摘要：Universal health coverage has become a rallying cry in health policy, but it is often presented as a consensual, technical project. It is not. A review of the broader international literature on the origins of universal coverage shows that it is intrinsically political and cannot be achieved without recognition of its dependence on, and consequences for, both governance and politics. On one hand, a variety of comparative research has shown that health coverage is associated with democratic political accountability. Democratization, and in particular left-wing parties, gives governments particular cause to expand health coverage. On the other hand, governance, the ways states make and implement decisions, shapes any decision to strive for universal health coverage and the shape of its implementation. Universal health coverage (UHC) has become a focal point in global health conversations. In the spirit of previous unifying concepts such as Health for All, basic health needs, and the Alma-Ata declaration, it presents a vision in which all citizens will enjoy (1) a strong and efficient health system that spans preventive and curative medicine, (2) affordable access to that health system, (3) access to relevant medicines, and (4) sufficient human resources for the health system. The 2010 World Health Report presented UHC as an objective and a strategy for its member states to reform, or design, their health systems. 1 UHC has been the focus of much research and policy prescription since then. Various authors have shown its implications for the health workforce and its governance, 2,3 health financing, 4 and management. 5 But is UHC likely to be attained? We draw on political science and public health literature to argue that politics and governance have been undervalued as key drivers for universal health coverage.
