Volume 46 | Number 6pt2 | December 2011

Abstract List

C. Jason Wang M.D., Ph.D., CHP/PCOR, Stacey M. Ellender Ph.D., Theodora Textor BA, Joshua H. Bauchner BA, Jen‐You Wu M.P.H., Howard Bauchner M.D., Andrew T. Huang M.D.


To understand the forces propelling countries to legislate universal health insurance.

Data Source/Study Design

Descriptive review and exploratory synthesis of historic data on economic, geographic, socio‐demographic, and political factors.

Data Extraction Methods

We searched under “insurance, health” on and oogle cholar, and we reviewed relevant books and articles via a snowball approach.

Principal Findings

Ten countries with universal health insurance were studied. For the five countries that passed final universal insurance laws prior to 1958, we found that two forces of “historical context” (i.e., social solidarity and historic patterns), one “ongoing dynamic force” (political pressures), and “one uniqueness of the moment” force (legislative permissiveness) played a major role. For the five countries that passed final legislation between 1967 and 2010, the predominant factors were two “ongoing dynamic forces” (economic pressures and political pressures) and one “uniqueness of the moment” force (leadership). In general, countries in the former group made steady progress, whereas those in the latter group progressed in abrupt leaps.


The lessons of more recent successes—almost all of which were achieved via abrupt leaps—strongly indicate the importance of leadership in taking advantage of generalized economic and political pressures to achieve universal health insurance.