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What people are saying about this paper

Professor Ronald Labonté, University of Ottawa
The American jurist, Oliver Wendell Holmes, once commented that 'taxes are the price they pay for civilization.' As this compelling briefing paper argues, they are also the price we must pay if we want just and equitable access to health care. In the wake of the 2008 financial crisis, it is surely time that the case for progressive tax reform, both nationally and internationally, assumed priority in public health policy and advocacy.

Professor Valery Ridde, University of Montreal/CRCHUM
To move towards universal health coverage without thinking about access to healthcare for the poorest would be nonsense, at the very least at the level of ethics and equity. The report comes at the right moment and reminds us of this obvious fact. It is indeed time to act.

Professor David Sanders, University of the Western Cape
A timely, clear and important publication from Oxfam. This report makes it clear that health insurance schemes, often promoted by the World Bank and other donors, invariably disadvantage the poorest and unhealthiest.

Professor Di McIntyre, University of Cape Town
This paper highlights some of the key issues in relation to financing for UHC and promises to contribute positively to current debates.

Dr Jane Chuma, KEMRI-Wellcome Trust Research Programme, Nairobi
Oxfam’s report clearly highlights the importance of adopting context specific financing mechanisms that meet the needs of the poor as well as the rich. Governments, policy makers, and funders should rally behind the report’s recommendations.

Universal Health Coverage: Why health insurance schemes are leaving the poor behind

Universal Health Coverage: Why health insurance schemes are leaving the poor behind
36 pages

Averill, Ceri
Marriott, Anna

Publication date
09 Oct 2013


Oxfam International

Briefing paper

Universal Health Coverage is about the right to health. Everyone – rich or poor – should get the health care they need without suffering financial hardship. Unfortunately, some donors and developing country governments are promoting health insurance schemes that exclude the majority of people and l may also reinforce inequality – by prioritizing people who are formally employed and excluding the most poor and marginalized who cannot afford to pay premiums, especially women.

However, a number of developing countries are rejecting this model and prioritizing general government spending for health to successfully scale up health coverage. Funding through progressive taxation and international aid is the key to achieving Universal Health Coverage. Oxfam estimates that improving tax collection in 52 developing countries could raise an additional $269bn – enough to double health budgets in these countries. 

This paper explains why urgent action on global tax evasion and avoidance is needed to ensure that countries can generate and retain more of their own resources for health. Donors and governments should abandon unworkable insurance schemes and focus on financing that delivers universal and equitable health care for all.