Coronavirus disease 2019 (COVID-19) has exposed the gaps and deficiencies in health systems across Asia and the Pacific and underscored the interdependence between health security and economic stability. That, in turn, has highlighted another reality: the importance of universal health coverage (UHC). Achieving UHC means that everybody can access the quality health services they need without suffering financial hardship. Countries that have made good progress towards UHC have been able to better manage the health impacts of the pandemic—and, therefore, the economic impacts.
WHO Member States are making headway towards the goal of achieving UHC. In the Western Pacific Region, the Republic of Korea and Viet Nam are two examples of countries that have made progress and limited the impact of COVID-19.
Republic of Korea
Approximately 97% of the population of the Republic of Korea is insured through the country’s universal single-payer health care system, while the remaining 3% are wholly covered with government subsidies. This coverage resulted from two milestones: the achievement of coverage of the entire population with health insurance in 1989 and then the merging of 370 insurance funds into to a single-payer system in 2000. The Republic of Korea’s health system is mostly financed through the National Health Insurance (NHI) system and generally delivered by private providers. All health providers are mandated to participate in the NHI and to treat patients under the same benefit packages and provider payments set by the NHI law. The total health expenditure is relatively high, at about 7.6% of gross domestic product (GDP) as of 2018. The country’s robust health infrastructure includes a high number of hospital beds per capita – 12.3 beds per 1000 people – along with 254 health-care centres, more than 1300 sub-health centres, more than 1900 primary health care posts and 46 community health promotion centres across the country as of 2018. Significant investments in health data and technology have also been made in the country. These have been used to improve quality, efficiency and effectiveness of service delivery.
The Republic of Korea’s response to COVID-19 owes much to experience gained from the outbreak of severe acute respiratory syndrome (SARS) in 2003, particularly the formation of an agency tasked with preparing for and responding to infectious disease outbreaks, the Korea Centers for Disease Control and Prevention (KCDC). In the early days of COVID-19, the Republic of Korea adopted a widespread testing strategy that included people who did not have symptoms. Strong surveillance and the roll-out of rapid diagnostics was a key pillar of the country’s response and relied largely on the country’s ability to quickly develop and manufacture tests. Shortly after the country’s first case was confirmed, KCDC officials met with more than 20 private sector partners to discuss mass production of COVID-19 testing kits. Within one week, on 4 February, the first company had been authorized to begin producing kits. In early February, testing was expanded with the help of a new, single-step, real-time reverse transcription polymerase chain reaction (RT-PCR) test kit, which gave results in just 6 hours. By 20 February, 12 000 people had been tested in the country; by 8 March, it was 181 000 people. This enabled public health officials to track the spread of the disease and effectively implement control measures.
Viet Nam has invested heavily in its public health-care system and health spending has outpaced the country’s recent booming economic growth. Since 2000, for every 1.0% increase in GDP per capita, public spending on health has increased by 1.7%. This has translated to an almost threefold increase of spending in constant United States dollars, from US$ 46.2 spent on health per capita in 2000 to US$ 129.6 in 2017. A social health insurance scheme was introduced in Viet Nam in 1992, and, between 2000 and 2017, coverage in the scheme increased from 13% to 87% of the population. Viet Nam’s tiered health infrastructure also helps to ensure that local needs are met. Across the country, there are more than 13 000 public facilities, with an additional 35 000 health facilities in the private sector. Viet Nam also performs well in terms of financial protection against catastrophic health spending. In 2016, 9.4% of the population suffered from catastrophic health expenditure, where household expenditures on health were greater than 10% of total household spending. As part of its commitment to achieving UHC and strengthening preventive care, Viet Nam has been building national emergency preparedness and response capacities.
Viet Nam has been hailed for its response to COVID-19, issuing public health warnings based on risk assessment before the first case had appeared in the country, instituting rigorous contact tracing procedures, introducing strict entry and exit requirements, and issuing Prime Minister’s directives on nationwide social distancing. However, the resurgence of cases in July in the coastal city of Da Nang and other cities/provinces underscored the flexibility and responsiveness of Viet Nam’s health system. Rapid response teams and additional health workers were deployed to the cluster’s epicentre, followed by the establishment of a 200-bed field hospital, the conversion of a stadium to a 1000-bed isolation facility and the expansion of testing capacity. While the number of cases increased sharply during the first two weeks of August, the situation now appears largely under control. Viet Nam’s investment in UHC, particularly in preventive measures, have helped to ensure that infrastructure and systems have effectively supported the COVID-19 response.
This article summarizes case studies prepared by the Western Pacific and South-East Asia regional offices of WHO and the ADB in September 2020 in preparation for a Joint Ministers of Finance and Health Symposium on Universal Health Coverage in Asia and the Pacific: COVID-19 and Beyond. ADB published a similar summary.