title: A proposed framework for understanding the forces behind legislation of universal health insurance: lessons from ten countries.
abstract: OBJECTIVE
  To understand the forces propelling countries to legislate universal health insurance.
  
  
  METHODS
  Descriptive review and exploratory synthesis of historic data on economic, geographic, socio-demographic, and political factors.
  
  
  METHODS
  We searched under "insurance, health" on MEDLINE and Google Scholar, and we reviewed relevant books and articles via a snowball approach.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, Center for Policy, Outcomes and Prevention Stanford University School of Medicine, Stanford, CA 94305-6019, USA. cjwang1@stanford.edu
authors.forename: C Jason
authors.initials: CJ
authors.lastname: Wang
authors.forename: Stacey M
authors.initials: SM
authors.lastname: Ellender
authors.forename: Theodora
authors.initials: T
authors.lastname: Textor
authors.forename: Joshua H
authors.initials: JH
authors.lastname: Bauchner
authors.forename: Jen-You
authors.initials: JY
authors.lastname: Wu
authors.forename: Howard
authors.initials: H
authors.lastname: Bauchner
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Huang
mesh_terms: D005380:Financing, Government / Q000706:statistics & numerical data; D018166:Health Care Reform / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007342:Insurance Benefits / Q000191:economics / Q000706:statistics & numerical data*; D009313:National Health Programs / Q000458:organization & administration; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D019472:Universal Health Insurance / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*
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