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For many of those among the working poor who lack coverage by medical insurance, the biggest problem is gaining access to a physician. Immigrants constitute a disproportionate number of the working poor families. Although progress had been made since the mid-1990s, this chapter reports that 44 percent of the immigrant children in working poor families were not covered by health insurance in 2001, along with 17 percent of the US born children of the working poor. The serious vulnerability of children in working poor families highlights the need for continued support of existing programs, such as Medicaid and the State Children's Health Insurance Program, so that they might be extended to the approximately 6 million uninsured children who are currently eligible for coverage. In addition to support for these programs, the chapter recommends that states provide universal coverage for all children along the lines of Governor Schwarzenegger's proposal to expand health insurance coverage for all uninsured Californians.

Many countries, including the United States, lack consensus about the core ethical principles concerning health and health care, beyond a market‐based approach to resource allocation. This chapter offers a normative theory for analyzing health policy decisions and recognizes that norms need fundamental restructuring to address existing health problems. Substantive normative principles (moral legitimacy) should be introduced into deliberative democratic process (political legitimacy) for a comprehensive, integrative theory of health and social justice. The chapter reviews the role of moral values in motivating citizens' support for public policies, and explores differences between social agreement frameworks such as incompletely theorized agreements (ITAs) and overlapping consensus and more traditional political bargaining models. ITA analysis of the American Clinton health care reform attempts reveals agreement on the mid‐level concept of universal coverage, but disagreement on both high‐ and low‐level principles. The chapter concludes that high‐level principle (e.g. health for all) or low‐level principle (e.g. willingness to pay for other's and future selves' health insurance) agreement, arising from internalization of shared public moral norms, might lead to more stable support for reform.

This chapter compiles data on health care coverage and access in twenty countries in Latin America. It summarizes legal coverage in the three health sectors and by population groups, and examines whether coverage targets have been met. It calculates coverage of the total population, as well as by sector, location, income, and groups difficult to incorporate. It compares coverage before and after the reforms; estimates access and utilization of services; and explores the causes of the failure to meet the universal coverage goal in some countries.

The Affordable Care Act (ACA) culminated a century of efforts to achieve universal health coverage. They increasingly focused on market approaches, and the ACA followed this trend by relying on private insurance companies to expand coverage. It facilitates a market for individual policies and expands Medicaid, which is widely administered by private plans. Obama garnered political supportfor the law through alliances with key industry sectors that stood to gain, including insurers, hospitals, physicians, and pharmaceutical firms. The ACA thereby extends to new lengths the public-private partnership underlying all American health care. Future reforms should address the partnership’s most glaring failings. These would transition reimbursement from fee-for-service to bundled payments, reduce administrative complexity, limit medicine’s specialist tilt, lessen the profession’s commercialization, and control the proliferation of expensive technology. Government activism created American health care, and it will always be the essential force in keeping it sustainable andvibrant.

This chapter focuses on two of the key functions of a health sector financing system: revenue collection and fund pooling. It uses as its starting point the World Health Organization resolution calling for health care financing systems to provide universal coverage and financial protection for citizens. Revenue collection concerns the sources of funds, contribution structures, and the means by which they are collected, while fund pooling addresses the need to spread the risk of incurring unexpected health care costs over as broad a population group as possible. In terms of revenue collection, the chapter reviews the equity, sustainability, and feasibility of alternative financing mechanisms (e.g., donor and tax funding, a range of health insurance mechanisms, and out-of-pocket payments) and highlights key lessons from recent research in low- and middle-income countries on these mechanisms. It also highlights the importance of carefully considering who the most appropriate revenue collection organization may be in different political contexts. The main focus of the section on fund pooling is on alternative strategies for reducing fragmentation in health care financing in order to maximize both income and risk cross-subsidies in the overall health care financing system. Such cross subsidies are critical to achieving universal coverage and adequate financial protection.

