Universal Coverage

Introduction: As high out-of-pocket healthcare expenses pose heavy financial burden on the families, Government of India is considering a variety of financing and delivery options to universalize health care services. Hence, an estimate of the cost of delivering universal health care services is needed.

1) The conception of a cultural moral right is useful in capturing the social-moral realities that underlie debate about universal health care. In asserting such rights, individuals make claims above and beyond their legal rights, but those claims are based on the society's existing commitments and moral culture. In the United States such a right to accessible basic health care is generated by various empirical social facts, primarily the conjunction of the legal requirement of access to emergency care with widely held principles about unfair free riding and just sharing of costs between well and ill. The right can get expressed in social policy through either single-payer or mandated insurance. (2) The same elements that generate this right provide modest assistance in determining its content, the structure and scope of a basic minimum of care. They justify limits on patient cost sharing, require comparative effectiveness, and make cost considerations relevant. They shed light on the status of expensive, marginally life extending, last-chance therapies, as well as life support for PVS patients. They are of less assistance in settling contentious debates about screening for breast and prostate cancer and treatments for infertility and erectile dysfunction, but even there they establish a useful framework for discussion. Scarcity of resources need not be a leading conceptual consideration in discerning a basic minimum. More important are the societal elements that generate the cultural moral right to a basic minimum.

This analysis of the Austrian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health-system performance. The Austrian health system provides universal coverage for a wide range of benefits and high-quality care. Free choice of providers and unrestricted access to all care levels (general practitioners, specialist physicians and hospitals) are characteristic features of the system. Unsurprisingly, population satisfaction is well above EU average. Income-related inequality in health has increased since 2005, although it is still relatively low compared to other countries. The health-care system has been shaped by both the federal structure of the state and a tradition of delegating responsibilities to self-governing stakeholders. On the one hand, this enables decentralized planning and governance, adjusted to local norms and preferences. On the other hand, it also leads to fragmentation of responsibi...

Limited access to Chagas disease diagnosis and treatment is a major obstacle to reaching the 2020 World Health Organization milestones of delivering care to all infected and ill patients. Colombia has been identified as a health system in transition, reporting one of the highest levels of health insurance coverage in Latin America. We explore if and how this high level of coverage extends to those with Chagas disease, a traditionally marginalised population. Using a mixed methods approach, we calculate coverage for screening, diagnosis and treatment of Chagas. We then identify supply-side constraints both quantitatively and qualitatively. A review of official registries of tests and treatments for Chagas disease delivered between 2008 and 2014 is compared to estimates of infected people. Using the Flagship Framework, we explore barriers limiting access to care. Screening coverage is estimated at 1.2% of the population at risk. Aetiological treatment with either benznidazol or nifurt...

Background In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015).

‘Post-national’ scholars have taken the extension of social rights to migrants that are normally accorded to citizens as evidence of the growing importance of norms of ‘universal personhood’ and the declining importance of the nation-state. However, the
distinct approach taken by the state toward another understudied category of noncitizen – stateless people – complicates these theories by demonstrating that the state
makes decisions about groups on different bases than theory would suggest. These findings suggest the need to pay more attention to how the state treats other categories of ‘semi-citizens’. This article examines the differential effects of universal healthcare reforms in Thailand on citizens, migrants, and stateless people and explores their ramifications on theories of citizenship and social rights. While the state has expanded its healthcare obligations toward people living within its borders, it has taken a variegated approach toward different groups. Citizens have been extended ‘differentiated but unambiguous rights’. Migrants have been granted ‘conditional
rights’ to healthcare coverage, dependent on their status as registered workers who pay mandatory contributions. Large numbers of stateless people, however, saw their right to state welfare programs disenfranchised following passage of the new universal healthcare law before later being granted ‘contingent rights’ through a new program.

A post-Millennium Development Goals agenda for health in Bangladesh should be defi ned to encourage a second generation of health-system innovations under the clarion call of universal health coverage. This agenda should draw on the experience of the fi rst generation of innovations that underlie the country's impressive health achievements and creatively address future health challenges. Central to the reform process will be the development of a multipronged strategic approach that: responds to existing demands in a way that assures aff ordable, equitable, high-quality health care from a pluralistic health system; anticipates health-care needs in a period of rapid health and social transition; and addresses underlying structural issues that otherwise might hamper progress. A pragmatic reform agenda for achieving universal health coverage in Bangladesh should include development of a long-term national human resources policy and action plan, establishment of a national insurance system, building of an interoperable electronic health information system, investment to strengthen the capacity of the Ministry of Health and Family Welfare, and creation of a supraministerial council on health. Greater political, fi nancial, and technical investment to implement this reform agenda off ers the prospect of a stronger, more resilient, sustainable, and equitable health system.

