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

Sharifi, H.; Cederroth, C.R.; Sachdev, P.S.; Sanabria, J.; Castro, F.; Krishan, K.; Boloor, A.; Eagan, A.W.; Bockarie, M.J.; Samy, A.M.; Pana, A.; Geberemariyam, B.S.; Yahyazadeh Jabbari, S.H.; Sinha, D.N.; Rezaei, N.; Soltani, S.; Aynalem, Y.A.; Omar Bali, A.; Shaw, D.H.; Hafiz, A.; Gill, T.K.; Neupane, S.; Hostiuc, M.; Rwegerera, G.M.; Alemu, Y.M.; Pease, S.A.; Sheikhtaheri, A.; Stokes, M.A.; Uddin, R.; Knight, M.; Otstavnov, S.S.; Oladnabi, M.; Karimi, S.M.; Gebremeskel, G.G.; Zhu, C.; Yonemoto, N.; Medina-Solís, C.E.; Sahebkar, A.; Pilgrim, T.; Gebrehiwot, A.M.; Bhattarai, S.; Han, C.; Jenabi, E.; Pakhale, S.; Chandan, J.S.; Hamadeh, R.R.; Burugina Nagaraja, S.; Filip, I.; Gaidhane, A.M.; Ezekannagha, O.; Soriano, J.B.; Ronfani, L.; Naderi, M.; Sheikh, A.; Shirkoohi, R.; Suleria, H.A.R.; Reshmi, B.; Handiso, D.W.; Chin, K.L.; Gesesew, H.A.; Almasi, A.; Massenburg, B.B.; Mustafa, G.; Antonio, C.A.T.; Unnikrishnan, B.; Akinyemi, R.O.; Shaheen, A.A.; Zamanian, M.; Yeshitila, Y.G.; Alipour, V.; Amini-Rarani, M.; Zaman, S.B.; Antriyandarti, E.; Costa, V.M.; Ancuceanu, R.; Younis, M.Z.; Abosetugn, A.E.; Kianipour, N.; Memiah, P.T.N.; Tela, F.G.; Topouzis, F.; Rahim, F.; Mahmoudi, M.; Korotkova, A.V.; Kumar, N.; Patton, G.C.; Majeed, A.; Tran, B.X.; Martopullo, I.; Okunga, E.W.; Gilani, S.A.; Mondello, S.; Smith, E.U.R.; Lee, P.H.; Moghadaszadeh, M.; Carvalho, F.; Kumar, M.; Sierpinski, R.; Skryabin, V.Y.; Krohn, K.J.; Wolfe, C.D.A.; Hosseinzadeh, M.; Islam, M.M.; Kamath, A.M.; Furtado, J.M.; Olusanya, J.O.; Øverland, S.; El Tantawi, M.; Guo, Y.; Duraes, A.R.; Ausloos, M.; Rasella, D.; Babaee, E.; Sarveazad, A.; Shaikh, M.A.; Ärnlöv, J.; Barker-Collo, S.L.; Adham, D.; Ji, J.S.; Kochhar, S.; Hankey, G.J.; Tarigan, I.U.; Baig, A.A.; Lu, A.; Hostiuc, S.; Shin, J.I.; Chu, D.-T.; Fazlzadeh, M.; Menezes, R.G.; Tonelli, M.; Baune, B.T.; Desai, R.; Sahraian, M.A.; Cahuana Hurtado, Lucero; Umeokonkwo, C.D.; Zhao, X.-J.G.; Catalá-López, F.; Fernandes, E.; La Vecchia, C.; Stanaway, J.D.; Meretoja, A.; 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Abedi, A.; Sharafi, K.; Uthman, O.A.; Schaeffer, L.E.; Yousefinezhadi, T.; Meretoja, T.J.; Carreras, G.; Khatab, K.; Razo, C.; Giussani, G.; Leonardi, M.; Palladino, R.; Alam, K.; Rubagotti, E.; Lopukhov, P.D.; Zhao, Y.; Berman, A.E.; Alla, F.; Bernstein, R.S.; Jayatilleke, A.U.; Jia, P.; Ranabhat, C.L.; Nayak, V.C.; Singh, P.; Pirsaheb, M.; Hassan, A.; Khan, M.; Rawassizadeh, R.; Dahlawi, S.M.A.; Aynalem, G.L.; Abu Haimed, A.K.; Mathur, M.R.; Folayan, M.O.; Onwujekwe, O.E.; Elgendy, I.Y.; Travillian, R.; Khader, Y.S.; Hassankhani, H.; Norheim, O.F.; Lau, K.M.