The challenge of private insurance for public good.

A fundamental principle of WHO’s work in health financing is the concept of universal coverage. This requires access for all people to appropriate promotive, preventive, curative and rehabilitative health care at an affordable cost. This is one requirement of health for all and is consistent with the principle of equity in access. The objective of universal coverage is also associated with equity in financing, whereby households contribute to financing the health system on the basis of their ability to pay. The goal of universal coverage is accepted in most countries, though its realization is dependent on organizational mechanisms that allow financial contributions to the health system to be collected efficiently from different sources, that pool these contributions so that the risk of having to pay for health care is shared by all and not borne by each contributor individually, and that use these contributions to purchase or provide effective health interventions. A variety of different arrangements can be observed in how funds are raised, pooled and used for health care, and it is this mix that determines the efficiency and equity of health systems. Unfortunately, in the majority of the poorest countries, a major — and sometimes the primary — financing mechanism is out-of-pocket payments at the point of service, which is the most inequitable system of financing health care (1). The paper by Sekhri & Savedoff (pp. 127–134) provides some valuable information on the significant degree to which private health insurance exists in many countries. Although the label “private” is quite comprehensive and merits further scrutiny (2), the authors posit that it can be one stepping stone or critical component on the way to universal coverage. The potential of a such a trajectory is contingent on two key