This article aims to illustrate and critically analyze the results from the 1-year experience of using health technology assessment (HTA) in the development of the Thai Universal Coverage health benefit package. We review the relevant documents and give a descriptive analysis of outcomes resulting from the development process in 2009-2010. Out of 30 topics nominated by stakeholders for prioritization, 12 were selected for further assessment. A total of five new interventions were recommended for inclusion in the benefit package based on value for money, budget impact, feasibility and equity reasons. Different stakeholders have diverse interests and capabilities to participate in the process. In conclusion, HTA is helpful for informing coverage decisions for health benefit packages because it enhances the legitimacy of policy decisions by increasing the transparency, inclusiveness and accountability of the process. There is room for improvement of the current use of HTA, including providing technical support for patient representatives and civic groups, better communication between health professionals, and focusing more on health promotion and disease prevention.

A number of low and middle income countries (LMICs) are considering social health insurance (SHI) for adoption into their social and economic environment or striving to sustain and improve already existing SHI schemes. SHI was first introduced in Germany in 1883. An analysis of the German system from its inception up to today may yield lessons relevant to other countries.

Many intrinsically related determinants of health and disease exist, including social and economic status, education, employment, housing, and physical and environmental exposures. These factors interact to cumulatively aff ect health and disease burden of individuals and populations, and to establish health inequities and disparities across and within countries. Biomedical models of health care decrease adverse consequences of disease, but are not enough to eff ectively improve individual and population health and advance health equity. Social determinants of health are especially important in Latin American countries, which are characterised by adverse colonial legacies, tremendous social injustice, huge socioeconomic disparities, and wide health inequities. Poverty and inequality worsened substantially in the 1980s, 1990s, and early 2000s in these countries. Many Latin American countries have introduced public policies that integrate health, social, and economic actions, and have sought to develop health systems that incorporate multisectoral interventions when introducing universal health coverage to improve health and its upstream determinants. We present case studies from four Latin American countries to show the design and implementation of health programmes underpinned by intersectoral action and social participation that have reached national scale to eff ectively address social determinants of health, improve health outcomes, and reduce health inequities. Investment in managerial and political capacity, strong political and managerial commitment, and state programmes, not just time-limited government actions, have been crucial in underpinning the success of these policies.

This is a special guest issue of Canadian Public Administration devoted to the rise and presumed decline of universality in social policy with special emphasis on the Canadian experience. Considerable attention is paid to the conceptualization and definition of universality as well as the historical trajectory of universality and the use of history in explaining such trends in public policy.

This chapter assesses health equity achievements of the Thai health system before and after the introduction of the universal coverage (UC) policy. It examines five dimensions of equity: equity in financial contributions, the incidence of catastrophic health expenditure, the degree of impoverishment as a result of household out-of-pocket payments for health, equity in health service use and the incidence of public subsidies for health. The standard methods proposed by O'Donnell, van Doorslaer, and Wagstaff (2008b) were used to measure equity in financial contribution, healthcare utilization and public subsidies, and in assessing the incidence of catastrophic health expenditure and impoverishment. Two major national representative household survey datasets were used: Socio-Economic Surveys and Health and Welfare Surveys. General tax was the most progressive source of finance in Thailand. Because this source dominates total financing, the overall outcome was progressive, with the ...

The constitutions of many countries in the Arab world clearly highlight the role of governments in guaranteeing provision of health care as a right for all citizens. However, citizens still have inequitable health-care systems. One component of such inequity relates to restricted fi nancial access to health-care services. The recent uprisings in the Arab world, commonly referred to as the Arab spring, created a sociopolitical momentum that should be used to achieve universal health coverage (UHC). At present, many countries of the Arab spring are considering health coverage as a priority in dialogues for new constitutions and national policy agendas. UHC is also the focus of advocacy campaigns of a number of non-governmental organisations and media outlets. As part of the health in the Arab world Series in The Lancet, this report has three overarching objectives. First, we present selected experiences of other countries that had similar social and political changes, and how these events aff ected their path towards UHC. Second, we present a brief overview of the development of health-care systems in the Arab world with regard to health-care coverage and fi nancing, with a focus on Egypt, Libya, Tunisia, and Yemen. Third, we aim to integrate historical lessons with present contexts in a roadmap for action that addresses the challenges and opportunities for progression towards UHC.

