Opinion: With political will, we can close the health financing gap

This article was first published on Devex on 12 December 2024.

Out-of-pocket payments for health care push hundreds of millions into poverty, making it crucial for global leaders to address the global health financing emergency domestically and internationally to achieve universal health coverage, or UHC.

Today, 2 billion people experience financial hardship due to health expenses, which they have to pay out of their own pockets. In 30 low- and lower-middle-income countries, out-of-pocket expenses remain the primary funding source for health.

Prospects for future improvement are grim. Many LMICs have struggled to return to pre-COVID-19 economic growth and government spending trajectories. In nearly half of 78 LMICs surveyed in a report by the World Bank in 2023, the health share of general government spending in 2022 fell below the pre-COVID-19 levels of 2019. The global health financing gap threatens to worsen this worrying trend of health care impoverishment, impeding progress toward UHC. Yet despite these pressing challenges, some countries are already pursuing strategies to expand health investments, demonstrating that progress is possible.

As the UHC Movement Political Panel, we use today's UHC Day to reflect on the current trajectory toward UHC, which means that everyone everywhere has access to the quality health services they need without facing financial hardship. To reverse current trends, which are taking us further away from the 2030 targets, more attention must be dedicated to sustainable health financing to achieve UHC in every country. This is particularly imperative for the most vulnerable who are already struggling to meet other basic needs such as food, shelter, and education.

2024 was marked by significant UHC-related key announcements, including the World Bank's pledge to expand UHC to 1.5 billion people and Japan's launch of a UHC Knowledge Hub. Looking ahead, the necessary steps to build healthy and resilient societies must be taken now to prepare future generations to cope with growing threats from pandemics, noncommunicable diseases and climate change.

In 2025, we urge decision-makers to take a strategic shift toward better health financing. The UHC Knowledge Hub offers a promising opportunity to bring ministries of health and finance together and move from high-level aspiration to concrete implementation.

This shift is critical as the burden of noncommunicable diseases, or NCDs, continues to grow, causing nearly three-quarters of deaths globally and resulting in catastrophic health expenditure for patients and their households due to the chronic nature of many NCDs and the costs of long-term care.

Investing in health presents enormous potential and represents the best use of countries’ limited budgets. Estimates from 2018 show that extending UHC to 1 billion more people could avert 24.4 million deaths over five years. Beyond improved health outcomes, investment in high-impact interventions in LMICs may have large economic and social returns, estimated at nearly $9 for every $1 invested.

There is also evidence that government health spending boosts consumption. Each year of life expectancy gained across the population is estimated to raise gross domestic product, or GDP, by 4%. Much of these gains could be realized through improved access to primary health care, which could account for approximately 75% of the projected health benefits under the Sustainable Development Goals.

These figures underscore that the journey toward UHC is good for the people and for the economy. The path to sustainable health financing demands decisive action: Governments must establish publicly funded national health insurance schemes that cover health care costs for the entire population. They must reduce or eliminate impoverishing spending where people have to pay out of their own pocket for their health care by minimizing or eliminating user charges for those most in need, including individuals with low incomes or chronic conditions.

Here are six priorities for the global health community to focus on to achieve UHC:

1. Governments must prioritize health in their national budgets. The first critical step is to enshrine a regular budgetary item for financial health protection, which guarantees equitable access to a package of affordable essential health services that everyone can access throughout their lives without financial hardship.
2. Given resource constraints in almost every national economy, prioritization of health in government spending must be accompanied by domestic reforms, including fiscal reforms to boost government revenues, and improving spending efficiency. The latter includes evaluating the effectiveness of subsidies and efforts to reduce corruption.
3. International development partners should work toward greater efficiency in their cooperation with LMICs by supporting national health priorities and strengthening integrated service delivery approaches through equitable, integrated, and resilient health systems instead of disease-focused interventions.
4. This includes the need for international development partners to ensure sufficient funding into major global health organizations such as the World Health Organization and ongoing replenishments to prioritize investment in equitable and resilient health systems, which includes a health financing focus.
5. U.N. member states must seize the opportunity of the U.N. high-level meeting on NCDs in September 2025 to take bold action for preventing catastrophic health expenditures that push individuals and their households into poverty or force them to forgo necessary medical treatment — leading to worse health outcomes and increased long-term costs for governments.
6. Lastly, U.N. member states need to use the Fourth International Conference on Financing for Development in 2025 to discuss ways to alleviate the high debt burden of low- and middle-income countries. Redirecting funds allocated to debt servicing obligations toward affordable health services could bring millions within the safety net of UHC.

The case for investing in UHC is clear. But ensuring the right to health becomes a reality for everyone by 2030 requires the determination of high-level decision-makers to tackle the current health financing crisis.

With political will, we can close the health financing gap and advance toward UHC, which can only be achieved if greater access to health care services is guaranteed through publicly funded financial protection schemes. The path is challenging, but the rewards — a world where everyone everywhere can access and afford the quality health services they need without the risk of being pushed into poverty — are worth every effort.

By The UHC Movement Political Panel