Universal health coverage: friend or foe of health equity?
Davidson R Gwatkin a, Alex Ergo b
a Results for Development Institute,
b Broad Branch Associates,
The Lancet, Volume 377, Issue 9784, Pages 2160 - 2161, 25 June 2011
“…..Once again, calls for universality are being heard from health advocates and planners. Last time around, such calls were for achieving the health-for-all goal at the 1978
This quest for universal coverage is often advocated as a way of improving health equity. If fully achieved, it would clearly do so. Everyone—rich and poor, men and women, ethnic or religious majorities and minorities—would enjoy full equal access to the services concerned.
Such an achievement would obviate both the stigma thought to accompany use of services designed specifically for people who are poor, and the possibility that such services might be of low quality.
But beware—universal coverage is much more difficult to achieve than to advocate. And people who are poor could well gain little until the final stages of the transition from advocacy to achievement, if that coverage were to display a trickle-down pattern of spread marked by increases first in better-off groups and only later in poorer ones. Should the resulting rise in inequality endure for an extended time—or worse, become permanent as a drive for universal coverage falls short of fully realising its goal—the result would be to reduce rather than enhance health equity….”
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