Universal Health Coverage and Ageing

Universal Health Coverage (UHC) is defined by WHO as ensuring that all people and communities receive the quality services they need, and are protected from health threats, without financial hardship. Population ageing will have an impact on the ambition of universal health coverage, because without considering the health and social care needs of the ever-increasing numbers of older people, UHC will be impossible to achieve.

Equally, Sustainable Development Goal 3 – “ensuring healthy lives and promoting well-being for all at all ages” – cannot be met without transforming health and social systems from a focus only on disease towards the provision of the integrated and person centred care that is known to have the greatest impact on functional ability in older age.

This Transformation requires specific attention to the following:

• organizing services to respond to older people’s diverse levels of physical and mental capacities as well as their needs and preferences;
• extending coverage of services to all older people – at present many older people, particularly those who have been in the informal workforce or who have filled caregiving roles, have very limited access to even basic services;
• ensuring that coverage extends to services that provide interventions that are key for maintaining intrinsic capacity and functional ability of older people (for example person-centred assessment and care plans, restorative surgery, oral supplemental nutrition, multimodal physical exercises and care including assistive products and caregiving);
• developing sustainable financing mechanisms that can protect older people and their families from undue financial burdens and that provide system incentives for the provision of the services older people need.

By adopting affordable, integrated and person-centred service delivery models and comprehensive systems of long-term care, based in the communities where older people live, we can accelerate progress towards UHC and the Sustainable Development Goals.

Increasing age is frequently associated with increased health-care utilization and costs. But when people have to pay fees or co-payments for health care, the amount can be so high in relation to their income particularly due to the occurrence of multiple complex health conditions or the need for long term care later in life, that it results in ‘financial catastrophe’.

Mechanisms to ensure older people can access services without financial burden will be crucial, however national health financing systems must be designed not only to allow older people to access services when they are needed, but also to protect them from financial catastrophe by abolishing out of pocket spending for older populations.

The most common shortcomings of health benefit packages are that they do not include interventions that are key for maintaining intrinsic capacity and functional ability of older people such as restorative surgery (cataract, knee/hip replacement), assistive products, oral supplemental nutrition, multimodal physical exercises and long term care services such as assistive care. The design and financing of universal coverage for health and long-term care must include interventions that have the greatest influence on healthy ageing trajectories and include investments in integrated health and social care for older people. The latest UHC compendium includes the list of interventions, relevant to Healthy Ageing including ICOPE interventions.  

WHO is working to develop a UHC service package for long-term care that will provide countries with a minimal list of long-term care services to be included in age-friendly benefits packages

Most of current social insurance schemes cover employees in the formal sector. Coverage needs to be extended to include retirees, older people who have spent all their lives in the informal sector or who are self-employed, and older women, with government either covering the financial contributions for the more vulnerable older people, or providing direct services to them.

Ensuring universal coverage for health and long-term care for older people is still a distant ambition in many countries and more attention will need to be given to the links between UHC and population ageing if the goals of healthy ageing are to be achieved.