-M.; Naghavi, M.; Amiri, F.; Sajadi, S.M.; Mirrakhimov, E.M.; Soheili, A.; Spurlock, E.E.; Vacante, M.; Mitchell, P.B.; Ikeda, N.; Ghith, N.; Kocarnik, J.M.; Ribeiro, D.C.; Kyu, H.H.; Shuval, K.; Roever, L.; Galles, N.C.; Ziapour, A.; Titova, M.V.; Fomenkov, A.A.; Farinha, C.S.E.S.; Almasri, N.A.; Braithwaite, D.; Postma, M.J.; Lasrado, S.; Ali, M.; Yip, P.; Azzopardi, P.S.; Soofi, M.; Hopf, K.P.; Violante, F.S.; Pereira, J.; Rickard, J.; 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dc.contributor.author	Simonetti, B.
dc.contributor.author	Simpson, K.E.
dc.contributor.author	Singh, J.A.
dc.contributor.author	Singh, P.
dc.contributor.author	Sinha, D.N.
dc.contributor.author	Skryabin, V.Y.
dc.contributor.author	Smith, E.U.R.
dc.contributor.author	Soheili, A.
dc.contributor.author	Soltani, S.
dc.contributor.author	Soofi, M.
dc.contributor.author	Sorensen, R.J.D.
dc.contributor.author	Soriano, J.B.
dc.contributor.author	Sorrie, M.B.
dc.contributor.author	Soyiri, I.N.
dc.contributor.author	Spurlock, E.E.
dc.contributor.author	Sreeramareddy, C.T.
dc.contributor.author	Stanaway, J.D.
dc.contributor.author	Steel, N.
dc.contributor.author	Stein, C.
dc.contributor.author	Stokes, M.A.
dc.contributor.author	Sufiyan, M.B.
dc.contributor.author	Suleria, H.A.R.
dc.contributor.author	Sultan, I.
dc.contributor.author	Szumowski, L.
dc.contributor.author	Tabarés-Seisdedos, R.
dc.contributor.author	Tabuchi, T.
dc.contributor.author	Tadakamadla, S.K.
dc.contributor.author	Taddele, B.W.
dc.contributor.author	Tadesse, D.B.
dc.contributor.author	Taherkhani, A.
dc.contributor.author	Tamiru, A.T.
dc.contributor.author	Tanser, F.C.
dc.contributor.author	Tareque, M.I.
dc.contributor.author	Tarigan, I.U.
dc.contributor.author	Teagle, W.L.
dc.contributor.author	Tediosi, F.
dc.contributor.author	Tefera, Y.G.G.
dc.contributor.author	Tela, F.G.
dc.contributor.author	Tessema, Z.T.
dc.contributor.author	Thakur, B.
dc.contributor.author	Titova, M.V.
dc.contributor.author	Tonelli, M.
dc.contributor.author	Topor-Madry, R.
dc.contributor.author	Topouzis, F.
dc.contributor.author	Tovani-Palone, M.R.R.
dc.contributor.author	Tran, B.X.
dc.contributor.author	Travillian, R.
dc.contributor.author	Troeger, C.E.
dc.contributor.author	Tudor Car, L.
dc.contributor.author	Uddin, R.
