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Figure 1.15
How health financing leads to UHC

Health financing within UHC intermediate Final coverage
the overall health system objectives goals

Creating
resources
Equity in Utilisation
resource relative
to need
distribution
Stewardship / Governance / Oversight Pooling Benefits Efficiency protection &
Revenue
raising
Financial

equity in
finance

Purchasing
Transparency &
accountability Quality

Service
delivery

Note: Adopted from the Developing a National Health Financing Strategy: a Reference Guide
Source: WHO, 2017a

Health financing policies that are prudently designed and implemented can improve the
quality, equity of access, and affordability of healthcare services, which are essential
concepts of UHC. In fact, studies from developed economies and health systems have
provided early evidence that health financing policy changes can improve
quality of care (Hofmarcher et al., 2007). Initial research and health financing policy
implementation shifts in high-income OECD countries, such as the Netherlands, the United
States, the UK, and Germany, have shown potential in care coordination and improvements
in cost-efficiency (de Bakker et al., 2012; Hofmarcher et al., 2007). In particular, health
systems that are considered “pro-poor” place the financial burden of payment on
governments rather than individuals, with greater access to funding and regulation on
payment for services to minimise impact on patients; such systems are deemed more
equitable by the WHO and are more likely to achieve UHC (WHO, 2007).

Recalling Box 1.3 on the coverage mechanism, the WHO advocates that a health financing
system should move health systems in progressing towards UHC through three primary
means: increasing population coverage, increasing service coverage, and increasing financial
protection coverage (WHO, 2010c). Closely corresponding to these three means, the final
coverage goals to be enabled by health financing policies are healthcare utilisation relative to
need, financial protection and equity in finance, and quality of healthcare (Figure 1.15) (WHO,
2010c). To achieve these goals, governments need to consider how financing policies are
designed in the three key components of health financing:

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