Canada, Chile, Colombia, Costa Rica, and Cuba have
all achieved universal health care—each with its own
mix of public-private coverage and benefits.
of UniveRsal
HealtH CaRe CoveRage
tHe five Cs
by Philip Musgrove
arlier this year, the U.S. Congress passed a landmark
health care reform bill that broadened access to health
insurance for millions of Americans. Even as U.S. pundits and politicians continue to argue about the meaning and the scope of the bill, many other countries in
the region might reasonably wonder what the fuss is all
about. At least seven countries in the Americas already
have universal health coverage or something close to it,
offering lessons for the region, including the U.S.
Nevertheless, inequities in access to and quality of
care continue across the region. Examining the different national paths taken toward universal health care
can shed light on how those systems work now—and
on what steps might be necessary to improve them, so
that they can serve as instructive models for other countries in the region.
The processes that affect the evolution of different universal health care systems range from the political to the
sociological and geographical. What follows is a snapshot
view of five of the hemisphere’s leading universal health
care systems and the variations between them: Canada,
Chile, Colombia, Costa Rica, and Cuba. The fact that each
of the universal health care models analyzed occurs in
a country whose name starts with “C” is a coincidence.
First, it is important to establish the commonalities
of the universal health systems and where they are
likely to differ. All of the region’s universal health care
systems, as with insurance coverage in general, cover
individual or personal health services while excluding
certain public health functions such as the regulation
of providers, practices and medications and the provision of health-related services that in principle apply to
the whole population. These functions are always the
responsibility of a ministry of health. When coverage
is incomplete, it is usually because of the difficulty of
reaching remote geographic areas or minority groups
that differ culturally or linguistically from the rest of
the population.
In practice, universal coverage varies in some important dimensions. While every person (citizen, resident or
some other definition) may be covered, this is not necessarily true of every possible medical service. Moreover, it
may be nearly impossible to extend formal coverage to
every member of a national population. Nomads, homeless people and remote indigenous populations may always represent an ill-defined residual responsibility of
