The study analyses the evolution of the supply and consumption of public healthcare services within the municipality of São Paulo between 2000 and 2012. In the period services offered grew and the disparity between the supply and consumption of public health services across the areas with the best and worst indices of income, education and health decreased. To explain these results we discuss the municipal policies adopted during the period and explore their relation with both electoral competition and the commitment to universal access to health care by a group of politicians and health professionals.