A Stepwise Approach to Universal Health Coverage: Embracing Comprehensive Patient‐Centered Management

Achieving universal health coverage (UHC) is a focal point of the global health agenda emphasized by the Sustainable Development Goals (SDGs) framework. The World Health Organization defines UHC as all people having access to the full range of affordable, quality health services [1]. Despite extensive global advocacy for UHC prioritization, achieving a practical consensus on implementation remains challenging due to fragmented strategies and the absence of actionable, unified frameworks. Although technical solutions such as resource-sharing initiatives, enhanced primary care programs, and tax-financed health systems have been proposed, they often fall short of providing practical, scalable models for resource-limited settings. This disconnect between policy objectives and real-world implementation highlights the urgent need for frameworks that inspire collective action and integrate the full spectrum of healthcare services. A critical barrier to UHC implementation is the lack of an inclusive framework that addresses all specialties. Current UHC framing and strategies disproportionately emphasize primary healthcare, often neglecting the critical role of hospital-based services in managing complex diseases while also ensuring financial protection. Consequently, UHC efforts often fail to provide actionable steps for integrating specialized care into broader health system policies and national agendas. This narrow focus fosters single-issue advocacy and creates silos that prioritize the needs of individual specialties over the continuum of care. Although individualized specialty efforts are important for calling attention to need, as evidenced by the momentum gained through global surgery and noncommunicable disease advocacy, these are insufficient on their own [2, 3]. Improving global health outcomes requires a shift toward larger-scale, systemic change and broader, collaborative agendas. Although broader strategies like value-based healthcare have shown promise, when approached conventionally, they often fail to deliver comprehensive, patient-centered care across multiple levels of the health system or integrate hospital-based services into a unified, practical framework. To address existing gaps, a comprehensive, patient-centered blueprint for UHC implementation is necessary. This perspective highlights real-world delivery models at both hospital and national levels that effectively bridge policy objectives with multidisciplinary care, offering a foundation for restructured UHC approaches. One practical pathway to achieving such integration is through team-based, disease-specific management. More specifically, instead of single-specialty or primary healthcare-focused approaches to patient care, multidisciplinary teams composed of primary care physicians, medical specialists, and surgeons, in addition to other healthcare providers, are organized to comprehensively address disease processes. This model exemplifies how UHC frameworks can prioritize holistic disease management, centering care around patients rather than subspecialty interests. This cross-cutting, patient-centered approach has been adopted by multiple institutions that have developed “institutes” to comprehensively address specific diseases using multispecialty, multidisciplinary models [4]. This approach contrasts with conventional models that segregate disciplines like primary care, cardiology, oncology, infectious diseases, maternal health, and surgical care into their own silos, each managing the same disease process but with their own needs and niche algorithms in mind. By breaking down silos and fostering collaboration, these models demonstrate how multidisciplinary care can serve as a foundation for more inclusive and effective UHC strategies. Building on these examples, hospital-level initiatives highlight how multidisciplinary frameworks can be operationalized to deliver integrated, patient-centered care. Cleveland Clinic's Heart, Vascular and Thoracic Institute serves as a successful model that collaborates among three departments—thoracic and cardiovascular surgery, vascular surgery, and cardiovascular medicine. Serving over 900,000 patients annually, this center has earned international acclaim as a leader in cardiovascular care delivery [5]. Employing a group practice model and a standardized physician payment structure, the center fosters increased interdisciplinary consultation, resulting in collaborative care with excellent clinical outcomes. This collaborative model poses the challenges of physician buy-in and upfront effort in optimizing workflow for effective interdepartmental coordination. However, after this initial investment, the optimized processes result in enhanced delivery of patient-centered care. Similar success has been demonstrated at the hospital level in low- and middle-income countries. The Narayana Institute of