Allotey et al. BMC Public Health 2012, 12(Suppl 1):S1 http://www.biomedcentral.com/1471-2458/12/S1/S1 Viroj and colleagues give a thorough account of the UHC scheme in Thailand that covers some 47 million people not otherwise covered by the private of govern- ment sectors. Employing data from a series of nationally representative household surveys conducted between 2003 and 2009, they were able to look at health service utilisation across wealth quintiles, answering a funda- mental question about equity and access. The positive view of the Thai UHC is attributed to the quality and geographical coverage of health infrastructure, function- ing financing, a functioning primary healthcare system, and zero co-payments at the point of service. It is now accepted, however, that a health system is not about the top-down provision of care. The population will have a view about the quality, accessibility, value, and appropriateness of the services, and this needs to be taken into account. Delivery of high quality services that a population does not want is inconsistent with a modern rhetoric of health systems responsiveness. Ma and collea- gues demonstrate the value of looking at residents’ satis- faction with their health services. Using data from a stratified random sample of Shanghai residence they are able to identify where health systems may be under-per- forming, and through sub-group analyses, they can also identify whether the system is working better for some strata of the population than others. Disadvantage groups, for instance, identified lower levels of satisfaction with the health related services than less disadvantaged groups. Implementation Most of the papers in this Supplement present insights for the implementation of UHC such as the approaches to monitoring and evaluation discussed by Tang et al., Viroj et al, and Ma et al., or the insights into financing provided by van der Heever, and Chua and Cheah. Sed- doh and Akor contextualise the implementation of UHC with a case study of social insurance in Ghana. They pro- vide critical insights into stakeholder processes and the need to engage with both politics and technical expertise. Concluding remarks Universal coverage is a noble health goal especially for low and middle income countries, but it is being challenged by a range of obstacles from within and outside the health sector. From an economic viewpoint, resources are always limited in any context, universal coverage can never be open-ended and universal access to all available health ser- vices does not necessarily need to be taken as the ultimate goal. On the contrary, a systematic and dynamic approach to formulate the appropriate covered services of any uni- versal coverage system is fundamental to its sustainability. This should ideally start with a clear, contextually specific definition of preferred health outcome goals that is used Page 3 of 3 to guide the determination of health and health related services as well as service goals for achieving such out- comes, which would be key in determining a core benefit package for universal access. Governments have a responsibility to ensure that all providers, public and private, operate appropriately and attend to patients’ needs cost effectively and efficiently. Achieving the goal of universal coverage requires expanding and improving the three facets of universality; the breadth and depth of health services, and levels of financial protection. While the primary mandate and social responsibility lies with the government, there is a growing call and recognition for the private sector to play a more substantive role. Nonetheless, there are groups of people slip through the gaps in most systems, and patterns of exclusion from services vary. In preser- ving and promoting health equity and equality, one has to be aware of who should benefit the most, as free pub- lic services under the umbrella of universal coverage may also be captured by the rich, who use them more than the poor, even though their need may be less. Competing interests The authors declare that they have no competing interests. Acknowledgements This article has been published as part of BMC Public Health Volume 12 Supplement 1, 2012: Universal Coverage: Can We Guarantee Health For All?. The full contents of the supplement are available online at http://www. biomedcentral.com/bmcpublichealth/supplements/12/S1. Author details 1School of Medicine and Health Sciences, Monash University, Sunway Campus Malaysia. 2Duke Global Health Institute, Duke University, Durham, NC, USA. 3Prince Court Medical Center, Kuala Lumpur, Malaysia. Published: 22 June 2012 References 1. MONASH University - Panelists and Presenters | projects. 2012 [http:// www.med.monash.edu.my/gph/projects/panelists-and-presenters.html]. 2. Global Health Oration 2011- Tim Evans.pdf. 2012 [http://c770304.r4.cf2. rackcdn.com/Symposium/Prof%20Tim%20-%20oration.pdf]. 3. UHC for the hard to reach_Allotey.pdf. 2012 [http://c770304.r4.cf2. rackcdn.com/Symposium/Prof%20Pascale.pdf]. 4. Allotey P, Reidpath DD, Yasin S, Chan CK, de-Graft Aikins A: Rethinking health-care systems: a focus on chronicity. Lancet 2011, 377(9764):450-1. 5. Jian W, Chan KY, Reidpath DD, Xu L: China’s rural-urban care gap shrank for chronic disease patients, but inequities persist. Health Aff (Millwood) 2010, 29(12):2189-96. doi:10.1186/1471-2458-12-S1-S1 Cite this article as: Allotey et al.: Universal coverage in an era of privatisation: can we guarantee health for all? BMC Public Health 2012 12 (Suppl 1):S1.