Global health. The current scenario and future perspectives

252 systems are considered an intermediate determinant of health (WHO, 2008). This means that while health systems alone cannot explain social inequalities in health, they can modulate differential vulnerability and exposure to factors that can harm people’s health through their actions (WHO, 2008). Challenges for Health Systems before Covid-19 Prior to the outbreak of the Covid-19 pandemic, challenges identified for health systems in transitioning towards universal health coverage were concentrated in three areas: availability of resources, high reliance on out- of-pocket payments at the time of seeking healthcare services, leading to financial burden, and inefficient and inequitable use of resources (WHO, 2010). In fact, in its 2010 report on financing health systems for universal coverage, the WHO states that countries closest to achieving this goal have chosen a path based on risk pooling within the population and adopting prepayment models. When policies enable access to these mechanisms for the population, achieving universal health coverage becomes more realistic (WHO, 2010). Based on reviewing country experiences, WHO itself presents three lessons that should be considered when formulating aforementioned policies: i) in all countries a proportion of the population is too poor to contribute financially through taxes or insurance premiums (e.g., contributions to social security) and require subsidies funded directly by the State or premium subsidies; ii) contributions must be mandatory as otherwise wealthy individuals and healthy people will opt out of the system, which would result in insufficient financial resources to meet the needs of those who are poor or sick; iii) pooled funds protecting healthcare needs for a small group are not viable long-term as they are vulnerable to high-cost disease episodes and segregate populations. Wealthier individuals end up with better benefits from these funds and are not willing to subsidize poorer populations (WHO, 2010). For some regions of the world, these challenges have been more specifically identified. Thus, for the health systems of Asian countries, ensuring coverage for the informal sector population has been posed as a challenge to achieve universal health coverage, to designing benefit plans that can effectively respond to current health challenges while being fiscally sustainable, and to ensuring preparedness of the provider response system, specifically availability and quality of services (Bredenkamp et al., 2015). In China’s health insurance system, limited financial protection, inequities in healthcare delivery, poor portability and ineffective fund supervision and administration have been estimated as challenges (Shan et al., 2017).