining financial sustainability.


  • James Chau, WHO Goodwill Ambassador for Sustainable Development Goals and Health (Moderator)
  • Kim Tae Hyun, Associate Professor at Yonsei University Graduate School of Public Health
  • Sheikh Mohammed bin Abdullah Al Khalifa, President of Bahrain Supreme Council of Health
  • Kim Kang-lip, Deputy Minister at Korean Ministry of Health and Welfare
  • Susan Myers, Senior Vice President of UN Foundation
  • John Ryu, Commissioner at Health Insurance Review and Assessment Service (HIRA)

Session Summary

- Kim Tae Hyun, Associate Professor at Yonsei University Graduate School of Public Health

Many prescription drug prices have gone up tremendously in the past 10 years. The high price of drugs is a major obstacle in achieving UHC, leading to lower quality of life. Many efforts should be undertaken to ensure the transparency and sustainability of the drug pricing, such as enhanced oversight, promoting market competition, and developing an information system to monitor and review cost and quality of drugs. More importantly, we need actions such as governance, engagement of all stakeholders at all levels, and involvement of international organizations.

- Sheikh Mohammed bin Abdullah Al Khalifa, President of  Bahrain Supreme Council of Health

Bahrain currently provides free healthcare to all registered at its National Health Services, fully covering their primary health care. What the Bahrain government is now trying to achieve is universal health coverage that is more effective. To explore ideas, we have observed several countries’ systems. I would like to share our findings and how we are using them to improve our healthcare policy.

 We have come to the conclusion that it is essential to provide a network for medical records, and at the same time, ensure accessibility, quality and equity for all. In order to do that, we plan to facilitate the formation of the National Electronic Health Record. This means health records of all people in Bahrain will be in the database, and every doctor in Bahrain will have access to that record. We are also looking at the National Health Insurance Information System, which will allow us to control financing by tracking all the claims from providers to buyers, and from hospitals to insurance companies. The system will also give us information on all the money crossing among the stakeholders.

To ensure financing, quality and safety, multiple departments in Bahrain are working together to create the Drug Utilization Review System, which traces and manages the distribution of medicines. To keep the healthcare cost under control, we also foster public-private partnership and regional cooperation. For example, gulf countries purchase drugs collectively as a whole so we can buy them cheaper. To promote competition, family physicians in Bahrain are paid by the number of patients registered with them. This forces doctors to provide good service to increase registration.

- Kim Kang-lip, Deputy Minister at  Korean Ministry of Health and Welfare

Korea took 12 years to achieve UHC for its 50 million people, the shortest period in the world. Today, we spend 7% of the total GDP on healthcare expenditure. OECD countries usually contribute nine percent, but health indicators show that Korea’s health is better than the average OECD country. In operating the Korean National Health Insurance System (NHIS), a key factor is how we can maintain financial sustainability.

A major financial burden comes from pharmaceutical expenditure and rising drug prices. But high prices of drugs do not always coincide with improvement in benefits. In Korea, we spent about 25% of our health expenditure on drugs in 2016.

The real-world evidence from NHIS’s big-data analysis can work as a global reference to review the process of pharmaceutical pricing. With massive patient information accumulated through the Korean UHC system and help from researchers, academia and the Health Insurance Review and Assessment Service (HIRA), numerous case studies are being done to assess the next generation drugs and revisethe benefit guidelines. The results allow us to create a research network that can be shared with the government, the pharmaceutical industry, doctors and patients. Thanks to the data, the government can carry out more cost-effective management, doctors have a tool to make a more reasonable decision when treating patients, pharmaceutical companies can reduce R&D costs and development period, and patients have better understanding of drug prices.

This model and other elements of the Korean UHC system can be shared on a global level and provide a reliable index to determine the efficiency of drugs. And with that, the world can have a more powerful tool to determine the pricing of the future drugs.

- Susan Myers, Senior Vice President of UN Foundation

UHC is inextricably linked to the achievement of the SDGs and its commitment to ‘leave no one behind.’ According to the medical journal Lancet, 800 million people spend at least 10% of their household income on health expenses. And for 100 million of those, this expense is enough to push them into poverty. Therefore, achieving UHC has benefits far beyond health outcomes, including the potential to prevent individuals from falling into poverty and reduce extreme poverty.

The good news on UHC is that there is a lot of global attention to and more momentum around the issue. For example, World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus called UHC his top priority, integrating it into the WHO’s Programme of Work through 2023. The UHC 2030, launched in 2016, has so far brought together 66 countries and a host of organizations to strengthen health systems and promote progress for healthcare for all. During a forum by the UHC 2030 last year in Tokyo, a number of high-level individuals came together and Japan pledged $2.9 billion to support healthcare in countries implementing UHC. The UN is also planning to host a high-level meeting on UHC in New York in September 2019. It will happen at the same time that world leaders come to the city for the Review Conference on the SDGs.

These meetings can be important drivers for progress to bring forward new commitments and new forms of leadership. Some of them can be opportunities for you to get involved and speak out on UHC and urge your government leaders to put effort and resources behind UHC. We already know drug pricing and the pharmaceutical industry have a big impact on UHC. That underlines the importance of the partnerships. The governments must create the right kinds of environment in their countries where more private sector activities and investments can be unlocked.

- John Ryu, Commissioner at Health Insurance Review and Assessment Service (HIRA)

Where UHC concerns the SDGs, what’s important is that everyone in the world receives quality care without a financial burden, no matter where they live. After working with 35 countries, I learned that we all face the same challenges: increasing elder population, catastrophic expenditure on non-communicable diseases (NCDs), price hike of new drugs, and ever-increasing healthcare cost.

No single solution can solve these problems. However, there is certainly a very important piece that a country must have: an evidence-based measurable system which will enhance the quality of service and change the behavior of providers. That’s where Korea’s Health Insurance Review and Assessment Service (HIRA) can help. HIRA has developed an ICT system to review and assess healthcare costs and healthcare service quality, and see how effectively and efficiently the resources can be used. Since the achievement of UHC in Korea in 1989, the annual increase in healthcare expenditure was 20.6% until the year 2000. But after HIRA was established in 2001, the rate dropped to 8.8%.

A recent phenomenon in Korea is that many Koreans living overseas come back to get medical treatment because it is good quality, extremely affordable, and you also get excellent aftercare. For the first time in the world, HIRA is working with the Kingdom of Bahrain to build its national health insurance system. Therefore, I believe the knowledge and technology that we have built in Korea can be shared and transferred to other countries and help the world make positive health indicators without a major expense.

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