Japan shows the advantages and limitations of pursuing universal health coverage by establishment of employee-based and community-based social health insurance. On the positive side, almost everyone came to be insured in 1961; the enforcement of the same fee schedule for all plans and almost all providers has maintained equity and contained costs; and the co-payment rate has become the same for all, except for elderly people and children. This equity has been achieved by provision of subsidies from general revenues to plans that enrol people with low incomes, and enforcement of cross-subsidisation among the plans to fi nance the costs of health care for elderly people. On the negative side, the fragmentation of enrolment into 3500 plans has led to a more than a three-times diff erence in the proportion of income paid as premiums, and the emerging issue of the uninsured population. We advocate consolidation of all plans within prefectures to maintain universal and equitable coverage in view of the ageing society and changes in employment patterns. Countries planning to achieve universal coverage by social health insurance based on employment and residential status should be aware of the limitations of such plans.

Brazil is a country of continental dimensions with widespread regional and social inequalities. In this report, we examine the historical development and components of the Brazilian health system, focusing on the reform process during the past 40 years, including the creation of the Unifi ed Health System. A defi ning characteristic of the contemporary health sector reform in Brazil is that it was driven by civil society rather than by governments, political parties, or international organisations. The advent of the Unifi ed Health System increased access to health care for a substantial proportion of the Brazilian population, at a time when the system was becoming increasingly privatised. Much is still to be done if universal health care is to be achieved. Over the past 20 years, there have been other advances, including investments in human resources, science and technology, and primary care, and a substantial decentralisation process, widespread social participation, and growing public awareness of a right to health care. If the Brazilian health system is to overcome the challenges with which it is presently faced, strengthened political support is needed so that fi nancing can be restructured and the roles of both the public and private sector can be redefi ned.

This analysis of the Austrian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health-system performance. The Austrian health system provides universal coverage for a wide range of benefits and high-quality care. Free choice of providers and unrestricted access to all care levels (general practitioners, specialist physicians and hospitals) are characteristic features of the system. Unsurprisingly, population satisfaction is well above EU average. Income-related inequality in health has increased since 2005, although it is still relatively low compared to other countries. The health-care system has been shaped by both the federal structure of the state and a tradition of delegating responsibilities to self-governing stakeholders. On the one hand, this enables decentralized planning and governance, adjusted to local norms and preferences. On the other hand, it also leads to fragmentation of responsibi...

Ghana has been institutionalizing a set of coordinated mechanisms to measure and monitor progress in health coverage. These periodic assessments have over time shown significant country progress towards achieving a fifty--percent reduction in childhood morality rate by 2015 and a two--thirds reduction in maternal deaths within the same period. However, a lot more effort remains for Ghana to actually attain these Millennium Development Goals targets post 2015. The push for universal health coverage is now more important than ever and has necessitated the adoption of a systematic set of measurement and monitoring tools that will overtime depict effective country progress towards improved health outcomes, consolidating optimum health coverage. Ghana is working towards developing a system that is comparable with those in other countries of similar population structure and economic status particularly in Sub--Saharan Africa, to ensure more meaningful analysis of desired national health goals and outcomes. The purpose of this review is to determine whether Ghana as a country endorses universal health coverage and how well Ghana is positioned to achieve universal health coverage as well as which existing policies can or should be developed to achieve this. The review examines the systems operational for measuring universal health coverage in Ghana, strategies for identifying and addressing relevant gaps as well as which indicators will most appropriately assess progress towards universal health coverage. The review is contributing to the World Summary Points: 13 1. Ghana has an elaborate range of indicator to measure and monitor its health outcomes, however, there is 14 need for greater clarity on which indicators sufficiently measure true coverage and which ones measure 15 impact or output 16 2. Policy--wise, success of Ghana achieving universal health coverage will depend to a large extent on 17 Government leadership in promoting its key initiatives of community--based health care and services 18 (CHPS), NHIS and Decentralization to increase focus on preventive and promotive health actions rather 19 than large capital investments on hospital--based care in order to contain cost.