This chapter examines the 10-year struggle of federal officials to introduce the measures of cost containment, discussing the effect this struggle had on the hope of national health insurance and looking at the revival of national health insurance, which began in 1968. Next, it looks at Jimmy Carter's role in the hospital industry, noting that Carter initially ignored health care during the first months of his presidential campaign, and then studies the “staging” of universal coverage and introduces the prospective payment system.

Set against existing explanations for Thailand’s landmark universal coverage policy, this chapter traces the historical rise of a movement of progressive physicians in Thailand (the Rural Doctors’ Movement). After establishing their origins, it explores the critical role they played in institutionalizing universal healthcare over powerful opposition forces. In the absence of the strategic actions of this professional movement, the evidence presented here suggests that there is little reason to believe that Thailand’s universal coverage policy would ever have become a major issue in the 2001 election, much less a policy that would have been implemented and gone on to receive international acclaim. It points to the knowledge, social networks, and privileged positions in the state that allowed the movement to have an outsized role in the policy process following democratic transition in 1992.

This chapter summarizes the overall argument and points to the influential role that elites from esteemed professions played in the institutionalization of policy in the three cases. While in all cases democratization provided new opportunities for professional movements in medicine to use the organizational vehicle of the state to advance universal health coverage and the power of the law to deepen commitments to essential medicine, The chapters relate how the differences in outcomes between Thailand and Brazil, on one hand, and South Africa, on the other, hinged on dramatically different political dynamics. I consider the contemporary state of professional movements and health reforms in the three countries; why health has remained a minor concern to mass movements; the durability of professional movements; the influence of professional movements in other policy domains and cases; and their relevance to the United States and other countries in the industrializing world.

This chapter examines archetypes of health care systems, from various European national health systems to the centrally planned model of the former Soviet Union and the market-driven US model. The chapter then analyzes two key health care policy approaches: primary health care and universal health coverage. It provides illustrations of recent and ongoing health system reforms across all world regions (covering China, Thailand, the Middle East, Brazil, Mexico, South Africa, South Korea, and India) that address—to varying degrees—questions of regulation, financing, resource allocation, the nature of service provision, and principles of universality, access, affordability, quality, and equity within the politics of their context. In addition, it provides an overview of the building blocks of health care systems including facilities, different types of health care personnel, problems around health workforce migration, technology, and the powerful role of the pharmaceutical industry.

This chapter considers two different ways of organizing revenue collection in statutory healthcare schemes: social health insurance and taxation. The two models are commonly referred to as ‘Bismarck vs Beveridge’ after the men associated with the origin of these systems: the first German chancellor Otto von Bismarck (1815–1898), and the British economist Lord William Beveridge (1879–1963). The differences between these two compulsory prepayment schemes are discussed and compared with private health insurance. Based on a simple diagram introduced by the World Health Organization, three dimensions of coverage are illustrated. Some policy dilemmas are highlighted when attempting to achieve universal health coverage. Finally, various combinations of public and private prepayment schemes are discussed.

Priority-setting is fundamental to the fair and efficient pursuit of universal health coverage (UHC). This chapter addresses the key choices in selecting services for UHC and the alternative criteria, tools, and processes to guide these choices. The authors first describe the choices decision-makers have to make on the path to UHC and the recommendations by the WHO Consultative Group on Equity and Universal Health Coverage for how these choices can be made. Using Thailand as a case study, the authors examine how the Thai government has set priorities in its pursuit of UHC. Against this background, the authors discuss alternative criteria, tools, and processes for guiding service selection and the design of benefit packages for UHC. When doing this, the authors consider past experiences in Thailand and other countries and examine how recent developments and the insights from the preceding chapters in this volume can provide directions for the future.

This chapter explores the seminal topic of Universal Health Coverage (UHC), an objective within the Sustainable Development goals. It reviews the theory and definitions that shape the current conversation on UHC. The movement from selective primary health care to UHC demonstrates a global commitment to the progressive realization of the right to health. However, access to UHC is limited by barriers to care, inadequate provision of care, and poor-quality services. To deliver UHC, it is critical to align inputs in the health system with the burden of disease. Quality of care must also be improved. Steady, sufficient financing is needed to achieve the laudable goal of UHC.This chapter highlights some important steps taken by countries to expand access to quality health care. Finally, the chapter investigates the theory and practice behind a morbidity-based approach to strengthening health systems and achieving UHC.

