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

dc.creatorLozano, Rafael
dc.creatorFullman, Nancy
dc.creatorEverett Mumford, John
dc.creatorKnight, Megan
dc.creatorBarthelemy, Celine M
dc.creatorAbbafati, Cristiana
dc.creatorAbbastabar, Hedayat
dc.creatorAbd-Allah, Foad
dc.creatorAbdollahi, Mohammad
dc.creatorAbedi, Aidin
dc.date2021-02-11T13:04:17Z
dc.date2021-02-11T13:04:17Z
dc.date2020-07-27
dc.date.accessioned2023-10-03T19:37:53Z
dc.date.available2023-10-03T19:37:53Z
dc.identifier0140-6736
dc.identifier1474-547X
dc.identifierhttps://hdl.handle.net/11323/7862
dc.identifierhttps://doi.org/10.1016/S0140-6736(20)30750-9
dc.identifierCorporación Universidad de la Costa
dc.identifierREDICUC - Repositorio CUC
dc.identifierhttps://repositorio.cuc.edu.co/
dc.identifier.urihttps://repositorioslatinoamericanos.uchile.cl/handle/2250/9170848
dc.descriptionBackground 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 noncommunicable 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.
dc.formatapplication/pdf
dc.formatapplication/pdf
dc.languageeng
dc.publisherCorporación Universidad de la Costa
dc.relation1 UNGA. Resolution 74/2: political declaration of the high-level meeting on universal health coverage. Oct 18, 2019. https://undocs. org/en/A/RES/74/2 (accessed Nov 15, 2019).
dc.relation2 Schmidt H, Gostin LO, Emanuel EJ. Public health, universal health coverage, and Sustainable Development Goals: can they coexist? Lancet 2015; 386: 928–30.
dc.relation3 UN. Transforming our world: the 2030 Agenda for Sustainable Development. UN, 2015. https://sustainabledevelopment.un.org/post2015/transformingourworld/publication (accessed March 25, 2020).
dc.relation4 UN Statistical Commission. SDG indicator 3·8.1 metadata. 2018. https://unstats.un.org/sdgs/metadata/files/Metadata-03–08–01.pdf (accessed March 25, 2020).
dc.relation5 UN Statistical Commission. SDG indicator 3.8.2 metadata. 2019. https://unstats.un.org/sdgs/metadata/files/Metadata-03-08-02.pdf (accessed April 22, 2020).
dc.relation6 WHO. Thirteenth General Programme of Work 2019–2023: promote health, keep the world safe, serve the vulnerable. Geneva: World Health Organization, 2019.
dc.relation7 WHO. Resolution A72/5. Thirteenth General Programme of Work, 2019–2023. WHO Impact Framework. Geneva: World Health Organization, 2019.
dc.relation8 Naoki Ikegami. Universal health coverage for inclusive and sustainable development: lessons from Japan. A World Bank study. Washington, DC: World Bank, 2014.
dc.relation9 McKee M, Balabanova D, Basu S, Ricciardi W, Stuckler D. Universal health coverage: a quest for all countries but under threat in some. Value Health 2013; 16: S39–45.
dc.relation10 Hurst JW. Reforming health care in seven European nations. Health Aff 1991; 10: 7–21.
dc.relation11 Atun R, de Andrade LOM, Almeida G, et al. Health-system reform and universal health coverage in Latin America. Lancet 2015; 385: 1230–47.
dc.relation12 Dmytraczenko T, Almeida G. Toward universal health coverage and equity in Latin America and the Caribbean: evidence from selected countries. Washington, DC: World Bank, 2015.
dc.relation13 Cotlear D, Nagpal S, Smith O, Tandon A, Cortez R. Going universal: how 24 developing countries are implementing universal health coverage from the bottom up. Washington, DC: World Bank, 2015.
dc.relation14 WHO, World Bank. Monitoring progress towards universal health coverage at country and global levels: framework, measures, and targets. Geneva; Washington, DC: WHO, World Bank, 2014.
dc.relation15 Boerma T, Eozenou P, Evans D, Evans T, Kieny M-P, Wagstaff A. Monitoring progress towards universal health coverage at country and global Levels. PLoS Med 2014; 11: e1001731.
dc.relation16 Shengelia B, Tandon A, Adams OB, Murray CJL. Access, utilization, quality, and effective coverage: an integrated conceptual framework and measurement strategy. Soc Sci Med 2005; 61: 97–109.
dc.relation17 Ng M, Fullman N, Dieleman JL, Flaxman AD, Murray CJL, Lim SS. Effective coverage: a metric for monitoring universal health coverage. PLoS Med 2014; 11: e1001730.
dc.relation18 Kruk ME, Gage AD, Joseph NT, Danaei G, García-Saisó S, Salomon JA. Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries. Lancet 2018; 392: 2203–12.
