Brazil

Focus: A community-based approach

In Brazil, a unique community-based program helps provide direct primary health care at the neighborhood level. The Family Health Strategy began in earnest a decade after the country’s national health system launched in 1985 — following Brazil’s transition from military dictatorship to democracy. This approach was developed as a cost-effective way of delivering health care that aims to bridge the gap between primary care and public health efforts.

Community health agents are the heart of the program, conducting monthly visits to each household within their area — regardless of demand. They may follow up on missed doctors’ appointments, check that patients have been taking their medications, and identify potential health risks such as smoking.

The system is, however, not without its limitations, including a lack of public spending to support it.

Colombia

Focus: Provision of care for vulnerable communities

An estimated 350,000 people are residing in Colombia’s border region due to the ongoing crisis in Venezuela. But with little access to health care, aid workers call this a health crisis. Meeting the health needs of vulnerable populations is a priority for Colombia, which is a signatory to the U.N.’s International Covenant on Economic, Social, and Cultural Rights that recognizes good health as a human right.

A 2017 response plan aimed to provide emergency care and health interventions for all undocumented people, and 200,000 Venezuelans reportedly received medical attention in the country in 2018. Earlier this year 600,000 pesos (around $190,000) was allocated for health care in the border zone. But a lack of adequate resources remains an issue.

But sustainable financing remains a concern. Undocumented people remain in health coverage limbo, unable to access health insurance under the subsidized system until their legal situation is defined. In July 2018 the government announced a “speeding up” in the regularization of undocumented people, which could help improve access, but funding remains a key issue.

Thailand

Focus: Incentives

Thailand introduced its Universal Coverage Scheme in 2001, which by 2011 reached 98% of its population and cost just $80 per person annually, primarily funded by general income tax.

These gains happened despite relative political instability — six elections, two coups, and 13 health ministers between 2001 and 2015.

UCS took time to develop. From its initial design in the 1970s, Thailand's primary health care system has evolved significantly to respond to changing health needs and community engagement, and now consists of health centers and district hospitals in all 878 districts across the country.

As well as raising basic salaries the government introduced incentives to attract and retain health workers, including a nonprivate practice incentive introduced in 1995, and a long-term service allowance introduced in 2005 for anyone who had worked for three or more years.

South Korea

Focus: Insurance schemes

Once South Korea introduced its National Health Insurance Service in 1977, it took just 12 years to achieve UHC. This was not without controversy, however, as population coverage — based on assessed incomes — expanded from full employees, to include more disadvantaged populations, and then self-employed people, leading to debates over the organizational structure of the now single insurer NHIS.

With economic growth and urbanization came an increase in health care providers to nonurban areas, helping improve access to care. But reports suggest inequity in access to technologies, due to additional out-of-pocket costs, remains an issue. And while a rapid increase in private-sector providers helped meet demands for health care, it also created financial sustainability challenges.

The country has also regularly convened with others as part of the Joint Learning Network, to address gaps in practical knowledge and offer guidance on setting up medical audits. This consultation process resulted in a comprehensive toolkit for other countries to follow.