**Abstract**

The choice of a health care financing system can have both good and unintended devastating consequences on access to and delivery of quality affordable universal health care of a country. This paper aims to explore successful factors of health insurance schemes and health policies that will ensure universal health coverage (UHC). The chapter explores equity or fairness as defined by the theory of justice to elucidate why there tend to be inequities in health insurance coverage. It proposes measures that could be adopted to ensure social health protection and financial sustainability of health financing schemes to achieve universal health coverage in low- and middleincome countries (LMICs). Good health is an essential capital good for promoting well-being and longevity, and quality health care is a derivative of good health among other social and economic determinants of health. Universal health insurance schemes provide financial risk protection for many population groups, especially the less privileged, against catastrophic episodes of illness and injury. However, inequities in health care are pervasive and have impoverished many because of catastrophic health care expenditures. Health insurance based on solidarity and progressive tax financing system with premium exemptions for the vulnerable, might be best for LMICs.

**Keywords:** health insurance, social health insurance, universal health coverage, low- and middle-income countries, equity, social justice, health care financing systems financial risk protection
