Anything goes on the path to universal health coverage? No.

Abstract

In its 2010 world health report,1 the World Health Organization noted that there is no single, best path for reforming health financing arrangements to move systems closer to universal health coverage, i.e. to improve access to needed, effective services while protecting users from financial ruin. However, this lack of a blueprint for health financing reforms was not meant to convey the message that “anything goes” on the path to universal health coverage. Indeed, concerns have been raised that some reforms, often implemented in the name of expanding coverage, may actually compromise equity.2 Theory and country experience yield important lessons on both promising directions and pitfalls to avoid. Interpretation of health financing reform experience requires getting beneath commonly used labels such as “tax-funded systems” or “social health insurance”, or simply even “health insurance”, which was used as the basis for a systematic review published in the September issue of the Bulletin.3 Such labels hide more than they illuminate, as shown by emerging evidence on reforms that increase access and financial protection but are funded predominantly from general tax revenues (e.g. Kyrgyzstan, Mexico, Rwanda, Thailand). Deriving meaningful lessons from innovative reform experiences requires a deeper understanding of how countries have altered their funding sources, pooling arrangements, purchasing methods, and policies on benefits and patient cost-sharing. All systems, regardless of what they are called, have to address these functions and policy choices.