Ghana has been institutionalizing a set of coordinated mechanisms to measure and monitor progress in health coverage. These periodic assessments have over time shown significant country progress towards achieving a fifty--percent reduction in childhood morality rate by 2015 and a two--thirds reduction in maternal deaths within the same period. However, a lot more effort remains for Ghana to actually attain these Millennium Development Goals targets post 2015. The push for universal health coverage is now more important than ever and has necessitated the adoption of a systematic set of measurement and monitoring tools that will overtime depict effective country progress towards improved health outcomes, consolidating optimum health coverage. Ghana is working towards developing a system that is comparable with those in other countries of similar population structure and economic status particularly in Sub--Saharan Africa, to ensure more meaningful analysis of desired national health goals and outcomes. The purpose of this review is to determine whether Ghana as a country endorses universal health coverage and how well Ghana is positioned to achieve universal health coverage as well as which existing policies can or should be developed to achieve this. The review examines the systems operational for measuring universal health coverage in Ghana, strategies for identifying and addressing relevant gaps as well as which indicators will most appropriately assess progress towards universal health coverage. The review is contributing to the World Summary Points: 13 1. Ghana has an elaborate range of indicator to measure and monitor its health outcomes, however, there is 14 need for greater clarity on which indicators sufficiently measure true coverage and which ones measure 15 impact or output 16 2. Policy--wise, success of Ghana achieving universal health coverage will depend to a large extent on 17 Government leadership in promoting its key initiatives of community--based health care and services 18 (CHPS), NHIS and Decentralization to increase focus on preventive and promotive health actions rather 19 than large capital investments on hospital--based care in order to contain cost.

Stakeholder analysis is widely recommended as a tool for gathering insights on policy actor interests in, positions on, and power to influence, health policy issues. Such information is recognized to be critical in developing viable health policy proposals, and is particularly important for new health care financing proposals that aim to secure universal coverage (UC).

Ghana has been institutionalizing a set of coordinated mechanisms to measure and monitor progress in health coverage. These periodic assessments have over time shown significant country progress towards achieving a fifty--percent reduction in childhood morality rate by 2015 and a two--thirds reduction in maternal deaths within the same period. However, a lot more effort remains for Ghana to actually attain these Millennium Development Goals targets post 2015. The push for universal health coverage is now more important than ever and has necessitated the adoption of a systematic set of measurement and monitoring tools that will overtime depict effective country progress towards improved health outcomes, consolidating optimum health coverage. Ghana is working towards developing a system that is comparable with those in other countries of similar population structure and economic status particularly in Sub--Saharan Africa, to ensure more meaningful analysis of desired national health goals and outcomes. The purpose of this review is to determine whether Ghana as a country endorses universal health coverage and how well Ghana is positioned to achieve universal health coverage as well as which existing policies can or should be developed to achieve this. The review examines the systems operational for measuring universal health coverage in Ghana, strategies for identifying and addressing relevant gaps as well as which indicators will most appropriately assess progress towards universal health coverage. The review is contributing to the World Summary Points: 13 1. Ghana has an elaborate range of indicator to measure and monitor its health outcomes, however, there is 14 need for greater clarity on which indicators sufficiently measure true coverage and which ones measure 15 impact or output 16 2. Policy--wise, success of Ghana achieving universal health coverage will depend to a large extent on 17 Government leadership in promoting its key initiatives of community--based health care and services 18 (CHPS), NHIS and Decentralization to increase focus on preventive and promotive health actions rather 19 than large capital investments on hospital--based care in order to contain cost.

Background: Health insurance scheme have been introduced with the aim of providing health insurance and making health services accessible and affordable to the average citizen in the country. Our objective is to evaluate clients' satisfaction with National Health Insurance Scheme in Jigawa State, Nigeria. Method: This study used a mixed method (both qualitative and quantitative designs) approach and was conducted between May 2016 and September 2017. Three hundred and twenty-one (321) enrollees filled questionnaires while 8 participated in face to face interview. The questionnaires were analysed using Statistical Package for Social Science (SPSS) and descriptive statistics was used to summarize the quantitative data using means, proportions and frequencies. Qualitative data were analyzed using themes. Results: The overall satisfaction score of the respondents was 80.6%). Specifically expressed satisfaction with the associated services (e.g. lab, radiology, pharmacy) (92.2%), agreed to have easy access to the medical specialist (77.9%), agreed to get prescribed drugs in the hospital (74.1%), agreed that the amount they pay during each visit before they got drug is reasonable (85.7%), satisfied with surgical procedure under NHIS (69.8%), satisfied with the referral arrangement (77%), satisfied with the overall NHIS services in this hospital (87.3%). Conclusion: More than three quarter (80.6%) of the clients are satisfied with healthcare services provided under NHIS in the hospital. Recommendations: NHIS scheme can be improved by 24 hours availability of designated doctors for NHIS clients, regular supply of drugs and by reducing waiting time.

