23rd Annual Session of the Seoul Model United Nations ​ Forum: World Health Organization (WHO) ​ Question of: Implementing Universal Health Coverage to improve ​ healthcare standards Student Officer: Alex Taehoon Kim, President ​ ​ Introduction The Earth’s population has skyrocketed in the last century and is envisioned to reach 9.7 billion by 2050.1 This expeditious growth has brought copious important societal and economic problems. However, arguably one of the most crucial and urgent issues to be dealt with in modern times is the provision of healthcare and ensuring the wellbeing for all. Despite impressive technological advancements, mankind has yet to find a means to provide basic medical services to all of its citizens, especially in developing nations. With the rise of Newly Industrialized Countries (NICs) in recent decades, it is tempting for many nations to neglect improvements in healthcare standards in favor of rapid economic development. But one must acknowledge that economic growth takes place via the interdependence with healthcare improvements, not in spite of them.2 The correlation between health improvements and societal improvements is not to be overlooked. An important step to achieving advancements in healthcare services is the implementation of Universal Health Coverage (UHC). Currently, there are 100 million people who are forced into extreme poverty (living on 1.90 USD or less per day) because of catastrophic health expenditure. 12% of the world’s population uses 10% or more of their budget on health services.3 According to an excerpt from the ministerial meeting between the World Bank and WHO in 2013, “only about 35% in public health facilities across the 27 developing countries with data” provided essential medicines.4 The implementation of UHC will enable individuals to 1Roser, Max, et al. “World Population Growth.” Our World in Data, 9 May 2013, ​ ​ ourworldindata.org/world-population-growth; Growing at a Slower Pace, World Population Is Expected to Reach 9.7 Billion in 2050 and Could Peak at Nearly 11 Billion around 2100 | UN DESA Department of Economic and Social Affairs.” United Nations, United Nations, ​ ​ www.un.org/development/desa/en/news/population/world-population-prospects-2019.html. 2Frenk, Julio. Health and the Economy: A Vital Relationship - OECD Observer, May 2004, ​ ​ oecdobserver.org/news/archivestory.php/aid/1241/Health_and_the_economy:_A_vital_relationship_.html. 3 “Universal Health Coverage (UHC).” World Health Organization, World Health Organization, ​ ​ ​ www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc). 4 WHO, and World Bank. “Background Document Towards Universal Health Coverage: Concepts, Lessons and Public Policy Challenges.” WHO/World Bank Ministerial-Level Meeting on Universal Health Coverage 18-19 ​ SEOMUN XXIII Research Report • 1 ​ ​ 23rd Annual Session of the Seoul Model United Nations ​ undergo adequate medical treatment, from crucial primary health services and palliative care to preventative measures and rehabilitation services, without the burden of financial ruin. Essentially, UHC is encapsulated by these three objectives: providing equitable, high quality, and affordable healthcare. It is historically fully rooted in the 1948 WHO constitution, in which health is declared to be a primary right for all, as well as the Alma-Ata declaration in 1978 where the Health for All agenda was established.5 Although providing health services free of cost for all citizens is indeed neither feasible nor sustainable, UHC allows people to receive quality healthcare without significant financial consequences. Many nations, therefore, have started to gradually recognize the importance of UHC, and UHC formally became part of the Sustainable Development Goals (SDG) adopted in 2015. Henceforth, all UN member states have been making efforts to implement UHC by 2030.6 In order to ensure nations are progressing in regards to the implementation, there needs to be a means to calculate or quantify the effectiveness of UHC. Currently, there are three main challenges when tracking UHC in a given country identified by the UN: “sourcing reliable data on a broad set of health service coverage and financial protection indicators,” “disaggregating data to expose coverage inequities,” and “measuring effective coverage, which not only includes whether people receive the services they need but also takes account the quality of services provided and the ultimate effect on health.”7 To mitigate these problems, household surveys and health facility data are in widespread use to accurately represent various groups with different socioeconomic levels, sex, and other factors. It is crucial to monitor both financial protection coverage and health services; this is because many