Achieving universal health coverage (UHC) is a central social aspiration of most developing countries, but one that poses multiple policy challenges. This research reviews reforms in four developing countries over the past 15 years: Colombia, Ghana, Vietnam, and the Philippines. The countries were selected to illustrate different circumstances, policy approaches, and results in different regions of the world and for countries with different income levels. The research examines the changes that took place in the four countries in absolute and relative spending levels for public, private, and total health spending, along with changes in health insurance coverage. In particular, it explores the hypotheses that effective coverage expansion requires additional public financing and reduces out-of-pocket spending. The research also analyzes the link that may exist between the countries’ economic cycles, health spending, and health insurance coverage. Finally, it looks at consequences of expanding coverage for equity.
All four countries have aimed to achieve UHC through social insurance mechanisms. Colombia’s reform started in 1993 and has been able to achieve near universal coverage while reducing out-of-pocket spending and controlling total health costs. Ghana’s reforms are more recent, starting in 2005, yet it has managed to achieve significant gains in health coverage and has also reduced dependence on out-of-pocket spending. Vietnam’s social insurance reforms started in the 1990s. It has increased coverage while modestly reducing reliance on out-of-pocket spending during a period when total health expenditures tripled. Reforms in the Philippines since 1995 show slow progress in expanding coverage, rising expenditures and a growing reliance on out-of-pocket expenditures.