Reaching out to the poor and the informal sector is a major challenge for achieving universal coverage in lesser-developed countries. In Cambodia, extensive coverage by health equity funds for the poor has created the opportunity to consolidate various non-government health financing schemes under the government's proposed social health protection structure. This paper identifies the main policy and operational challenges to strengthening existing arrangements for the poor and the informal sector, and considers policy options to address these barriers. Conducted in conjunction with the Cambodian Ministry of Health in 2011e12, the study reviewed policy documents and collected qualitative data through 18 semi-structured key informant interviews with government, non-government and donor officials. Data were analysed using the Organizational Assessment for Improving and Strengthening Health Financing conceptual framework. We found that a significant shortfall related to institutional, organisational and health financing issues resulted in fragmentation and constrained the implementation of social health protection schemes, including health equity funds, community-based health insurance, vouchers and others. Key documents proposed the establishment of a national structure for the unification of the informal-sector schemes but left unresolved issues related to structure, institutional capacity and the third-party status of the national agency. This study adds to the evidence base on appropriate and effective institutional and organizational arrangements for social health protection in the informal sector in developing countries. Among the key lessons are: the need to expand the fiscal space for health care; a commitment to equity; specific measures to protect the poor; building national capacity for administration of universal coverage; and working within the specific national context. (P. Ir). 1 Tel.: þ61 413 784 936 (mobile). 2 Tel.: þ855 23 426 372, þ855 12 855 735 (mobile). 3 Tel.: þ855 23 362 342, þ855 12 657 725 (mobile).

Ghana has been institutionalizing a set of coordinated mechanisms to measure and monitor progress in health coverage. These periodic assessments have over time shown significant country progress towards achieving a fifty--percent reduction in childhood morality rate by 2015 and a two--thirds reduction in maternal deaths within the same period. However, a lot more effort remains for Ghana to actually attain these Millennium Development Goals targets post 2015. The push for universal health coverage is now more important than ever and has necessitated the adoption of a systematic set of measurement and monitoring tools that will overtime depict effective country progress towards improved health outcomes, consolidating optimum health coverage. Ghana is working towards developing a system that is comparable with those in other countries of similar population structure and economic status particularly in Sub--Saharan Africa, to ensure more meaningful analysis of desired national health goals and outcomes. The purpose of this review is to determine whether Ghana as a country endorses universal health coverage and how well Ghana is positioned to achieve universal health coverage as well as which existing policies can or should be developed to achieve this. The review examines the systems operational for measuring universal health coverage in Ghana, strategies for identifying and addressing relevant gaps as well as which indicators will most appropriately assess progress towards universal health coverage. The review is contributing to the World Summary Points: 13 1. Ghana has an elaborate range of indicator to measure and monitor its health outcomes, however, there is 14 need for greater clarity on which indicators sufficiently measure true coverage and which ones measure 15 impact or output 16 2. Policy--wise, success of Ghana achieving universal health coverage will depend to a large extent on 17 Government leadership in promoting its key initiatives of community--based health care and services 18 (CHPS), NHIS and Decentralization to increase focus on preventive and promotive health actions rather 19 than large capital investments on hospital--based care in order to contain cost.

Bangladesh, the eighth most populous country in the world with about 153 million people, has recently been applauded as an exceptional health performer. In the fi rst paper in this Series, we present evidence to show that Bangladesh has achieved substantial health advances, but the country's success cannot be captured simplistically because health in Bangladesh has the paradox of steep and sustained reductions in birth rate and mortality alongside continued burdens of morbidity. Exceptional performance might be attributed to a pluralistic health system that has many stakeholders pursuing womencentred, gender-equity-oriented, highly focused health programmes in family planning, immunisation, oral rehydration therapy, maternal and child health, tuberculosis, vitamin A supplementation, and other activities, through the work of widely deployed community health workers reaching all households. Government and non-governmental organisations have pioneered many innovations that have been scaled up nationally. However, these remarkable achievements in equity and coverage are counterbalanced by the persistence of child and maternal malnutrition and the low use of maternityrelated services. The Bangladesh paradox shows the net outcome of successful direct health action in both positive and negative social determinants of health-ie, positives such as women's empowerment, widespread education, and mitigation of the eff ect of natural disasters; and negatives such as low gross domestic product, pervasive poverty, and the persistence of income inequality. Bangladesh off ers lessons such as how gender equity can improve health outcomes, how health innovations can be scaled up, and how direct health interventions can partly overcome socioeconomic constraints.

