Authors Davidson Gwatkin and Alex Ergo warn that universal health coverage is much more difficult to achieve than to advocate. And people who are poor could well gain little until the final stages of the transition from advocacy to achievement, if that coverage were to display a trickle-down pattern of spread marked by increases first in better-off groups and only later in poorer ones. Should the resulting rise in inequality endure for an extended time—or worse, become permanent as a drive for universal coverage falls short of fully realizing its goal—the result would be to reduce rather than enhance health equity. The authors call for an approach called progressive universalism. At its centre lies a determination to ensure that people who are poor gain at least as much as those who are better off at every step of the way toward universal coverage, rather than having to wait and catch up as that goal is eventually approached.
(The Lancet, Volume 377, Issue 9784 <http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2962058-2/fulltext> , Pages 2160 – 2161, 25 June 2011)