dc.relation19 Hogan DR, Stevens GA, Hosseinpoor AR, Boerma T. Monitoring universal health coverage within the Sustainable Development Goals: development and baseline data for an index of essential health services. Lancet Glob Health 2018; 6: e152–68.
dc.relation20 WHO, World Bank. Tracking universal health coverage: 2017 global monitoring report. Geneva; Washington, DC: WHO, World Bank, 2017.
dc.relation21 WHO. Primary health care on the road to universal health coverage: 2019 monitoring report. Geneva: World Health Organization, 2019.
dc.relation22 Leegwater A, Wong W, Avila C. A concise, health service coverage index for monitoring progress towards universal health coverage. BMC Health Serv Res 2015; 15: 230.
dc.relation23 Wagstaff A, Dmytraczenko T, Almeida G, et al. Assessing Latin America’s progress toward achieving universal health coverage. Health Aff 2015; 34: 1704–12.
dc.relation24 Wagstaff A, Neelsen S. A comprehensive assessment of universal health coverage in 111 countries: a retrospective observational study. Lancet Glob Health 2020; 8: e39–49.
dc.relation25 Fullman N, Barber RM, Abajobir AA, et al. Measuring progress and projecting attainment on the basis of past trends of the healthrelated Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016. Lancet 2017; 390: 1423–59.
dc.relation26 Lozano R, Fullman N, Abate D, et al. Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 2091–138.
dc.relation27 Bergen N, Ruckert A, Labonté R. Monitoring frameworks for universal health coverage: what about high-income countries? Int J Health Policy Manag 2019; 8: 387–93.
dc.relation28 Ataguba JE, Ingabire M-G. Universal health coverage: assessing service coverage and financial protection for all. Am J Public Health 2016; 106: 1780–81.
dc.relation29 The Lancet. Ensuring and measuring universality in UHC. Lancet 2019; 393: 1.
dc.relation30 Fullman N, Lozano R. Towards a meaningful measure of universal health coverage for the next billion. Lancet Glob Health 2018; 6: e122–23.
dc.relation31 Fullman N, Lozano R. Measurement matters: who and what counts on the road to universal health coverage. Lancet Glob Health 2020; 8: e2–3.
dc.relation32 Kyu HH, Abate D, Abate KH, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1859–922.
dc.relation33 WHO Expert Reference Group on the Draft GPW 13. Preliminary report 2018: metrics for the GPW13. May, 2018. https://www.who.int/ docs/default-source/documents/about-us/expert-reference-grouppreliminary-report.pdf?sfvrsn=27a03101_2 (accessed March 27, 2020).
dc.relation34 GBD 2019 Demographics Collaborators. Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019. Lancet (in press).
dc.relation35 GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet (in press).
dc.relation36 GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet (in press).
dc.relation37 Stevens GA, Alkema L, Black RE, et al. Guidelines for accurate and transparent health estimates reporting: the GATHER statement. Lancet 2016; 388: e19–23.
dc.relation38 WHO. Expert Reference Group on the Draft GPW 13 Impact Framework 2019–2023. https://www.who.int/about/what-we-do/ thirteenth-general-programme-of-work-2019-2023/expert-referencegroup-on-the-draft-gpw-13-impact-framework-2019-2023 (accessed Feb 25, 2020).
dc.relation39 WHO. An updated method for the essential health services coverage index. Jan 17, 2019. https://unstats.un.org/sdgs/files/ meetings/webex-17jan2019/1_3.8.1_Tier%20Reclassification%20 Request_WHO.pdf (accessed March 27, 2020).
dc.relation40 Nolte E, McKee M. Does healthcare save lives? Avoidable mortality revisited. London: London School of Hygiene & Tropical Medicine, 2004. https://researchonline.lshtm.ac.uk/15535/1/does-healthcaresave-lives-mar04.pdf (accessed March 27, 2020).
dc.relation41 Fullman N, Yearwood J, Abay SM, et al. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016. Lancet 2018; 391: 2236–71.
dc.relation42 Nolte E, McKee CM. Measuring the health of nations: updating an earlier analysis. Health Aff 2008; 27: 58–71.
dc.relation43 Barber RM, Fullman N, Sorensen RJD, et al. Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015. Lancet 2017; 390: 231–66.
dc.relation44 Coleman MP, Quaresma M, Berrino F, et al. Cancer survival in five continents: a worldwide population-based study (CONCORD). Lancet Oncol 2008; 9: 730–56.
dc.relation45 De Angelis R, Sant M, Coleman MP, et al. Cancer survival in Europe 1999–2007 by country and age: results of EUROCARE-5— a population-based study. Lancet Oncol 2014; 15: 23–34.
dc.relation46 Allemani C, Matsuda T, Carlo VD, et al. Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet 2018; 391: 1023–75.
dc.relation47 Marten R, McIntyre D, Travassos C, et al. An assessment of progress towards universal health coverage in Brazil, Russia, India, China, and South Africa (BRICS). Lancet 2014; 384: 2164–71.
