From a utilitarian universal health coverage to an inclusive health coverage

Abstract

Healthcare systems vary across countries but the access to health is considered fundamental both individually and collectively. Individually, good health is one of the main contributors to well-being, and collectively it has an important effect on countries’ productivity. From a utilitarian perspective, governmental intervention in health coverage has the purpose to maximise the total ‘utility’, in this case the total welfare, of all the members of society. Health services must therefore be produced and allocated efficiently, and distributed in accordance to equity. This approach gave origin to the so-called ‘universal’ healthcare systems, in trying to provide healthcare for as many members of a community as possible. Such systems can be considered inclusive insofar to try not to leave anyone out of coverage, but their implementation is not free of criticism. One of the limitations is that they tend to provide the same level of coverage for everyone, regardless of their differing characteristics, circumstances, and needs. This also means that some health issues will not be covered by the public health system, and if patients need specialised attention they will need to use private health provision, with the subsequent exclusion of those without enough resources. It is for this reason that healthcare systems are evolving to become ‘inclusive’ in a different manner, away from the ‘one size fits all’ approach covering only basic minimum health services, and aiming to provide different services to people with different needs, including giving access to health to the poorest of society.