A comprehensive assessment of universal health coverage in 111 countries: a retrospective observational study

Abstract

Background The goal of universal health coverage (UHC) requires that everyone receive needed health services, and that families who get needed services do not suffer undue financial hardship. Tracking progress towards UHC requires measurement of both these dimensions, and a way of trading them off against one another. Methods We measured service coverage by a weighted geometric average of four prevention indicators (antenatal care, full immunisation, and screening for breast and cervical cancers) and four treatment indicators (skilled birth attendance, inpatient admission, and treatment for acute respiratory infection and diarrhoea), financial protection by the incidence of catastrophic health expenditures (those exceeding 10% of household consumption or income), and a country's UHC performance as a geometric average of the service coverage index and the complement of the incidence of catastrophic expenditures. Where possible, we adjusted service coverage for inequality, penalising countries with a high level of inequality. The bulk of data used in this study were from the World Bank's Health Equity and Financial Protection Indicators database (2019 version), comprising data from household surveys. Gaps in the data were supplemented with other survey data and (where necessary) non-survey data from other sources (administrative, modelled, and imputed data).Findings A low incidence of catastrophic expenses sometimes reflects low service coverage (often in low-income countries) but sometimes occurs despite high service coverage (often in high-income countries). At a given level of service coverage, financial protection also varies. UHC index scores are generally higher in higher-income countries, but there are variations within income groups. Adjusting the UHC index for inequality in service coverage makes little difference in some countries, but reduces it by more than 10% in others. Seven of the 12 countries for which we were able to produce trend data have increased their UHC index over time (with the greatest average yearly increases seen in Ghana [1•43%], Indonesia [1•85%], and Vietnam [2•26%]), mostly by improving both financial protection and service coverage. Some increased their UHC index, despite reductions in financial protection, by substantially increasing their service coverage. The UHC index decreased in five of 12 countries with trend data, mostly because financial protection worsened with stagnant or declining service coverage. Our UHC indicators (except inpatient admissions) are significantly and positively associated with GDP per capita, and most are correlated with the share of health spending channelled through social health insurance and government schemes. However, associations of our UHC indicators with the share of GDP spent on health and the shares of health spending channelled through non-profit and private insurance are ambiguous.Interpretation Progress towards UHC can be tracked using an index that captures both service coverage and financial protection. Although per-capita income is a g...

Clinical research in cancer palliative care: a metaresearch analysis

“…Indeed, the physiopathology of symptoms may differ between different clinical settings, which should be taken into account to deliver the best treatment to patients. In addition to these biological factors, and again in alignment with WHO definition of UHC, broader determinants of health (including social, economic, environmental, as well as people’s characteristics and behaviours) should be considered and incorporated into future palliative care research 27 28…”

A vulnerability index for COVID-19: spatial analysis at the subnational level in Kenya

“…Constructing SVI COVID-19 disease vulnerability indices have been created using different approaches ranging from technical [50][51][52] to simpler approaches. [53][54][55] In this analysis, the indices were created following approaches used to define universal health coverage (UHC) and equity in maternal and child health, [56][57][58][59][60] infectious disease vulnerability index 61 and some of the recent COVID-19 vulnerability indices. [53][54][55] To create SVI for Kenyan subcounties, three subdomain indices were first defined based on major thematic areas related to COVID-19 vulnerability (table 1 and figure 1).…”

On the Measurement of Financial Protection: An Assessment of the Usefulness of the Catastrophic Health Expenditure Indicator to Monitor Progress Towards Universal Health Coverage

“…However, the current health coverage indicator only includes data on a limited number of key health services, many of which currently lack data to be adequately measured across countries and over time. 29 As a result, the current UHC measurement strategy is unlikely to be adequately distinguishing between improvements in UHC due to changes in FP without controlling for changes in the proportion of the population with unmet need. For example, if rates of unmet need were to increase in a country, we might estimate lower levels of CHE in that country.…”