Universal health care coverage (UHC) is now an integral part of the global health agenda, with the adoption of a resolution of the United Nations by most country governments in 2012 that committed to attain and sustain UHC for their populations [1]. The subsequent commitment to health intervention and technology assessment at the 2014 World Assembly (the World Health Organization’s [WHO’s] decision-making body) [2] and the numerous public statements by leaders at the WHO and the World Bank to the same effect reinforced this view. At the center of UHC is “a set of services that is available when needed without causing financial hardship to the population” [3]; indeed, the UN resolution describes UHC as “access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost,” and also calls for UHC to deliver equitable opportunities for the “highest attainable standard of physical and mental health.” The obvious questions remain: How best may countries determine what is truly “key”? How might that judgment change as time passes and further development happens? By what trajectory might the barriers to access be removed and full population coverage achieved—not merely in name but also in reality?

For countries to deliver on their UHC aspirations, they need to be able to create fit-for-purpose institutions and processes through which either advice will be given or decisions made. Common desirable features of such processes include the use of the best possible evidence, the participation of relevant stakeholders, and sufficient transparency for decision makers to be held to account. Countries also need to decide which services and interventions are the main priorities. To do this it will be necessary to describe and justify the associated resource requirements, target budgets and payments, and the expected outcomes for the public of reforming service delivery and supply chains. Countries also need to determine the preferred mix of public and private agencies within their systems. Within global targets and metrics, it will be up to countries themselves to explicitly determine and adjust their priorities for public spending on health to achieve UHC goals, such as selecting a benefits “package,” determining social insurance entitlements and short-term co-payments, and using instruments such as the Essential Medicines List to good purpose [4,5,6,7].