Monitoring Frameworks for Universal Health Coverage: What About High-Income Countries?

Abstract

Implementing universal health coverage (UHC) is widely perceived to be central to achieving the Sustainable Development Goals (SDGs), and is a work program priority of the World Health Organization (WHO). Much has already been written about how low- and middle-income countries (LMICs) can monitor progress towards UHC, with various UHC monitoring frameworks available in the literature. However, we suggest that these frameworks are largely irrelevant in high-income contexts and that the international community still needs to develop UHC monitoring framework meaningful for high-income countries (HICs). As a first step, this short communication presents preliminary findings from a literature review and document analysis on how various countries monitor their own progress towards achieving UHC. It furthermore offers considerations to guide meaningful UHC monitoring and reflects on pertinent challenges and tensions to inform future research on UHC implementation in HIC settings.

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

“…Development of the UHC effective coverage measurement framework and selection of effective coverage indicators was based on consultation, methods testing, and refinement via the WHO ERG on the GPW13 from 2017 to 2019; 7,33,38,39 the background and details of this process are provided in the appendix 1 (pp 12-28). The resulting framework (figure 1) and currently included effective coverage indicators (table 1) sought to represent the range of different health services that populations need across their lifespans while recognising present data gaps and appeals for measurement parsimony (appendix 1 pp [18][19][20][21][22][23][24][25][26][27][28].…”

“… 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 Although each effort has shown recognition of prevailing data limitations and challenges with operationalising UHC service coverage across myriad settings, 21 , 24 they each have limitations in how well they capture country-level trends and health service needs across the life course. 17 , 27 , 28 , 29 , 30 , 31 First, current indices primarily rely solely on household survey point estimates from multi-country survey series, which can lead to various measurement limitations (ie, being primarily focused on low-income to middle-income countries; restricted sets of interventions captured; and lags in data availability for understanding trends). Second, most indices include either risk factor indicators (eg, prevalence of non-smoking and non-raised blood pressure in the UHC service coverage index, 19 , 20 , 21 the SDG indicator 3.8.1 4 ) or health-system inputs or process indicators (eg, health workers per capita and hospital beds per capita in the UHC service coverage index; inpatient admission rates for Wagstaff and colleagues' service coverage index 23 , 24 ), or both.…”

The impact of macro-fiscal factors and private health insurance financing on public health expenditure: evidence from the OECD countries for the period 2000–2017

“…Undoubtedly, population financial hardship due to OOP medical spending is inherent with underfinanced public health systems in low and lowermiddle income economies, such as Ethiopia, Guatemala, India, Indonesia, and Vietnam, with moderate UHC achievements in the latest years (Wagstaff et al, 2016). Despite the fact that nearly the majority of OECD health systems succeeded in achieving UHC objectives based on a OECD report (OECD, 2016), a more recent study raises doubts regarding the economic barriers decline of the worse-off income segments of population to qualitative healthcare in OECD countries (Bergen et al, 2019). The one-third of OECD group (i.e.…”

Variation in financial protection and its association with health expenditure indicators: an analysis of low- and middle-income countries

“… 12 , 13 LMICs such as Rwanda, Mexico, Ghana, Brazil and Malaysia have taken great strides towards achieving the health service coverage target; some of which have received international commendation and projected as trailblazers for the UHC concept. 14 , 15 However, access to health service does not translate to protection from financial risk associated with the use of health services 16 ; therefore, the overarching goal of the UHC agenda might be truncated if the financial protection component is ignored or not given adequate attention in research and implementation.…”