Several developing countries lack a medical insurance system with universal coverage, so access to medical services is not easy, principally for people living in poverty. One of the biggest issues for designing healthcare systems in developing countries is how to include those not formally employed. Therefore, it is important to implement targeted interventions so that the most in need are not left out. The World Health Report 2000 distinguishes four functions for the health system to fulfill: (i) the provision of health services; (ii) the creation of the necessary investment and training resources for health; (iii) health financing; and (iv) government stewardship. The need for Health insurance in the developing world is again relevant because there is no compulsory health insurance in Pakistan. This special communication is a discussion of how we in Pakistan have proposed a design for the first ever indigenous health insurance system for the poor. What various other developing countries have done and the policies adopted to provide health coverage to their people have also been reviewed.