Universal health coverage: good health, good economics.

862 www.thelancet.com Vol 380 September 8, 2012 Underpinning the trends examined in The Lancet’s Series on universal health coverage are several points that deserve deeper appreciation. Call them EPIC—a fi tting acronym, in view of the epic transition now underway as the world moves towards universal coverage. The E in EPIC is for economics. Good health is not only a consequence of economic development, but also a driver of it, since healthier people can do mo re (greater productivity, more entrepreneurialism, improved educational performance, and reduced poverty). Good health systems not only enhance these benefi ts by improving health but also yield additional economic benefi ts. In particular, improved fi nancial protection for families against large medical bills reduces their risk of fi nancial ruin and makes assets and savings more secure, enabling them to save more; when many families benefi t, their increased economic activity can stimulate improved economic development. The 1993 World Development Report, Investing in Health, emphasised this idea of health as an investment rather than an expenditure. The 2001 report of the Commission on Macroeconomics and Health took this idea further, showing that a 10% improvement in life expectancy at birth is associated with annual economic growth increases of 0·3–0·4%. P is for policies and politics. The importance of good policies and good management of the political challenges is compellingly evident from the huge diff erences in health achievements between countries with similar Universal health coverage: good health, good economics fi nances are vastly more important than what outsiders bring through development aid. The papers in the accompanying Series in The Lancet investigate the evidence for universal health coverage. Rodrigo Moreno-Serra and Peter Smith explore the eff ects of progress towards universal health coverage on population health, while William Savedoff and colleagues delve into the political and economic dimensions of the story. A third paper, by Gina Lagomarsino and colleagues, examines the structure and progress of some health insurance reforms in low-income and lower-middleincome countries. Finally, in an accompanying Viewpoint, Jeff rey Sachs calls for continued progress and argues for a large role for the public sector. Among the many important messages are these two. First, since so many countries are moving so strongly towards universal health coverage, attention should now focus not on whether but on how to make the most of this transition. Second, universal health coverage is an opportunity but not a guarantee for progress: getting things right now can have big payoff s later, but letting things go wrong initially can be highly problematic and costly. The precise contours of what will emerge in the decades ahead in each country undertaking reform is not entirely clear, but, as this Series and many country examples suggest, we are getting closer to a time when this third transition will be achieved and families will no longer be at risk of having the cost of sickness ruin their lives. Judith Rodin, *David de Ferranti Rockefeller Foundation, New York, NY, USA (JR); and Results for Development Institute, Washington, DC 20005, USA (DdF) [email protected]