« En chemin vers la couverture sanitaire universelle ». Les enjeux de l'intégration des pauvres aux systèmes de santé

Universal Health Coverage (UHC), is defined by the World Health Organization (WHO) as ?ensuring that all people can use the promotive, preventive, curative and rehabilitative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship?. In a Sociology of Public Action perspective, then, UHC appears as a benchmark for public policies, or as a framework for progress. The first part of this paper outlines the institutional path of this benchmark, as the product of an evolution in the way of thinking about public health issues at the international level. The second part presents the pathways ?towards UHC? of three countries that we selected on the basis of our research experience, and highlights three types of linkages between stakeholders : ?statist?, ?negociated market? and ?subsidiarity-based?. Finally, we discuss some of the issues around implementation of the UHC benchmark, mainly the issue of control and regulation, by national public policies, of the commodification of health care, and the political aspect of cost and risk pooling.