Cardiac Sciences in India integrates general practitioners, cardiac surgeons, and cardiologists and is known for their exceptional and cost-sensitive outcomes [6]. Cross-disciplinary task shifting increases access to care while maintaining quality in this model. For example, physicians here have worked together to establish coronary care institutes in rural areas linked to the main facility. Real-time telemedicine consultations, including ECG analysis, between trained general practitioners in rural areas and in-hospital cardiac care providers allow early risk assessment and treatment initiation. Furthermore, the hospital's advanced hybrid catheterization laboratories demonstrate adaptability in conducting both surgical and interventional cardiac procedures, effectively catering to a wide range of cardiovascular diseases. Cost-effectiveness and reliability, evidenced by Narayana Health's contribution to over 10% of all cardiac surgeries in India and the affordable cost of open-heart surgery at only 2% of the price of care in the United States, underscore the long-term benefits of a fully operationalized approach [6]. However, implementing such an integrated model in resource-constrained settings poses challenges in securing sustainable upfront investment for cost-effective infrastructure development. Another example of patient-centered approaches that address the full continuum of care can be seen at national levels, where multidisciplinary frameworks are scaled to address both prevention and treatment. Although hospital-level initiatives illustrate the potential for integrated care delivery within institutions, national-level programs demonstrate how comprehensive strategies can bridge gaps across the healthcare system, ensuring equitable access to care for broader populations. Current global efforts to combat cervical cancer primarily focus on prevention through HPV vaccination and Pap smears in primary care settings. However, this strategy only reaches a subset of patients and overlooks those already diagnosed who require comprehensive treatment, such as surgery, chemotherapy, and radiation. To address this gap, the African nation Rwanda has implemented a nationwide integrated care model aimed at improving cervical cancer outcomes [7]. This model expands beyond primary care screening to include effective referral systems and complementary treatment strategies. It involves multidisciplinary partnerships established by the Rwandan Ministry of Health, leveraging the expertise of organizations like the International Cancer Institute, BIO Ventures for Global Health, and the International Gynecologic Cancer Society, which provide support for primary care delivery, advanced diagnostics, and technical training for comprehensive treatment, respectively [8, 9]. Similarly, breast cancer initiatives in Turkey and Rwanda, in collaboration with the Global Surgery Foundation and UNITAR, offer a patient-centered approach that focuses on overcoming early screening barriers, reducing diagnosis and treatment delays, and assessing the impact on patient outcomes. These projects also address gaps in surgical training and stigma surrounding breast cancer. By adopting a more holistic value-based healthcare approach, they emphasize coordinated, multidisciplinary care tailored to local needs [10]. Coordinating extensive infrastructural changes at a national level is a complex and time-consuming process, often complicated by bureaucratic obstacles and shifts in political priorities. Despite these challenges, prioritizing comprehensive, patient-focused care can facilitate the utilization of funding with the needs of the individual patient in mind. This adaptable approach not only addresses disease burdens more holistically but also transcends the limitations of single-issue advocacy, making it a promising strategy for meeting diverse stakeholder and country-specific needs. Reframing the approach to UHC requires broader advocacy for health system strengthening through integrative, patient-centered healthcare management. Hospital-driven and national-level initiatives showcase the potential for bridging policy goals with practical, scalable solutions. By fostering multidisciplinary collaboration, breaking down silos, and prioritizing the full continuum of care, these models offer actionable frameworks for UHC implementation. Emphasizing comprehensive, cross-cutting management equips institutes, hospitals, and policymakers with an organizing framework for advancing UHC efforts effectively and equitably. Anam N. Ehsan: writing – original draft, writing – review and editing. Nefti Bempong-Ahun: writing – review and editing. Geoffrey C. Ibbotson: writing – review and editing. Kavitha Ranganathan: conceptualization, supervision, writing – review and editing. G.C.I. serves as the executive director and N.B.-A. serves as the project manager for the Global Surgery Foundation. K.R. and A.N.E. serve as advisors to the Global Surgery Foundation.