Background: This paper discusses national programs implemented in India, Pakistan, Malaysia, and Philippines to generate and apply evidence in making informed policy decisions on the approval, pricing, reimbursement and financing of medicines, diagnostics, and medical devices.

In this article, we use cultural theory to investigate the nature of health systems governance and management, showing that it may be helpful in identifying key aspects of the debate about how to promote universal health coverage. Cultural theory argues that ''how'' we govern and manage health services depends on what we think about the nature of government organizations and the legitimacy of their scope of action. The values that are implied by universal health coverage underlie choices about ''how'' health systems are governed and their organizations are managed. We draw two main conclusions. First, the translation of principles and goals into practice requires exceptional efforts to design adequate decision-making arrangements (the essence of governance) and management practices. Management and governance, or ''how'' policies are decided and conducted, are not secondary to the selection of the best policy solutions (the ''what''). Second, governance and management solutions are not independent of the values that they are expected to serve. Instead, they should be designed to be consonant with these values. Cultural theory suggests-and experience supports-the idea that ''group identity'' is favorable for shaping different forms of social life and public administrations. This approach should thus be a starting point for those who strive to obtain universal health coverage.

The public social policy and programme decisions that are made in low-income countries have critical effects on human social and development outcomes. Unfortunately, it would appear that inadequate attention is paid to analysing, understanding and factoring into attempts to reshape or change policy, the complex historical, social, cultural, economic, political, organizational and institutional context; actor interests, experiences, positions and agendas; and policy development processes that influence policy and programme choices. Yet these can be just as critical as the availability of research or other evidence in influencing decision making on policies and their accompanying programmes and the resulting degree of success or failure in achieving the original objectives. Ghana, a low-income developing country in sub-Saharan Africa, embarked on a national policy process of replacing out-of-pocket fees at point of service use with national health insurance in 2001. This paper uses a case study approach to describe and reflect on the complex interactions of context with actors and processes including political power play; and the effects on agenda setting, decision making and policy and programme content. This case study supports observations from the literature that although availability of evidence is critical, major public social policy and programme content can be heavily influenced by factors other than the availability or non-availability of evidence to inform content decision making. In the low-income developing country context there can be imbalances of policy decision-making power related to strong and dominant political actors combined with weak civil society engagement, accountability systems and technical analyst power and position. Efforts at major reform need to consider and address these issues alongside efforts to provide evidence for content decision-making. Without an analysis and understanding of the politics of reform and how to work within it, researchers and other technical actors may find their information to support reform is not applied effectively. Similarly, without an appreciation of the need for critical technical analysis to support decision making rather than an indiscriminate use of political approaches, political actors may find that even with the best of intentions, desired policy objectives may not be attained.

""Background:  The vision of Universal Health Coverage for the nation envisages a lot of primary care physicians working in underserved rural areas. Yet, very few of the current generation of doctors seem to be inclined or equipped for practicing in a primary care setting. While the healthcare need for the country has been clearlycharted out, the wants of young medical graduates have seldom been documented. The current study aims to document the career aspirations and apprehensions among interns graduating from a private medical college in south India. 
Methods:  A questionnaire based survey was carried out among 147 medical graduates undergoing their internship. The interns’ career aspirations, apprehensions and choices of postgraduation were documented.  Proportions and Fisher's exact test were used for statistical analysis. 
Results:  Personal interest & passion for the profession (45.3%), financial stability (43.5%) and parents’ wish (35.8%) were the primary factors quoted by the interns for choosing medicine as a career. Majority of the interns (73.7%) wish to join one or other post-graduation course while only around 10% were inclined
towards general practice and/or working in a primary care setting under government service. 
Conclusions: The wants of the current generation of doctors need to factored-in in the action plan towards achieving Universal Health Coverage. Incentives  and perks that appeal to the young medicos would attract them to join government service in underserved rural areas.""

