Health Financing Systems, Health Equity and Universal Health Coverage in Arab Countries

摘要

This article provides an overview of health financing structures in Arab countries in the context of their preparedness for universal health coverage. Current arrangements have left large swathes of the population shouldering high financial burdens and facing hardships when using healthcare, with significant impoverishing and deterrent effects. Health protection schemes are most comprehensive for those who can afford healthcare; they are mainly based on contributions and formal employment and thus fail to cater for the poor and the rural and informal sectors. Financing systems also lack the operational bases and institutional prerequisites for effective resource pooling and risk sharing, with segmentation and fragmentation worsening horizontal and vertical inequities. The neglect of public health systems has reinforced inequities by widening the gap between needs and provision, and by emphasizing the ability to pay as a basis for accessing quality care. In a context of informality and poverty, focusing reforms on health insurance is not a panacea. Rather, moving towards universal health coverage and reducing health inequities will require changes in the level of political tolerance for social injustice, and a paradigm shift to a more equity-based political economy which views health as an investment and an entitlement.