Until very recently, universal coverage (“UC”) has been achieved in the health systems primarily in the wealthiest countries. Though there have been notable exceptions, including Cuba, it has been assumed that most of the world’s peoples would have to wait until economic development in their countries lifted them into the world’s upper class. The successful UC initiatives of middle-income countries such as Mexico, Thailand, and Taiwan demonstrated that UC was achievable without very high national GDP. Can Universal Coverage be achieved in even the world’s lowest-income countries? China’s recent health reform, which in three years has extended health coverage to 95% of Chinese citizens, including innovative financing initiatives in some of the poorest provinces, has focused the attention of governments of low-income countries on UC. The World Health Organization’s annual report of 2010, Health Systems Financing: The Path to Universal Coverage identified the prospects for UC in even the least-developed countries and sparked an international effort to pursue this once-elusive goal. While maintaining a constructive and optimistic frame of mind is essential for progress toward UC, it is necessary also to identify the key ethical dilemmas arising in trying to extend the health system to all with so few resources.

The choices are unavoidable:

• Between goals of UC (including financial protection against catastrophic medical expenses; health; and personal and national overall wellbeing); 
• Between dimensions of UC (who is covered; what is covered; what share of costs are covered); and
• Trade-offs within and between each of these. Each country will resolve these dilemmas in its own way.

Our hope is that this conference will enhance their capacity for ethical deliberation in UC, so that the ethical choices can be made responsibly and thoughtfully.

Conference co-sponsors include: The Division of Medical Ethics and the Department of Global Health and Social Medicine at Harvard Medical School, the Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics and the Edmond J. Safra Center for Ethics, Harvard Global Health Institute, Department of Global and Public Health, University of Bergen, and with support from the Oswald DeN.Cammann Fund.