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Submitted by Rob Yates on
Excellent piece Adam - your definition of UHC and emphasis on ensuring that coverage is effective are spot-on. However I wouldn’t dismiss the importance of the “who is covered” dimension. This in effect is the political dimension of UHC [one could argue that the other axes represent the economic and medical dimensions]. As you rightly point out it is “the who is covered” issue that interests political leaders because more covered people can mean more votes and/or political stability. But it is this political self-interest that can create the elusive political will needed to catalyse radical UHC reforms. As Savedoff et al show in their excellent transitions in health financing paper it is political negotiation that often leads to greater levels of pooled financing and better coverage. Now I fully admit there has been a tendency for some political leaders to forget the other crucial dimensions of UHC and make hollow claims about extending coverage and just increase entitlements to non-existent services. For many years I worked in one of these countries. These stunts have done the UHC cause no good at all. But thankfully electorates are beginning to wise up to this and are increasingly complaining about inadequate and shallow coverage and are telling politicians they must do better. The demand for effective coverage is particularly noticeable in middle income countries which are adjusting their benefit packages and contribution policies in response to mounting political pressures. Some of the BRICS are good examples of this. So rather than dismiss the political dimension we should be aware that this can be an extremely powerful driving force for UHC. However we need to make sure that the politicians construct a substantial UHC box and not just knock-up a two dimensional facade that only lasts until the votes are counted.