Skip to content

Throughout the Region of the Americas, the development of national health care systems providing universal access to health care services has been a major driving force of health sector reform initiatives, and it is the main objective of proposed changes to the way national health care systems are financed.

Universal access to health care services is the main thrust of proposed health financing initiatives based on developing comprehensive national social health insurance schemes, decentralizing health care systems, or developing unified national (public) health cares systems. However, few such policy reform proposals have explored in depth the fiscal implications of ensuring the feasibility and sustainability of expanding coverage or of achieving universal health care systems.

A necessary but not sufficient condition

In HSS/HS project we promote the need for a fiscal pact, to create the fiscal space for increasing public expenditures to strengthening public health care systems under the primary health care approach. In the region of the Americas no country that may be classified as a universal health care system (Aruba, Canada, Cuba and Netherlands Antilles) were able to achieve a universal coverage with a level of public expenditure of less than 6% of the GDP. Currently, public expenditure in Canada is around 8% of the GDP, and in the other countries is more than 10% of the GDP. In other AMRO countries with quasi universal health insurance systems, covering at least 80% of the population, public expenditure is around 4% to 5% of the GDP. This is a necessary but not a sufficient condition. Efficiency and equity issues of public health care system need to be address, also. 


Technical Cooperation Activities

Health for All. Can it be financed?

Health for All: Can it Be Financed? Fiscal Space and the Financing of Universal Health Care Systems: Issues and Policies. (November 29-30, 2007. Washington, D.C., USA)

The main objectives of the Regional Workshop were to present and discuss the fiscal issues involved in connection with the feasibility and sustainability of financing universal health care systems in countries of the Region of the Americas. Experts on the organization and financing of national health care systems and in the area of public finance and fiscal policies presented and discussed the fiscal implications of building and sustaining national health care systems providing universal access to health care services.


Last Updated on Wednesday, 17 October 2012 13:23

Regional Office for the Americas of the World Health Organization
525 Twenty-third Street, N.W., Washington, D.C. 20037, United States of America
Tel.: +1 (202) 974-3000 Fax: +1 (202) 974-3663

© Pan American Health Organization. All rights reserved.