Ravindran BMC Public Health 2012, 12(Suppl 1):S4 http://www.biomedcentral.com/1471-2458/12/S1/S4 countries, the uninsured have to pay out of pocket for health care services. Where there is a basic package of services financed by tax revenue and free at the point of service delivery, costs of other health services have to be met by out-of-pocket payment (OOP), or through a combination of different types of health insurance. Women’s out-of-pocket payments has been found to be systematically higher than that of men [19] at least in part because of the high financial burden related to and paying for delivery care and other reproductive health services [20,21]. Another contributing factor may be the higher prevalence of a number of chronic diseases and mental health problems among women. High out-of- pocket expenses results in a higher proportion of women than men with unmet need for health services [22-24] not only among low income groups but in some settings, also among the wealthiest. For example, data from Latvia on unmet need for health services by sex and income quintile shows that while unmet need for health services was higher for the lowest income quintile and decreased with increasing income, women had a higher unmet need for health services than men in every income quintile [25]. Non-coverage of contraceptive services and other preventive or promotive sexual and reproductive health services is likely to contribute to unmet need for these services, judging from studies about the low willingness to pay for such services [26,27]. The extent of financial protection provided by Social Protection Health Schemes and Conditional Cash Trans- fers depends on the extent to which they cover associated non-medical expenses such as drugs and transportation. In the Safe Delivery Incentive Programme (SDIP) in Nepal payments, the cash incentive amount of NRP 1000 covered at most 25% of the cost of a normal delivery and only 5% of the cost of a caesarean section, not providing effective protection against catastrophic health expendi- tures [28]. Achieving universal coverage of women: examples of Mexico and Thailand Mexico Mexico introduced the Seguro Popular or Popular Insur- ance in 2004 to expand coverage to nearly half the popula- tion who were not covered by the two insurance schemes in place for those in formal employment: the Mexican Social Security Institute (IMSS) and the Institute for Social Security and Services for State Workers (ISSSTE). Enrol- ment is voluntary. An annual fee is charged, ranging from US$ 60 to US$ 950 based on income levels, but the lowest income quintiles are exempted from payment [29]. The Seguro Popular provides access to 255 health inter- ventions and drugs prescribed for these, covering 90% of medical conditions seen in outpatient departments. In addition, 18 high cost interventions are covered by a Page 4 of 7 special fund. Interventions covered include a wide range of sexual and reproductive health services including mammography and cervical cancer screening as well as non-communicable diseases and mental health [29]. Entire families are enrolled in the Scheme ensuring that women are not excluded. Studies carried out within 2-3 years of implementation show an increase in deliveries by skilled birth attendants, mammography, cervical cancer screening and treatment of hypertension, among others [30] and an improvement in all indicators of financial protection [31]. Thailand Thailand adopted Universal Health Care Coverage in 2001 to expand coverage to those who were not covered by existing insurance schemes. Financing is from tax rev- enue. Entire households are covered. The Benefits pack- age is comprehensive and includes preventive, promotive, curative and rehabilitative services with a small number of exceptions. In 2006, ARV for HIV was included in the Benefits package and in 2008 renal replacement therapy was added on [32]. A wide range of sexual and reproduc- tive health services are covered. However, safe abortion service is covered only for rape victims and for those whose health is at risk. Essential obstetric care is covered only for the first two deliveries. Universal coverage successfully reduced incidence of catastrophic health expenditure from 5.4% in 2000 to 2% in 2006. Not a single household had experienced impov- erishment due health expenditure in 21 of 76 provinces in 2008 [33]. A study covering 40,000 women in 2005-06 found that there were almost no rich-poor gaps in access to maternal health care and contraceptive services [34]. Moving from universal coverage to universal access Even when universal coverage has been achieved, univer- sal access remains a challenge for many reasons including resource constraints, unequal distribution of existing health resources and organisational and managerial bot- tle-necks. Studies have also shown that in the absence of specific efforts to prioritise inclusion of those from mar- ginalized sections of society, measures to achieve univer- sal coverage could in fact widen inequities in health because access increases first in the better-off groups and then trickles down to the rest [35]. Gender-power inequalities which underlie women’s limited access to resources and lack of decision-making power are an important barrier to moving from universal coverage to universal access. For example, in six coun- tries of the WHO-Western Pacific Region (Cambodia, Nauru, Philippines, Samoa, Solomon Islands and Tuvalu), 78- 97% of women aged 15-19 years had one or more problems in accessing health care when they were sick, many of these not related to affordability. About a fifth had problems in getting permission for treatment,