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Reimagining Health Financing for Universal Health Assurance

By Somrwita Mondal
Published Apr 6, 2026

Universal health assurance (UHA) is a more ambitious framework than traditional universal health coverage (UHC). It suggests access to essential services without financial hardship. Also, guarantees that people can count on their health system through shocks, crises and over the course of their lives. The SDG-3 goals emphasise leaving no one behind; pushing countries to rethink how they finance health systems and not just how much they spend, but how these resources are utilised.

A good place to start is to shift from scheme‑based coverage to population‑wide assurance backed by public financing. Many countries continue to rely on a mix of contributory insurance for formal workers, targeted schemes for the poor, leaving heavy out‑of‑pocket spending for the rest. This kind of system falls short of SDG-3’s emphasis on universalism and equity. Reimagining health financing means accepting that a large share of the population, such as informal workers and unpaid caregivers, cannot be reached through payroll contributions alone. Tax‑funded budget transfers and broad risk pools must become the backbone, with contributory arrangements playing a complementary role.

Secondly, the focus should move from merely asking ‘more money for health’ to ‘better use of money for healthcare and beyond.’ Here, ‘beyond’ refers to investments that lie outside the health sector but strongly influence whether people fall sick in the first place or recover when they do. Securing adequate fiscal space is critical, especially in low‑ and middle‑income countries grappling with concurrent pressures from debt, climate shocks and demographic change. But UHA asks a key question: Is each unit of public money buying what matters the most for population health? This means, (1) Prioritise spending on primary healthcare, prevention and community services (2) Align health budgets with social determinants like, nutrition; water and sanitation; and climate resilience etc. Because the SDGs are interdependent and health outcomes are shaped by investments across sectors.

At the same time, health financing must place equity at its core. Traditional benefit designs often entrench inequities by offering generous packages for those already well served. Meanwhile, rural populations and marginalised groups are left with fewer benefits and weaker provider networks. UHA prioritises expanding financial protection and service coverage for those at highest health risk and impoverishment; while also designing benefits, co-payment policies and provider payments to decrease the gaps. This requires robust data disaggregated by income, gender, geography and other markers of exclusion.

Health financing must be shock‑responsive and politically durable. The COVID‑19 pandemic showed how quickly services can be disrupted and how households are pushed into poverty when financing arrangements are rigid, under‑resourced or heavily dependent on out‑of‑pocket expenditure. UHA therefore implies contingency financing, flexible purchasing arrangements that can be rapidly redirected. Strong governance is equally essential to protect health budgets during downturns.

UHA represents a reorientation of health financing towards guarantees of access, of protection and of fairness. The real test for countries is whether their financing choices make these guarantees more credible in the future.

FAQs

1. What is Universal Health Assurance?

Universal Health Assurance (UHA) is a health system approach. It goes beyond simply providing health “coverage.” UHA ensures that every individual has a guaranteed right to comprehensive, equitable and quality healthcare, primarily delivered through a strong public system. UHA also addresses ‘health beyond healthcare’ by aligning policies and programmes in other sectors to the goals of population health.

2. How is UHA different from UHC?

Traditional Universal Health Coverage (UHC) focuses on who is covered under schemes or insurance. UHA emphasises on assurance, meaning people can actually access the care they need without barriers and receive the promised services. It shifts the focus from healthcare as a service people “receive” to a right they are entitled to, especially for marginalised populations. This approach addresses key gaps in existing systems, such as high out-of-pocket costs, exclusion of the “missing middle,” limited access to quality care, ‘foregone care’ due to access or affordability barriers, while projecting healthcare not as a commodity for purchase but as a fundamental right.

3. Why is equity important in health financing?

Equity is important in health financing because not everyone starts from the same place. People differ in education, income, location, gender and access to services, so a “one-size-fits-all” approach often ends up benefiting those who are already better off. Without an equity focus, health systems can unintentionally widen gaps. An equitable approach ensures that resources are preferentially directed towards those who need them the most, such as low-income households, rural communities and high-risk groups.

4. Why is public financing important for UHA?

Public financing is the most reliable way to ensure that everyone can access essential health services without causing financial hardship. It gives the government a stronger base to cover informal workers, unpaid caregivers and other groups that are often missed. It creates the largest ‘risk pool’ wherein the principle of cross-subsidisation operates without exclusionary filters which operate in a ‘purchased insurance’ system. In short, public financing is essential because UHA is not just about enrolling people in a scheme; it is about guaranteeing access, protection and fairness for the whole population.

Sources:

For details of these arguments and how UHA can be achieved, please Visit Road to Viksit Bharat: From Achieving Universal Health Coverage to Attaining Universal Health Assurance – ISPP | India’s Leading Public Policy Institution

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