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

Fecha de publicación: 17/10/2020

Autores organización

Jeadran Nevardo Malagon Rojas

Autor

0

Autores

Lozano, R
Fullman, N
Mumford, JE
Knight, M
Barthelemy, CM
Abbafati, C
Abbastabar, H
Abd-Allah, F
Abdollahi, M
Abedi, A
Abolhassani, H
Abosetugn, AE
Abreu, LG
Abrigo, MRM
Abu Haimed, AK
Abushouk, AI
Adabi, M
Adebayo, OM
Adekanmbi, V
Adelson, JD
Adetokunboh, OO
Adham, D
Advani, SM
Afshin, A
Agarwal, G
Agasthi, P
Aghamir, SMK
Agrawal, A
Ahmad, T
Akinyemi, RO
Alahdab, F
Al-Aly, Z
Alam, K
Albertson, SB
Alemu, YM
Alhassan, RK
Ali, M
Ali, S
Alipour, V
Aljunid, SM
Alla, F
Almadi, MAH
Almasi, A
Almasi-Hashiani, A
Almasri, NA
Al-Mekhlafi, HM
Almulhim, AM
Alonso, J
Al-Raddadi, RM
Altirkawi, KA
Alvis-Guzman, N
Alvis-Zakzuk, NJ
Amini, S
Amini-Rarani, M
Amiri, F
Amit, AML
Amugsi, DA
Ancuceanu, R
Anderlini, D
Andrei, CL
Androudi, S
Ansari, F
Ansari-Moghaddam, A
Antonio, CAT
Antony, CM
Antriyandarti, E
Anvari, D
Anwer, R
Arabloo, J
Arab-Zozani, M
Aravkin, AY
Aremu, O
Ärnlöv, J
Asaad, M
Asadi-Aliabadi, M
Asadi-Pooya, AA
Ashbaugh, C
Athari, SS
Atout, MMW
Ausloos, M
Avila-Burgos, L
Quintanilla, BPA
Ayano, G
Ayanore, MA
Aynalem, GL
Aynalem, YA
Ayza, MA
Azari, S
Azzopardi, PS
Darshan, BB
Babaee, E
Badiye, AD
Bahrami, MA
Baig, AA
Bakhshaei, MH
Bakhtiari, A
Bakkannavar, SM
Balachandran, A
Balassyano, S
Banach, M
Banerjee, SK
Banik, PC
Bante, AB
Bante, SA
Barker-Collo, SL
Bärnighausen, TW
Barrero, LH
Bassat, Q
Basu, S
Baune, BT
Bayati, M
Baye, BA
Bedi, N
Beghi, E
Behzadifar, M
Bekuma, TTT
Bell, ML
Bensenor, IM
Berman, AE
Bernabe, E
Bernstein, RS
Bhagavathula, AS
Bhandari, D
Bhardwaj, P
Bhat, AG
Bhattacharyya, K
Bhattarai, S
Bhutta, ZA
Bijani, A
Bikbov, B
Bilano, V
Biondi, A
Birihane, BM
Bockarie, MJ
Bohlouli, S
Bojia, HA
Bolla, SRR
Boloor, A
Brady, OJ
Braithwaite, D
Briant, PS
Briggs, AM
Briko, NI
Nagaraja, SB
Busse, R
Butt, ZA
dos Santos, FLC
Cahuana-Hurtado, L
Cámera, LA
Cárdenas, R
Carreras, G
Carrero, JJ
Carvalho, F
Castaldelli-Maia, JM
Castañeda-Orjuela, CA
Castelpietra, G
Castro, F
Catalá-López, F
Causey, K
Cederroth, CR
Cercy, KM
Cerin, E
Chandan, JS
Chang, AY
Charan, J
Chattu, VK
Chaturvedi, S
Chin, KL
Cho, DY
Choi, JYJ
Christensen, H
Chu, DT
Chung, MT
Ciobanu, LG
Cirillo, M
Comfort, H
Compton, K
Cortesi, PA
Costa, VM
Cousin, E
Dahlawi, SMA
Damiani, G
Dandona, L
Dandona, R
Gela, JD
Darwesh, AM
Daryani, A
Dash, AP
Davey, G
Dávila-Cervantes, CA
Davletov, K
De Neve, JW
Denova-Gutiérrez, E
Deribe, K
Dervenis, N
Desai, R
Dharmaratne, SD
Dhungana, GP
Dianatinasab, M
da Silva, DD
Diaz, D
Dippenaar, IN
Do, HT
Dorostkar, F
Doshmangir, L
Duncan, BB
Duraes, AR
Eagan, AW
Edvardsson, D
El Sayed, I
El Tantawi, M
Elgendy, IY
Elyazar, IRF
Eskandari, K
Eskandarieh, S
Esmaeilnejad, S
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Ezekannagha, O
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Faraon, EJA
Farinha, CSES
Farioli, A
Faris, PS
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Fazlzadeh, M
Feigin, VL
Fernandes, E
Ferrara, P
Feyissa, GT
Filip, I
Fischer, F
Fisher, JL
Flor, LS
Foigt, NA
Folayan, MO
Fomenkov, AA
Foroutan, M
Francis, JM
Fu, WJ
Fukumoto, T
Furtado, JM
Gad, MM
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Gakidou, E
Galles, NC
Gallus, S
Gardner, WM
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Gebrehiwot, AM
Gebremeskel, GG
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Gesesew, HA
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Ghashghaee, A
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Ginindza, TG
Gitimoghaddam, M
Giussani, G
Glagn, M
Gnedovskaya, EV
Godinho, MA
Goharinezhad, S
Gopalani, SV
Goudarzian, AH
Goulart, BNG
Gubari, MIM
Guimaraes, RA
Guled, RA
Gultie, T
Guo, YM
Gupta, R
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Hafezi-Nejad, N
Hafiz, A
Haile, TG
Hamadeh, RR
Hameed, S
Hamidi, S
Han, C
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Hanif, A
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Haro, JM
Hasaballah, AI
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Hashi, A
Hassan, A
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Khan, EA
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Khang, YH
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Khater, AM
Khater, MM
Khatib, MN
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Khubchandani, J
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Kimokoti, RW
Kinfu, Y
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Kissimova-Skarbek, K
Kivimäki, M
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Gbd Universal Hlth Coverage

