There are compelling reasons to justify the role of states in health provision.1 First, there are equity and social justice considerations – the poor cannot always afford health care. Health is a basic need and access to health care is a fundamental right. Any democratic government therefore has the responsibility to ensure that its people have access to health care. Support can be provided to the poor through health insurance or direct provision of health services. The health system in a country can be one that provides universal access or targeted support. While there are debates on the form in which health care should be provided (public vs. private, state funding vs. state provision), it is well accepted there is a need for governments to spend on the health care of the population and that out of pocket health care expenditure must be minimised (CSDH 2008).