In a global report on financing health systems, the United Nations health body said all countries, rich and poor, could do more toward getting universal coverage and urged them to think about ways to increase efficiency and use new taxes and innovative fund-raising measures to boost access to healthcare.

“For many, health services just don’t exist, for others they are not affordable. When they’re not affordable it means you either choose not to use them or you suffer severe financial hardship,” David Evans, the WHO’s director of health systems financing, said in a briefing on the report’s findings.

The World Health Report 2010 lays out steps countries could take to raise more funds and reduce financial barriers to obtaining healthcare, and to make health services more efficient.

It found that to stop payment for healthcare impoverishing people, direct, out-of-pocket payments should make up less than 15 to 20 percent of a country’s total health spending.

Yet currently, in 33 mainly low- and middle-income countries, direct payments from individuals receiving healthcare still account for more than 50 percent of total health spending.

It suggested governments should look at diversifying sources of revenue from levies such as “sin” taxes on products like tobacco and alcohol, currency transaction taxes, and national “solidarity” taxes on certain sectors.

If India were to implement a levy of 0.005 percent on foreign exchange transactions, it could raise $370 million per year, the report said. Gabon raised $30 million for health in 2009 by imposing a 1.5 percent levy on companies handling remittances and a 10 percent tax on mobile phone operators.

HEALTH, OR FINANCIAL RUIN?

WHO director general Margaret Chan wrote in a foreword to the report that “no one in need of healthcare, whether curative or preventive, should risk financial ruin as a result.”

“As the world grapples with economic slowdown, globalization of diseases ... and growing demands for chronic care ... the need for universal health coverage, and a strategy for financing it, has never been greater,” the report said.

“There is no magic bullet to achieving universal access. Nevertheless, a wide range of experiences from around the world suggests that countries can move forward faster.”

The WHO said that typically, 20 to 40 percent of health spending is wasted, often through spending on expensive but unnecessary drugs, hospital-related inefficiency and poor use of skilled professionals’ time.

More than half all medicines globally are prescribed, dispensed, or sold inappropriately and half of all patients fail to take their medication as prescribed. Better use of medicines could save nations up to 5.0 percent of health spending, it said.

To improve efficiency, it suggested 10 areas where changes could be made, including reducing unnecessary spending on drugs, targeting medicines properly and adopting a generics policy whereby any branded medicine for which there is an equally effective generic version is substituted.

The report found some countries pay far more for medicines than others - in some places prices are up to 67 times the international average. France’s strategy of generic substitution led to savings equivalent to $1.94 billion in 2008, it said.

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By Kate Kelland, Health and Science Correspondent

LONDON