Introduction: As high out-of-pocket healthcare expenses pose heavy financial burden on the families, Government of India is considering a variety of financing and delivery options to universalize health care services. Hence, an estimate of the cost of delivering universal health care services is needed.

Background: Assuring equitable universal access to essential health services without exposure to undue financial hardship requires adequate resource mobilization, efficient use of resources, and attention to quality and responsiveness of services. The way providers are paid is a critical part of this process because it can create incentives and patterns of behaviour related to supply. The objective of this work was to describe provider behaviour related to supply of health services to insured clients in Ghana and the influence of provider payment methods on incentives and behaviour.

The rising health care cost has reached the point where cost sharing from patients might be essential to sustain the health system. This report is aimed to synthesize lessons on cost charing policies in 10 countries; namely, Australia, Canada, Finland, Germany, Japan, Singapore, South Korea, Taiwan, R.O.C., United Kingdom, and United States of America.
The study comprises two components. The first is literature review general information of each country on its current health insurance systems, basic principles for cost sharing, approaches and rates used for cost sharing, mechanisms to protect the disadvantaged population, as well key concerns about implementing cost sharing policy. Second, a systematic review is used to explore the effects of cost sharing and copayment policies on health services access/utilization, out-of-pocket expenditures, health care expenditures, quality of care, administrative cost.

There is now widespread acceptance of the universal coverage approach, presented in the 2010 World Health Report. There are more and more voices for the benefit of creating a single national risk pool. Now, a body of literature is emerging on institutional design and organizational practice for universal coverage, related to management of the three health-financing functions: collection, pooling and purchasing. While all countries can move towards universal coverage, lower-income countries face particular challenges, including scarce resources and limited capacity. Recently, the Lao PDR has been preparing options for moving to a single national health insurance scheme. The aim is to combine four different social health protection schemes into a national health insurance authority (NHIA) with a single national fund-and risk-pool. This paper investigates the main institutional and organizational challenges related to the creation of the NHIA. The paper uses a qualitative approach, drawing on the World Health Organization's institutional and Organizational Assessment for Improving and Strengthening health financing (OASIS) conceptual framework for data analysis. Data were collected from a review of key health financing policy documents and from 17 semi-structured key informant interviews. Policy makers and advisors are confronting issues related to institutional arrangements, funding sources for the authority and government support for subsidies to the demand-side health financing schemes. Compulsory membership is proposed, but the means for covering the informal sector have not been resolved. While unification of existing schemes may be the basis for creating a single risk pool, challenges related to administrative capacity and cross-subsidies remain. The example of Lao PDR illustrates the need to include consideration of national context, the sequencing of reforms and the timescale appropriate for achieving universal coverage.

Background: Thailand has achieved universal health coverage since 2002 through the implementation of the Universal Coverage Scheme (UCS) for 47 million of the population who were neither private sector employees nor government employees. A well performing UCS should achieve health equity goals in terms of health service use and distribution of government subsidy on health. With these goals in mind, this paper assesses the magnitude and trend of government health budget benefiting the poor as compared to the rich UCS members. Figure 7 Payers and payment amount for IP public facility by wealth quintile, 2004. Note: Q1 -poorest 20% of population, Q5 -richest 20% of population. Circle sizes are proportional to number of the in-patients who were UCS beneficiaries for each quintile Limwattananon et al. BMC Public Health 2012, 12(Suppl 1):S6

Cost-effectiveness analysis (CEA) can help countries attain and sustain universal health coverage (UHC), as long as it is context-specific and considered within deliberative processes at the country level. Institutionalising robust deliberative processes requires significant time and resources, however, and countries often begin by demanding evidence (including local CEA evidence as well as evidence about local values), whilst striving to strengthen the governance structures and technical capacities with which to generate, consider and act on such evidence. In low-and middle-income countries (LMICs), such capacities could be developed initially around a small technical unit in the health ministry or health insurer. The role of networks, development partners, and global norm setting organisations is crucial in supporting the necessary capacities. Citation: Chalkidou K, Li R, Culyer AJ, Glassman A, Hofman KJ, Teerawattananon Y. Health technology assessment: global advocacy and local realities: Comment on " Priority setting for universal health coverage: we need evidence-informed deliberative processes, not just more evidence on cost-effectiveness.