Where the bulk of the labour force is already employed, government policies that extend insurance coverage to the rest of the population – including the self-employed, the elderly and the poor – remove the inequities inherent in multi-tiered systems of health financing and expand the content of the universally available package of care.
Whilst most high-income countries have provided for at least a basic comprehensive health insurance, only a few middle-income countries have had the combination of adequate financial resources, political resolve and administrative capacity to achieve universal insurance coverage. Korea's bold initiative to create a national health insurance system from scratch between 1978 and 1989 and Costa Rica's efforts in the 1980s to universalize a system that had previously covered only the industrial labour force show that this is a difficult but achievable goal.
When insurance coverage becomes universal, subsidies actually end up targeting the poor and are thus progressive.