The Ethical Framework for Policy-making of Universal Health Coverage: A Systematic Review

Abstract

Introduction: Countries have set a central policy to achieve universal health coverage by 2030. Resource constraint and the variety of ways to fulfill the purposes of the universal health coverage, however, have led policymakers to face ethical challenges. An elaboration of ethical frameworks can facilitate the right move in this direction. Aim: This study examines the ethical frameworks used by countries and postulated by studies for policy-making on universal health coverage. Materials and Methods: This systematic review built on the PRISMA guidelines to search the Scopus and PubMed databases for papers published from January 2010 to March 2018. Studies will be considered for inclusion that have focused on the dimensions of policy-making ethics on universal health coverage and referring to the role of ethics in policy-making on health universal coverage. State and organisational reports, book’s chapters, proceedings and editorials were not included. The data were analysed using the thematic analysis method and categorised into two groups according to the data extraction forms. The first was related to articles that were the result of a research study and recommendations from international organisations; the second concerned with articles that reflected the experiences of different countries. The extracted data of both groups were classified into three themes, including the role of ethics in universal health, ethical principles, and ethical criteria. Results: Out of the 685 articles found in the initial search, 24 met the inclusion criteria. Findings indicate that ethics acts as the driving force, guidance for decision-making, provider of public acceptance, and a guarantee for justice administration. The ethical framework contains principles of fairness, justice, equality, maximisation of benefits, solidarity, sustainability, good governance, human rights, financial risk protection measures, efficiency, and cost-effectiveness. Most studies have emphasised the principles of human rights, solidarity, justice and fairness, cost-effectiveness, and financial risk conservation in the policy-making of health universal coverage. Varying cultural and social conditions, the political orientation of countries, and local values underlie the difference in the contents of the moral framework. Conclusion: In their attempts to realise universal health coverage, countries must undertake a selection of principles and criteria for their ethical framework through a research process. Given the emergence of the scientific field of ethics for health policy-making, researchers can review the ethical principles and criteria identified in this study in other areas of health policy-making and determine the generalisability of these principles.

Keywords

• government programs
• insurance
• morals
• philosophy
• population health
• politics