Universal Health Care
Implementing an essential set of cancer services as part of universal health coverage could save more than 7 million lives by 2030.
Universal health coverage (UHC) ensures all individuals have access to the high-quality health services they need without experiencing financial hardship. However, UHC access remains unequal worldwide, and in 2021, about 4.5 billion people lacked full coverage for essential health services (Map 46.1).
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Coverage of essential health services (defined as the average coverage of essential services based on indicators that include reproductive, maternal, newborn and child health, infectious diseases, non-communicable diseases and service capacity and access, among the general and the most disadvantaged population).
Currently, only 28% of countries surveyed by the World Health Organization (WHO) include priority cancer services, inclusive of prevention, screening, treatment, and palliative care services in their national health benefits plans with varying degree across regions (Figure 46.1).
Only 13% of low-income countries surveyed by WHO include essential cancer services in their national health benefit plans, compared to 70% of high-income countries.
Proportion of cancer and palliative services in countries’ public-sector health benefit plans, by World Bank income group, 2021
Several countries have implemented successful programs to expand UHC, resulting in improved survival and other positive cancer outcomes. In 2002, Thailand implemented a UHC program with nearly the entire population entitled to essential cancer services from preventative to curative and palliative care. The program has improved access to early detection and treatment, leading to increases in five-year net survival for female breast (from 61% to 75%), cervix uteri (55% to 60%), and colorectal cancer (40% to 48%) from 1997 to 2012 (Figure 46.2).
Improvements in 5-year net survival of multiple cancers after universal health coverage implementation in 2022 in Thailand
FEMALE BREAST
CERVIX UTERI
COLORECTUM
“Health is a human right, not a privilege to be purchased.”
All countries, including high-income countries, must invest in all dimensions of UHC to adapt new services, ensure access for vulnerable populations, and curb out-of-pocket costs. In the United States, the Affordable Care Act was implemented in 2010 and expanded health care coverage for low-income people under 65, barred coverage denial due to preexisting conditions, and eliminated lifetime and annual limits on essential health benefits. Since then, the percentage of uninsured Americans has halved, and early cancer diagnoses and cancer survival have improved.
To increase global health care coverage, all governments have made commitments to UHC attainment through the 2030 Agenda for Sustainable Development. Treating cancer through a UHC system is not expensive and saves lives. The 2020 WHO Report on Cancer calculated that implementing a basic package of priority cancer services as a part of UHC could save more than 7 million lives by 2030. Progress toward UHC has been made, with low- and lower-middle income countries experiencing the largest gains in coverage for infectious diseases, leaving opportunity for improvement in noncommunicable diseases.