Perspectives Universal health coverage: does anything go? Joseph Kutzin financing instrument for promoting efficiency in the use of funds is purchasing, and more specifically, strategic purchasing. Developing the skills and systems needed for this is at the heart of strengthening national health financing systems, as it requires ongoing use and analysis of data generated by the system, which enables countries to adapt their systems to changing circumstances. As with the term “insurance”, much attention is given to initiatives described as schemes:“performance-based funding”,“results-based financing” or “payfor-performance”, etc. The important question is not the “success” of a given scheme or project; undue attention has probably been given to trying to prove whether or not these schemes work. 11 This is not the central issue. We know that passive purchasing methods, whether in the form of unmanaged fee-for-service reimbursement or rigid line-item budgets, harm efficiency. Thus, the point is that these initiatives should be more appropriately conceived (and evaluated) as entry points to move away from passive methods and strengthen purchasing arrangements within a national health financing system, not as stand-alone projects or time-limited interventions.