The paper asks whether the pursuit ofuniversal coverage by a wide range of free governmentservices constitutes the most promising approach to meetingthe needs of disadvantaged population groups. The responsegiven to that question is probably not. The record to datepoints clearly to the danger that the benefits of subsidizedgovernment health services will flow primarily to thebetter-off, rather than to the poor for whom the servicesare intended. While there is no perfect approach to dealingwith this issue, the record also points to severalapproaches that can significantly ameliorate the situation.Two of them, discussed in the paper, are the adoption oftargeting measures to increase the proportion of benefitsfrom government expenditures that flow to the poor; and thedevelopment of alternative, self-sustaining servicefinancing and delivery mechanisms to serve the better-off.Successful implementation of approaches like these wouldallow governments to focus their efforts to achieveuniversal free coverage on a limited number of interventionsthat are particularly important for poor groups.
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