PHM-Exch> Universal health coverage: friend or foe of health equity?

[Claudio Schuftan]

From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia at paho.org>
crossposted from: EQUIDAD at listserv.paho.org


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*Universal health coverage: friend or foe of health equity?*

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Davidson R Gwatkin a, Alex Ergo b****

a Results for Development Institute, ****Washington**, **DC**  **USA********

b Broad Branch Associates, ****Washington**, **DC**, **USA********

*The Lancet, Volume 377, Issue 9784, Pages 2160 - 2161, 25 June 2011
* doi:10.1016/S0140-6736(10)62058-2****

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Website: http://bit.ly/mJpecA ****

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“…..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 ****Alma-Ata**** conference. Now they are
re-emerging, as more limited but nonetheless stirring appeals to seek
universal coverage or access in a wide range of health-related areas such as
HIV/AIDS,1 reproductive health,2 health insurance,3 and free health
services, particularly for women and children.4 Reflecting such interest,
universal coverage will figure as the organising theme of a large WHO
research meeting on Nov 16—19 2010.5****

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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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