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A Roadmap to Attain Universal Health Coverage in Developing Countries



Congratulations to AHEAD Network member Sameera AWAWDA for having successfully defended her PhD thesis entitled "“A roadmap to attain universal health coverage in developing countries: A microsimulation based dynamic general equilibrium model”", on Sept 25th 2019, at Aix-Marseille School of Economics (AMSE). In her thesis Sameera AWAWDA has addressed the question of how developing countries can achieve Universal health coverage (UHC), which has been considered as a primary vehicle to achieve Sustainable Development Goals of 2015-2030 (Target 3.8).

While “striving for universal coverage is an admirable goal” – as stated by the former Director-General of the WHO Dr. Margaret Chan, – there has been hitherto no theoretical-empirical work that can enable to assess the feasibility of UHC and the potential multiple effects that it may have at both micro- and macro-economic levels. This thesis presents an operationalizing theoretical framework that is capable of addressing the above issues using dynamic stochastic general equilibrium (DSGE) model and microsimulation technique. The use of microsimulation within the DSGE allows to assess ex-ante the impact of alternative UHC designs and financing policies on, inter alia, household welfare, government fiscal sustainability, and intergenerational inequalities. The thesis consists of three self-contained chapters that address the above issues relating to the implementation of UHC-oriented reforms, first, in the broader context of developing countries, and then, in the particular context of the occupied Palestinian territory (oPt). The first chapter presents the DSGE model that is calibrated to capture the salient features of an archetype developing economy. The model is used to simulate alternative UHC-design and financing policies. Results from this first analysis illustrate how the degree of financial-risk protection (the main UHC goal) can vary with the financing-mix used to implement the UHC-oriented reform. The second chapter assesses the macro-fiscal conduciveness of UHC-oriented reforms and its impact on welfare and public finance in the particular context of Palestine. Results show that while UHC can enhance welfare, particularly, of the least well-off, a parallel expansion of the breadth and width of coverage may not be feasible unless a policy adjustment is undertaken. The choice of the UHC-financing policy may result in welfare losses that exceed the benefits from the expansion of the coverage of healthcare costs. The third chapter examines the potential impact of UHC reforms on intergenerational inequalities in view of fiscal sustainability. The touchy question of who bears the burden of the UHC is addressed using an overlapping generation model within a DSGE, while a convenient measure to assess the social impact of alternative financing strategies of UHC is proposed (viz. deferred-debt finance vs. current-finance). Results show that under conditions of limited fiscal space, the choice between deferred-debt and current UHC-financing implies a trade-off between fiscal sustainability against different levels in intergenerational inequalities, with which the policy-maker will have to confront. The thesis concludes by advancing some policy directions to progress towards UHC and future research perspectives.