Moving Universal Health Coverage from Ambition to Practice

December 12, 2019


Moving Universal Health Coverage from Ambition to Practice

December 12, 2019

Elizabeth Sukkar

Senior research manager

Elizabeth is a senior research manager in global health in the policy and insights team at Economist Impact. Prior to this, she was the managing editor and global healthcare editorial lead at Economist Intelligence Unit’s Thought Leadership division. She is the lead on global health projects that help build effective action to develop a sustainable health economy, with patients at the centre. She has led major research projects on universal healthcare, climate change and its impact on lung health, health literacy, digital health, cancer care, self-care, sin taxes, health financing and patient-centred care.  She is also the lead on The Economist Group’s World Cancer Initiative which has led to the development of new thinking in cancer care and is a key moderator at the Economist Impact Events’ such as the World Cancer Series, Future of Healthcare and Sustainability Summit. She is a member of the Royal Pharmaceutical Society, a fellow of the Royal Society for Public Health, and has two degrees: a bachelor of pharmacy degree from Monash University (Australia) and a Master of Science in International Health Policy from the London School of Economics (LSE). She has been a journalist and editor for more than 15 years, covering healthcare policy, R&D and science for medical journals and UK newspapers, including the British Medical Journal and the Guardian. Before joining The Economist Group, she was the deputy news editor at the Royal Pharmaceutical Society, where she ran the news and analysis desk and was often called to comment about healthcare issues on BBC radio. She also managed an international team of journalists when she was the world editor of Informa’s Scrip Intelligence, a global publication on pharmaceutical and healthcare policy, where she won the Informa Journalist of Year award. Before moving into journalism, Elizabeth worked as a pharmacist in community, hospital and health authority settings, and she maintains her pharmacist registration.


This Economist Intelligence Unit study analyses how 10 countries meet the goals of Universal Health Coverage in five key domains, including policy, health system resources, access and outcomes. Countries are allocated Traffic Lights, which we hope will serve as a starting point for further discussion on progress and gaps around UHC. The study was undertaken after an extensive literature review and consultation with an advisory board of experts in this field.

Executive Summary

Universal Health Coverage (UHC) is one of the health targets within the sustainable development goals (SDGs). It means that everyone who needs healthcare services receives ones of sufficient quality without having to experience financial hardship. Reaching this goal is a task both large and urgent: currently more than a half of the world’s population lack access to at least some essential element of healthcare.

Download workbook: A Traffic Light assessment of key middle and low-income countries

The Economist Intelligence Unit prepared a Traffic Light study to assess how far 10 key countries at different levels of economic development have come in the implementation of UHC. The countries are: Brazil, Chile, China, Colombia, India, Indonesia, Mexico, Philippines, Russia and Rwanda.


Brazil has reduced some socio-economic disparities in health, but funding has, in recent years, become a large concern, meaning the system will be underfunded over the longterm. After Russia, Brazil scores the most yellow traffic lights across our five domains. 

Download country profile: Brazil



Chile has among the best results in our study of UHC. It has a comprehensive UHC policy with widespread population coverage. The country has the highest level of government and compulsory spending on health as a percentage of GDP in the study (5%), earning it the only green traffic light in this category. 

Download country profile: Chile



China has made mixed progress in UHC in the last 10 years, especially around primary care. We give China a green traffic light on the growth of its spending to date. Our study finds there has been solid growth in government and compulsory spending on healthcare, a relative increase of 14% in aggregate between 2011 and 2016.

Download country profile: China



Colombia has been moving towards UHC, in steps, for more than 25 years, making healthcare a right in its constitution in 1991. It has had some successes, such as best healthcare outcomes of the countries we look at, but the number of healthcare professionals could improve.

Download country profile: Colombia



India aims to insure about 500m poor Indians, but it still has substantial work to do. Some areas that need addressing include the high levels of out-of-pocket payments and poor capacity for non-communicable disease clinical management in primary care.  

Download country profile: India



Indonesia is still in the early stages of an ambitious effort to roll out UHC which began in 2014. The effort has seen some substantial accomplishments, but its rapid growth has raised questions about its sustainability.

Download country profile: Indonesia



Mexico’s efforts to achieve UHC, in particular through the launch of Seguro Popular in 2004 and its subsequent expansion, provide many examples of good practice for other countries.

Download country profile: Mexico



The state of UHC in the Philippines is expected to change in the coming years because of a major new law, passed in February 2019, which aims to provide population-wide health insurance.

Download country profile: Philippines



Russia is the only country in our UHC study to get yellow traffic lights for all five domains—which indicates that each area is one of moderate concern.

Download country profile: Russia



Rwanda is the only low-income country in this study but does as well as middle-income ones across several areas related to UHC.

Download country profile: Rwanda



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