| Title | Towards resilient and sustainable universal healthcare coverage |
|---|---|
| Contributor | Alistair McGuire (author) |
| Ranjeeta Thomas (author) | |
| Joan Costa-i-Font (author) | |
| DOI | https://doi.org/10.31389/lsepress.tlc.m |
| Landing page | https://doi.org/10.31389/lsepress.tlc.m |
| License | https://creativecommons.org/licenses/by-nc/4.0/ |
| Publisher | LSE Press |
| Published on | 2025-10-16 |
| Short abstract | Over the past three decades, health systems have made significant strides towards achieving universal health coverage. However, household out-of-pocket payments for medical care still remain high, and disparities in financial risk protection and healthcare quality continue to give rise to pervasive health inequalities, and some Western countries exhibit a slowdown in life expectancy. The COVID-19 pandemic has shown that global health systems need to be both (i) resilient to shocks and (ii) sustainable in their ability to provide for basic healthcare needs. However, the challenge that health systems in ageing societies face today include how to overcome staffing shortages, waste of resources, and poor regulation, as well as the incomplete integration of long-term care programmes into the main insurance package. Interventions include the expansion of the fiscal space, more efficient allocation of public funding, designing policies to provide high-quality care, and institutions to regulate the diffusion of new, generally costly, healthcare technologies and drugs, and limiting expenditures on waste and corruption. This chapter includes responses to Alistair McGuire, Joan Costa-i-Font and Ranjeeta Thomas by Carol Propper and Michael Marmot. |
| Long abstract | Over the past three decades, health systems have made significant strides towards achieving universal health coverage. However, household out-of-pocket payments for medical care still remain high, and disparities in financial risk protection and healthcare quality continue to give rise to pervasive health inequalities, and some Western countries exhibit a slowdown in life expectancy. The COVID-19 pandemic has shown that global health systems need to be both (i) resilient to shocks and (ii) sustainable in their ability to provide for basic healthcare needs. However, the challenge that health systems in ageing societies face today include how to overcome staffing shortages, waste of resources, and poor regulation, as well as the incomplete integration of long-term care programmes into the main insurance package. Interventions include the expansion of the fiscal space, more efficient allocation of public funding, designing policies to provide high-quality care, and institutions to regulate the diffusion of new, generally costly, healthcare technologies and drugs, and limiting expenditures on waste and corruption. This chapter includes responses to Alistair McGuire, Joan Costa-i-Font and Ranjeeta Thomas by Carol Propper and Michael Marmot. |
| Language | English (Original) |
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Alistair McGuire is Head of Department and Chair of Health Economics at the Department of Health Policy. Prior to this he was Professor of Economics at City University, London, after being a tutor in Economics at the University of Oxford. McGuire has also been a Visiting Professor at Harvard University, the University of Sydney, the University of York, and the Universitat Pompeu Fabra, Barcelona. He has acted as an advisor to a number of governments and governmental bodies, including the UK Government, the UK Competition Commission, the UK Medical Research Council, the German Institut fur Qualität Wirtschaftlichkeit im Gesundheitswesen, as well as for a number of international bodies (including the World Bank, the WHO, and the IMF) and pharmaceutical and healthcare insurance companies.
Ranjeeta Thomas is Associate Professor of Health Economics in the Department of Health Policy at LSE. She is an applied economist with research interests in understanding the drivers of risky health behaviours, the role of incentives in improving demand for preventative healthcare, and early childhood development and health, including the long-term benefits of childhood health and education interventions. She has been a co-investigator on grants from the National Institute of Mental Health USA and the European & Developing Countries Clinical Trials Partnership, and led consultancy projects for the Global Fund and the Bill & Melinda Gates Foundation.
Joan Costa-i-Font is an academic and policy-oriented economist currently working as a Professor of Health Economics at LSE, where he co-leads the Ageing@LSE group. He is a faculty associate at the International Inequalities Institute, and LSE Health, where he leads the Ageing and Health Incentives Lab. He is affiliated with prominent global economics research networks including the IZA and CESifo and holds a PhD in Economics, yet has an interdisciplinary background, which includes undergraduate degrees in Law, Politics, and Sociology. He has authored numerous articles in leading journals covering debates in health and behavioural economics, as well as political economy, and general interest journals. He has authored and edited books for both Cambridge University Press and Oxford University Press, and he has held prestigious fellowships and visiting positions at Harvard University, Princeton University, and Columbia University, as well as Sciences Po Paris. He has served as a consultant for the World Bank, the European Commission, the World Health Organization (WHO), and the Inter-American Development Bank. In the UK, he has contributed to National Institute for Health and Care Research research committees, advised the Cabinet Office and various House of Lords committees, served on the scientific board of the LSE Press, some NHS Trusts, the Nuffield Council on Bioethics and the Ada Lovelace Institute, among others.
Carol Propper is Professor of Economics at Imperial College. Her research focuses on the impact of incentives on the quality of healthcare delivery and health system productivity and, more widely, on the design and consequences of incentives within the public sector and the boundary between the state and private markets. She was made a Dame in the 2021 New Year’s Honours in recognition of her public services to health and economics. She is a Fellow of the British Academy, an International Fellow of the NAM and Fellow of the Association for Social Sciences and a Life-Vice President of the RES. Carol is currently a non-executive director of the UK Statistics Authority and was a member of the Prime Minister’s Council of Science and Technology 2023–24. She was Associate Dean for Faculty and Research at Imperial Business School 2016–19, Co-Director and Director of the Centre for Market and Public Organisation at the University of Bristol 1998–2009 and Co-Director of the Centre for the Analysis of Social Exclusion at London School of Economics 1997–2007. From 2016 to 2023 she was Deputy Editor of VoxEU.
Sir Michael Marmot has been Professor of Epidemiology at UCL since 1985, and is Director of the UCL Institute of Health Equity. He is the author of The Health Gap: The Challenge of an Unequal World (Bloomsbury, 2015), and Status Syndrome (Bloomsbury, 2004). Marmot is a Distinguished Visiting Professor at Chinese University of Hong Kong (CUHK) (2019–), and Co-Director of the CUHK Institute of Health Equity. He is the recipient of the WHO Global Hero Award; the Harvard Lown Professorship (2014–17); the Prince Mahidol Award for Public Health (2015), and 20 honorary doctorates. Marmot has led research groups on health inequalities for nearly 50 years. He chaired the WHO Commission on Social Determinants of Health, several WHO Regional Commissions, and reviews on tackling health inequality for governments in the UK. He served as President of the British Medical Association in 2010–11, and as President of the World Medical Association in 2015. He is President of Asthma + Lung UK. He is a Fellow of the Academy of Medical Sciences and Honorary Fellow of the American College of Epidemiology and of the Faculty of Public Health; an Honorary Fellow of the British Academy; and of the Royal Colleges of Obstetrics and Gynaecology, Psychiatry, Paediatrics and Child Health, and General Practitioners. He is an elected member of the US National Academy of Medicine (NAM), the National Academy of Medicine of Mexico and the Brazilian Academy of Medicine. He was knighted by Queen Elizabeth II, for services to epidemiology and the understanding of health inequalities. He was appointed a Companion of Honour in recognition of his services to public health in the King’s 2023 New Year Honours.