Editorial: Universal health coverage and universal access

Bulletin of the World Health Organization
Volume 91, Number 8, August 2013, 545-620

Universal health coverage and universal access
David B Evans a, Justine Hsu a & Ties Boerma a
a. World Health Organization, 20 avenue Appia, CH-1211 Geneva 27, Switzerland.
Bulletin of the World Health Organization 2013;91:546-546A. doi: http://dx.doi.org/10.2471/BLT.13.125450 [PDF]

Universal health coverage has been set as a possible umbrella goal for health in the post-2015 development agenda.1 Whether it is a means to an end or an end in itself and whether it is measureable are subjects of heated debate.2 In this issue of the Bulletin, Kutzin argues that universal health coverage not only leads to better health and to financial protection for households, but that it is valuable for its own sake.3 More recently, attention has shifted to just what the goal should be: whether universal coverage or universal access. This editorial focuses on this question.

Universal health coverage is the goal that all people obtain the health services they need without risking financial hardship from unaffordable out-of-pocket payments.4 It involves coverage with good health services – from health promotion to prevention, treatment, rehabilitation and palliation – as well as coverage with a form of financial risk protection. A third feature is universality – coverage should be for everyone. Although many countries are far from attaining universal health coverage, all countries can take steps in this direction.3,4 Improving access is one such step.

Universal health coverage is attained when people actually obtain the health services they need and benefit from financial risk protection. Access, on the other hand, is the opportunity or ability to do both of these things. Hence, universal health coverage is not possible without universal access, but the two are not the same…