Rethinking Universal Healthcare: A Path Toward Financial Sustainability and Equality

In August 2017, at BRD Medical College in Gorakhpur, India, medical oxygen was fully cut off due to the hospital's inability to pay over 7 million dollars in overdue debts. Throughout the month, over 60 people (mainly infants) died as the hospital staff frantically scrambled to save their patients. This is the sad reality of many developing countries with disorganized healthcare systems.

"Universal healthcare" is defined by a healthcare system where all residents of a country or region have access to quality healthcare services without financial hardship. The BRD Medical College incident shows the necessity of healthcare reform—with an ultimate goal of universal healthcare. Public discussions on universal healthcare have started a longstanding debate concerning the upside of equal access to healthcare, its operational inefficiencies, and its financial implications. Many economists argue universal healthcare could be highly beneficial to developing countries—as long as they implement the right fiscal policies. The glaring failures of healthcare systems in countries like Thailand and India, where underfunded systems and misallocated resources hinder equitable access to care, make evident that reform is urgent.

Laissez-Faire Healthcare Governance

While universal healthcare may appear to be a straightforward solution to the lack of structure, equity, and efficiency in global healthcare systems, many economists argue that laissez-faire healthcare governance is far more practical. Economist, professor, and laissez-faire healthcare governance advocate David Marsland argues that universal healthcare can amplify, rather than mitigate, inequality and biases. Marsland explains that (given diverse citizen populations), a one-size-fits-all approach is not realistic nor beneficial for the average state. For this reason, Marsland states that the laissez-faire approach to healthcare allows a situation where healthcare can be dictated by the populace’s needs, through open market private provision, not the government's. Marsland’s economic view gives a new argument for state-led healthcare systems, pointing to overspending and wasted funds as a detrimental outcome. His views highlight the urgency to find more economically sustainable alternatives to universal healthcare models to guarantee that healthcare will remain accessible while also being fiscally sustainable in the long run.

Developing Nations Failed Attempts to Implement Universal Healthcare Coverage

Expanding on the argument for laissez-faire healthcare governance, Ben Harkins’ study of Thailand’s Universal Coverage Scheme shows how fiscal sustainability is a key issue associated with universal healthcare. In his article "Reevaluating Pro-Poor Health Care: A Model for Monitoring of the Universal Coverage Scheme in Thailand," Harkins highlights how constant reparations of pre-existing health insurance programs and obstacles prevented the transition to a new financing and service delivery model. Though this model was successful when expanding health insurance coverage in the short term, as time passed it proved unsustainable—as the upkeep costs of constant insurance change piled up. Harkins’ research shows that despite having sensitive economies, developing nations overestimate their ability to maintain dynamic social healthcare programs—and thus face the economic consequences on the backend. Harken argues that being proactive and prioritizing financial stability through policymaking promotes longevity and sustainability—a fatal flaw of many developing nations' healthcare systems.

In Xu Tao's study on healthcare expenditure allocation, "The Impact of Fiscal Policies on Healthcare Systems," he argues that the common lack of program sustainability in failing universal healthcare systems stems from a lack of tax revenue. He explains that countries that are not fully developed and use tax revenue to fund their healthcare systems usually have budgeting issues from inconsistent tax revenues—resulting in diminished quality of care and service delivery and ultimate system failure. Ultimately, Tao comes to the conclusion that sustainable funding models should foundationally reduce reliance on unstable tax revenues for better results.

Kishore Rana’s research on public-private partnerships in healthcare, "Economic Impacts of Public-Private Collaboration in Healthcare Systems," proves that hiring help from private corporations can help lower financial issues for governments while still having accessible healthcare for their citizens. The research done by Rana shows that public and private partnerships can improve sustainability by promoting better financial management within healthcare models.

These studies together highlight past government failures to create universal healthcare systems, but propose the potential for reform that could optimize such systems and save lives along the way.

A Better, Hybrid, Future for Universal Healthcare

A hybrid model, using both public and private involvement, sets the stage for more feasible solutions—this could help ensure equality and financial sustainability. For example, in Thailand’s Universal Coverage Scheme, Ben Harkins shows the financial sustainability issues when transitioning to a new healthcare financing model. Private corporations can help lower the fiscal pressure on Thailand's public system by partially privatizing care management to create a plan that is adaptable yet stable—rather than volatile and costly. David Marsland’s argument against state-run systems also aligns with the hybrid approach. Marshland says that higher costs and poor fiscal management are some big issues in government-funded healthcare systems. Involving private corporations could better compartmentalize operations of universal healthcare rather than relying on less specialized government employees. The hybrid system could mitigate inefficiencies while reducing wasted funds. Furthermore, the research from Xu Tao's study on fiscal policies and healthcare expenditure shows how countries relying heavily on tax revenue have budget issues. A hybrid system would reduce the reliance on inconsistent tax revenues by accepting financial support from the private sector and nonprofits. Using both private and public resources, this model can help bring a strong yet fair healthcare system to fix both financial and equality issues.

Ultimately, an ideal yet impractical concept can become realistic and effective through targeted reform. Through necessary policy changes, we can prevent heartbreaking incidents such as the oxygen outage at BRD Medical College and create a healthier and more productive developing world—one where Universal Healthcare works as intended.

Works Cited

Marsland, David. "Health and Healthcare in a Democratic Society." Society, vol. 42, no. 2, 2005, pp. 7–9. DOI: 10.1007/BF02687393.

Harkins, Brian. "Reevaluating Pro-Poor Health Care: A Model for Monitoring of the Universal Coverage Scheme in Thailand." Journal of Alternative Perspectives in the Social Sciences, vol. 2, no. 2, 2010, pp. 819–845.

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Xu, Tao, et al. "The Impact of Fiscal Policies on Healthcare Systems." Health Economics Review, vol. 15, no. 4, 2021, pp. 345–368. DOI: 10.1186/s13561-021-00234-7.

Rana, Keshav, et al. "Economic Impacts of Public-Private Collaboration in Healthcare Systems."

International Journal of Health Policy, vol. 18, no. 3, 2019, pp. 456–479. DOI: 10.1080/13561820.2019.1827345.

Kumar, Rajesh. "Healthcare Financing in Low-Income Nations." Global Health Journal, vol. 10, no. 2, 2020, pp. 201–221. DOI: 10.1016/j.ghj.2020.08.004.

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