dc.contributor.author	Ullah, I.
dc.contributor.author	Umeokonkwo, C.D.
dc.contributor.author	Unnikrishnan, B.
dc.contributor.author	Upadhyay, E.
dc.contributor.author	Uthman, O.A.
dc.contributor.author	Vacante, M.
dc.contributor.author	Valdez, P.R.
dc.contributor.author	Varughese, S.
dc.contributor.author	Vasankari, T.J.
dc.contributor.author	Vasseghian, Y.
dc.contributor.author	Venketasubramanian, N.
dc.contributor.author	Violante, F.S.
dc.contributor.author	Vlassov, V.
dc.contributor.author	Vollset, S.E.
dc.contributor.author	Vongpradith, A.
dc.contributor.author	Vos, T.
dc.contributor.author	Waheed, Y.
dc.contributor.author	Walters, M.K.
dc.contributor.author	Wamai, R.G.
dc.contributor.author	Wang, H.
dc.contributor.author	Wang, Y.-P.
dc.contributor.author	Weintraub, R.G.
dc.contributor.author	Weiss, J.
dc.contributor.author	Werdecker, A.
dc.contributor.author	Westerman, R.
dc.contributor.author	Wilner, L.B.
dc.contributor.author	Woldu, G.
dc.contributor.author	Wolfe, C.D.A.
dc.contributor.author	Wu, A.-M.
dc.contributor.author	Wulf Hanson, S.
dc.contributor.author	Xie, Y.
dc.contributor.author	Yahyazadeh Jabbari, S.H.
dc.contributor.author	Yamagishi, K.
dc.contributor.author	Yano, Y.
dc.contributor.author	Yaya, S.
dc.contributor.author	Yazdi-Feyzabadi, V.
dc.contributor.author	Yearwood, J.A.
dc.contributor.author	Yeshitila, Y.G.
dc.contributor.author	Yip, P.
dc.contributor.author	Yonemoto, N.
dc.contributor.author	Younis, M.Z.
dc.contributor.author	Yousefi, Z.
dc.contributor.author	Yousefinezhadi, T.
dc.contributor.author	Yusefzadeh, H.
dc.contributor.author	Zadey, S.
dc.contributor.author	Zahirian Moghadam, T.
dc.contributor.author	Zaidi, S.S.
dc.contributor.author	Zaki, L.
dc.contributor.author	Zaman, S.B.
dc.contributor.author	Zamanian, M.
dc.contributor.author	Zandian, H.
dc.contributor.author	Zastrozhin, M.S.
dc.contributor.author	Zewdie, K.A.
dc.contributor.author	Zhang, Y.
dc.contributor.author	Zhao, X.-J.G.
dc.contributor.author	Zhao, Y.
dc.contributor.author	Zheng, P.
dc.contributor.author	Zhu, C.
dc.contributor.author	Ziapour, A.
dc.contributor.author	Zlavog, B.S.
dc.contributor.author	Zodpey, S.
dc.contributor.author	Murray, C.J.L.
dc.date.accessioned	2020-12-14T16:06:30Z
dc.date.available	2020-12-14T16:06:30Z
dc.date.issued	2020
dc.identifier.uri	https://hdl.handle.net/20.500.12866/8731
dc.description.abstract	Background: Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods: Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings: Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation: The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC.	en_US
dc.language.iso	eng
dc.publisher	Elsevier
dc.relation.ispartofseries	Lancet
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.rights.uri	https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject	universal health coverage	en_US
dc.subject	effective coverage of health services	en_US
dc.subject	systematic analysis	en_US
dc.subject	Global Burden of Disease Study	en_US
dc.subject	2019	en_US
dc.title	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	en_US
dc.type	info:eu-repo/semantics/article
dc.identifier.doi	https://doi.org/10.1016/S0140-6736(20)30750-9
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.02.00
dc.relation.issn	1474-547X

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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

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