This chapter focuses on the new Medicare Part D prescription drug program. Participation in Medicare Part D requires individuals to make active enrollment and plan choice decisions. Active decisions are made initially when first enrolling in the program, and can be revisited periodically during the program's annual open enrollment periods. Whether consumers make wise choices at these decision points is of interest not only for the evaluation of this particular market, but for consumer-directed health care more generally. The chapter explores how people decided among the prescription drug plan options made available through Medicare Part D, based on their prior drug use, self-rated health, and other factors.

In the last few decades, several initiatives have been undertaken by Government of India to increase access to essential health services. A framework for UHC was also developed by a High Level Expert Group (HLEG). The recently developed National Health Policy of India also espouses equity, universality, and affordability among its key principles and commits higher financial resources with emphasis on Primary Health Care. For UHC to be viable, it has to be embedded in a broad based framework of health assurance, based on a conceptual model that extends from financial protection, across a well-functioning health system, to the social determinants of health.

Strengthening health systems in poorer countries has long been a focal point in development aid debates. Visionary models of comprehensive primary health care caught the global imagination in the late 1970s but were quickly eclipsed with the rise of neoliberal globalization in the 1980s, truncated into ‘selective’ silos appealing to donor nations. ‘Investing in health’ for economic growth eclipsed more humanitarian principles for health assistance. Corporate philanthropies began to set health agendas resonant with those of a century earlier, while private health care financing and delivery models that grew under neoliberalism’s first wave (structural adjustment) have yet to yield to the evidence of the efficiencies of public health care models. The current push to achieve Universal Health Coverage captures the ongoing tension between the interests of private capital and the need for public goods.

Despite a strong legacy of human development, the state of Kerala faces challenges of shifting epidemiologic burden and privatization driven cost escalation. Mindful of this, the Government of Kerala initiated a pilot study on Universal Health Coverage reforms in two districts. An assessment was carried out, drawing data from about 60 sources, revealing critical information about overcrowding and understaffing at block level facilities, critical gaps in health human resources, the top 20 conditions and events for which care is sought—where non-communicable conditions dominate. On the basis of this, it was proposed that comprehensive care pathways be created—Kerala’s version of an Essential Health Package, delivered through a re-engineered health system.

In the twenty-first century, globalization of trade, travel, and culture is likely to impose complex effect on health protection: increased trade is likely to improve material access and services but also bring harm to health and the environment; travel and human migration enrich human experience but also exacerbate health threats such as the rapid dissemination of communicable diseases; and globalized food production and ineffective regulation of food production have led to adverse human health outcomes. This chapter discusses ideas that bridge traditional public health disciplines and concepts to enable multidisciplinary actors to examine, plan, act, and implement together to protect human health and well-being. This chapter also explains how health protection might be linked to some important global policies such as Sustainable Development Goals and the New Urban Agenda. Specifically, ‘One Health’, ‘planetary health’, and ‘sustainable development’ allow the conceptualization of the relationship between human, other living organisms, and eco-system.

The United Nation’s Sustainable Development Goals of achieving universal health coverage (UHC) by 2030 have energized many governments to devise bold strategies and make big investments in their health systems. The global movement around UHC has gathered momentum at blistering speed. Within a few years it has transformed the focus of healthcare in low- and middle-income countries from a few diseases to a comprehensive vision of affordable, accessible, and acceptable care for all. In this chapter, Mark Britnell looks at how Philippines, Vietnam, Kenya, India, Indonesia, Columbia, Costa Rica, Panama, Nigeria, South Africa, Cyprus, islands across the Caribbean, and many others have announced significant UHC reforms since the development goals were passed in 2014, and UHC has been a headline issue in a number of national elections. He analyses UHC across the world, and looks to at the future of healthcare globally.