First, due to limited revenue-raising capacity as well as fiscal sustainability issues, switching to a tax-funded universal health system would imply lower health benefits than those provided by current contributory programmes (Ribe et al, 2010), thus reducing the effective coverage of those currently covered by such programmes. The better-off segments of the population could resort to private insurance as a complement (top up). In addition, the higher the population coverage of existing social security programmes, the higher the resistance to this change is likely to be.