dc.relation48 Aguilera X, Castillo-Laborde C, Ferrari MN-D, Delgado I, Ibañez C. Monitoring and evaluating progress towards universal health coverage in Chile. PLoS Med 2014; 11: e1001676.
dc.relation49 de Andrade LOM, Filho AP, Solar O, et al. Social determinants of health, universal health coverage, and sustainable development: case studies from Latin American countries. Lancet 2015; 385: 1343–51.
dc.relation50 Reich MR, Harris J, Ikegami N, et al. Moving towards universal health coverage: lessons from 11 country studies. Lancet 2016; 387: 811–16.
dc.relation51 Nyonator F, Ofosu A, Segbafah M, d’Almeida S. Monitoring and evaluating progress towards universal health coverage in Ghana. PLoS Med 2014; 11: e1001691.
dc.relation52 Chemouni B. The political path to universal health coverage: power, ideas and community-based health insurance in Rwanda. World Dev 2018; 106: 87–98.
dc.relation53 Tan KB, Tan WS, Bilger M, Ho CWL. Monitoring and evaluating progress towards universal health coverage in Singapore. PLoS Med 2014; 11: e1001695.
dc.relation54 Tangcharoensathien V, Limwattananon S, Patcharanarumol W, Thammatacharee J. Monitoring and evaluating progress towards universal health coverage in Thailand. PLoS Med 2014; 11: e1001726.
dc.relation55 Savedoff WD, Smith AL. Achieving universal health coverage: learning from Chile, Japan, Malaysia, and Sweden. Results for Development (R4D), 2011. https://www.r4d.org/resources/achievinguniversal-health-coverage-learning-chile-japan-malaysia-sweden/ (accesed March 27, 2020).
dc.relation56 Global Burden of Disease Health Financing Collaborator Network. Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3. Lancet 2020; published online April 23. http://doi.org/10.1016/S0140-6736(20)30608-5.
dc.relation57 Stevens G, Hogan D. Service coverage within universal health coverage: how large is the gap? Technical note. Geneva: World Health Organization, 2017.
dc.relation58 WHO. Methods for the 13th General Programme of Work (GPW13) Impact Measurement. Draft for consultation. Version 1.3.1. Jan 30, 2020. Geneva: World Health Organization, 2020.
dc.relation59 Dieleman JL, Sadat N, Chang AY, et al. Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016–40. Lancet 2018; 391: 1783–98.
dc.relation60 Vollset SE, Goren E, Yuan C-W, et al. Fertility, mortality, migration, and population scenarios for 195 countries and territories from 2017 to 2100: a forecasting analysis for the Global Burden of Disease Study. Lancet 2020; published online July 14. https://doi.org/10.1016/ S0140-6736(20)30677-2.
dc.relation61 Chang AY, Cowling K, Micah AE, et al. Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050. Lancet 2019; 393: 2233–60.
dc.relation62 Dieleman JL, Schneider MT, Haakenstad A, et al. Development assistance for health: past trends, associations, and the future of international financial flows for health. Lancet 2016; 387: 2536–44.
dc.relation63 GBD 2019 Viewpoint Collaborators. Five insights from the Global Burden of Disease Study 2019. Lancet (in press).
dc.relation64 Asma S, Lozano R, Chatterji S, et al. Monitoring the health-related Sustainable Development Goals: lessons learned and recommendations for improved measurement. Lancet 2019; 395: 240–46.
dc.relation65 WHO. World report on vision. Geneva: World Health Organization, 2019.
dc.relation66 WHO. World report on hearing. 2020. http://www.who.int/ deafness/world-report-hearing/en/ (accessed May 27, 2020).
dc.relation67 De Silva MJ, Lee L, Fuhr DC, et al. Estimating the coverage of mental health programmes: a systematic review. Int J Epidemiol 2014; 43: 341–53.
dc.relation68 WHO. Measles—global situation. Nov 27, 2019. http://www.who. int/csr/don/26-november-2019-measles-global_situation/en/ (accessed March 3, 2020).
dc.rightsCC0 1.0 Universal
dc.rightshttp://creativecommons.org/publicdomain/zero/1.0/
dc.rightsinfo:eu-repo/semantics/openAccess
dc.rightshttp://purl.org/coar/access_right/c_abf2
dc.sourceThe Lancet
dc.sourcehttps://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30750-9/fulltext#%20
dc.subjectUniversal health
dc.subjectDisease
dc.subjectHealth services
dc.subjectMorbility
dc.titleMeasuring 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
dc.typeArtículo de revista
dc.typehttp://purl.org/coar/resource_type/c_6501
dc.typeText
dc.typeinfo:eu-repo/semantics/article
dc.typeinfo:eu-repo/semantics/publishedVersion
dc.typehttp://purl.org/redcol/resource_type/ART
dc.typeinfo:eu-repo/semantics/acceptedVersion
dc.typehttp://purl.org/coar/version/c_ab4af688f83e57aa


Este ítem pertenece a la siguiente institución