nations with subpar medical services score higher on financial protection, as many of their citizens choose to forgo basic or essential health services.8 In order to track health services, the UN and WHO mainly focuses on reports on “reproductive and newborn health (family planning, antenatal care, skilled birth attendance),” “child immunization (three doses of diphtheria, tetanus and pertussis-containing vaccine), “infectious disease treatment,” and “non-health sector determinants of health.” To monitor financial protection, the UN focuses on reports on instances of Out-Of-Pocket payment, or February 2013, WHO Headquarters, Geneva, Switzerland , WHO/World Bank, 18 Feb. 2013, ​ www.who.int/mediacentre/events/meetings/2013/uhc_who_worldbank_feb2013_background_document.pdf. 5 “What Is Universal Coverage?” World Health Organization, World Health Organization, 9 July 2019, ​ ​ www.who.int/health_financing/universal_coverage_definition/en/#:~:text=UHC%20is%20firmly%20based%20on,p rotection%20for%20the%20world's%20poorest. 6 United Nations. “Political Declaration of the High-Level Meeting on Universal Health Coverage.” ​ INAL-Draft-UHC-Political-Declaration.pdf, 23 Sept. 2019, ​ www.un.org/pga/73/wp-content/uploads/sites/53/2019/07/FINAL-draft-UHC-Political-Declaration.pdf. 7 Boerma, Ties, et al. “TRACKING UNIVERSAL HEALTH COVERAGE.” TRACKING UNIVERSAL HEALTH ​ ​ COVERAGE FIRST GLOBAL MONITORING REPORT, WHO, World Bank, Rockefeller Foundation, and the ​ Ministry of Health, Japan., Apr. 2015. 8 Boerma, Ties, et al. SEOMUN XXIII Research Report • 2 ​ ​ 23rd Annual Session of the Seoul Model United Nations ​ catastrophic health expenditure (defined as spending 25% or more of the household budget on healthcare services).9 Despite clear guidelines outlined by the UN, many nations find it difficult to make progress in implementing UHC. This is most prevalent in Less Economically Developed Countries (LEDCs) due to rurality, poverty, or war. Although the global economic trends indicate that by 2030 demands for health workers will increase by 40 million, most of the demands will be created in wealthier, More Economically Developed Countries (MEDCs). Currently, there need to be 18 million more health service workers in LEDCs to achieve UHC in those areas.10 Urgent action must be taken or this problem will be exasperated. Another major challenge when implementing UHC is the accrescent price of various drugs and medicines. This is a serious problem and cannot be attributed to the advent of newer, better drugs; even older brand-name oral and injectable drugs that have been out in the market for over a decade increases in price 9% and 15% respectively, annually.11 These results exemplify that inflation of branded medication prices can be traced back to manufacturers artificially increasing prices of drugs that are already available. While this does hinder the implementation of UHC, the challenge is determining the appropriate monetary value that pharmaceutical companies deserve–especially when the said companies prioritize returning their profit to various shareholders over developing innovative medicines.12 The lack of transparency displayed by the companies regarding how they derive at their price and profit margin, as well as the lacklustre “information on the patent status of essential medicines,” further complicates the countries’ assessment on their progress of the implementation of UHC.13 The implementation itself is not a simple task. Governments need to carefully self-evaluate their respective countries’ societal and economic position as well as consider their citizen demographics before determining their appropriate healthcare system. Various countries have taken different approaches to address this issue. Countries, such as the Netherlands, Japan, and Germany, have implemented a health insurance mandate system where citizens are required 9 Boerma, Ties, et al. 10 Kieny, Marie-Paule. “Universal Health Coverage: Unique Challenges, Bold Solutions.” World Health ​ ​ Organization, World Health Organization, 3 Aug. 2016, ​ www.who.int/mediacentre/commentaries/2016/universal-health-coverage-challenges-solutions/en/. 11 University of Pittsburgh. "Rising drug prices linked to older products -- not just newer, better medications." ScienceDaily. ScienceDaily, 7 January 2019. <www.sciencedaily.com/releases/2019/01/190107161655.htm>. 12 K​ ieny, Marie-Paule. 13 K​ ieny, Marie-Paule. SEOMUN XXIII Research Report • 3 ​ ​ 23rd Annual Session of the Seoul Model United Nations ​ to be insured for hospital and outpatient medical treatment by law.14 15 16 The amount each person pays depends on their wealth. This system, known as the Bismarck model, eradicates unfairness and ensures UHC to all citizens.17 However, it should be noted