Resumen

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. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.

Datos de la publicación

ISSN/ISSNe:: 0140-6736, 1474-547X
Tipo:: Article
Páginas:: 1250-1284
DOI:: 10.1016/S0140-6736(20)30750-9
Enlace a otro recurso:: www.scopus.com

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Keywords

Global Burden of Disease; Health Expenditures; Humans; Universal Health Insurance; World Health Organization; economics; global disease burden; health care cost; human; World Health Organization

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Financiación

African Academy of Sciences

Alexander von Humboldt Foundation

Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award - German Federal Ministry of Education and Research

BHF Centre of Research Excellence, Oxford

Brazilian Ministry of Health

Centro de Investigacion en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III

Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital

Comunidad de Madrid (B2017/BMD-3686 CIFRA2-CM)

Conselho Nacional de Desenvolvimento Cientifico e Tecnologico

Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior - Brasil (001)

China Medical University, Taichung, Taiwan (CMU108-MF-95)

Deakin University

Department of Health Policy and Management, Faculty of Public Health, Kuwait University

DST PURSE grant

Egyptian Fulbright Mission Program

European Fund for Regional Development through Operational Program for Competitiveness (P_40_382)

FCT (DL 57/2016)

FCT/MCTES (UID/MULTI/04378/2019)

FCT/MCTES (UID/QUI/50006/2019)

FLAIR fellowship - UK Royal Society

Fogarty International Center/NIMH (K43 TW010716)

Foundation for the Support of Research of the State of Rio Grande do Sul

FRIAT

Fundacao de Amparo a Pesquisa do Estado de Minas Gerais

Grants-in-Aid for Scientific Research (18K10082)

Health Data Research UK

International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia

ISCIII (DTS18/00032)

ISCIII (PI19/00815)

ISCIII-FEDER (PI17/00719)

ISCIII-RETIC REDinREN Fondos FEDER (RD016/0009)

Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4 -Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche)

Medical Research Council (MC_UU_12017/13)

Medical Research Council (MC_UU_12017/15)

Medical Research Council Fellowship

Ministry of Education Science and Technological Development of the Republic of Serbia (OI175014)

Ministry of Education, Culture, Sports, Science, and Technology of Japan (18K10082)

Ministry of Education, Science and Technological Development of the Republic of Serbia (175087)

MRC (MC_UU_00022/2)

MRC (MC_UU_12017/13)

MRC (MC_UU_12017/15)

MRC (MR/R024227/1)

MRC (MR/S011676/1)

National Health AMP

National Health and Medical Research Council Early Career Fellowship, Australia

National Heart Foundation of Australia

National Institutes of Health (U01HG010273)

National Institutes of Health T32 grant (T32GM086270)

NHMRC Australia

NIHR Oxford Biomedical Research Centre

NRS Senior Clinical Fellowship (SCAF/15/02)

Portuguese national funds through Fundacao para a Ciencia e a Tecnologia (DL57/2016/CP1334/CT0006)

Portuguese national funds through Fundacao para a Ciencia e a Tecnologia (SFRH/BHD/110001/2015)

Research Management Centre, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/0001)

Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI (PN-III-P4-ID-PCCF-2016-0084)

Scottish Government Chief Scientist Office (SPHSU13)

Scottish Government Chief Scientist Office (SPHSU15)

Secretaria Nacional de Ciencia Tecnologia e Innovacion

Sir Charles Hercus Health Research Fellowship - Health Research Council of New Zealand (18/111)

Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III/ESF, European Union) (CP18/00074)

Swedish Research Council (2019-01059)

UGC Center of Advanced Study (CAS II)

Wellcome Trust (201900/Z/16/Z)

Wellcome Trust DBT India Alliance Senior Fellowship (IA/CPHS/14/1/501489)

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