OBJECTIVES: Universal health coverage for all persons worldwide was the focus of the First Global Symposium on Health Systems Research (Montreux, Switzerland; Nov 2010). As part of a larger initiative sponsored by The Rockefeller Foundation to transform health systems (accessible, affordable, equitable), we studied how coverage decisions are made by publicly funded health care programs in low- and middle-income countries (LMICs). METHODS: An online survey was administered to representatives of >30 health care programs in LMICs. In-depth case studies, based on ethnographic research methodologies, were conducted on a subset of programs to address the following research questions: Who is covered in the program? What health conditions and services are covered?  What are the cultural, political, ethical, scientific, and economic factors that influence coverage decisions? What are the administrative processes for coverage decisions? What evidence is used to determine coverage? What processes are used to monitor outcomes? RESULTS: Maternal health, cardiovascular diseases, and preventing catastrophic illness that results in large financial burden to the public tend to be the highest priority conditions for coverage.  Dental care and treatment for substance abuse are the least commonly covered conditions. Most programs provide coverage for drugs; policies for drugs are based mostly on published reports of clinical safety and efficacy. Factors influencing decisions included limiting the financial risk from catastrophic illness, ability to scale programs, and equity issues. Evidence used for coverage decisions was based on medical literature, regional and global health research, and coverage policies of other programs. Some programs undertake economic appraisals and comparative effectiveness assessments in determining policies. CONCLUSIONS: This ethnographic survey on how coverage policies are being developed provides opportunities for LMICs to share their experiences with each other, and thus further develop and refine their programs to meet goals of accessible, affordable, and equitable heath care for all.