Many countries are now striving to meet the Sustainable Development Goals by establishing a system of Universal Health Coverage (UHC). UHC aims to develop basic, quality, accessible health services, regardless of people’s ability to pay contributions.
This horizontal and vertical approach to extending coverage must build confidence across the population through an ongoing process of social dialogue and concerted strategies involving multiple stakeholders (the State, public social security and social assistance institutions, social partners, civil society, private insurers) in order to be relevant to people of all ages, taking into account the changing health, economic and social context, and to ensure the continuity of entitlements. Indeed, public confidence is vital as it improves acceptance of contribution payments and strengthens support for public health policies.
Coverage must also take into account the increasing environmental constraints and be capable of coping with crises.
Furthermore, due to the major impact of health crises and the complexity of managing them, it is important to establish some form of structured health monitoring system in order to process the messages coming from the different actors. The development of national or international multidisciplinary expertise often leads public authorities to take over from coverage managers and provide immediate responses, sometimes departing from classic procedures (supplying masks, vaccination, adapting benefits and so on).
Health coverage often serves as the gateway to social protection, with health care benefits feeling, in the eyes of the population, more tangible than retirement benefits. As such, signing up sectors of the population (rural workers, self-employed workers, informal workers) that have traditionally been excluded from health coverage is often a good way of helping them ultimately to extend their social protection, thanks to a better understanding of their needs.
In this context, it is necessary to safeguard and ensure the sustainability of coverage by mobilizing regulatory mechanisms that range from a legal and budgetary framework and diversity of funding through to the control of expenditure, good governance and the fight against fraud.
More so than for other risks, where coverage is essentially financial, regulating health coverage must also involve fostering the quality and accessibility of the health care procedures and products provided, ensuring the financial stability of the system in a context of ever-increasing expenses linked to chronic diseases and population ageing, promoting innovation and managing pandemic-related episodes. These multiple objectives go beyond the mere control of health expenditure and create a need for regulatory policies that continually set a balance between health care supply and demand. For this reason, given the specific nature of certain regulatory strategies in the field of health coverage, the need for some targeted new guidelines has become apparent. These will be available to support countries as they move towards providing high-quality care to all of their citizens, without major financial or societal barriers.
This overview of regulation shows the different regulatory roles, stakeholders and functions (Figure 1). The various stakeholders play a critical role in the different processes, notably in consolidating, implementing and assessing collaborative strategies (between health professionals, politicians, target groups and other actors in the field).
Figure 1. Regulatory actors and tools