Measuring Progress towards Universal Health Coverage
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World Bank, Washington, DC
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The last few years have seen a growing
commitment worldwide to universal health coverage (UHC). Yet
there is a lack of clarity on how to measure progress
towards UHC. This paper proposes a ‘mashup’ index that
captures both aspects of UHC: that everyone—irrespective of
their ability-to-pay—gets the health services they need; and
that nobody suffers undue financial hardship as a result of
receiving care. Service coverage is broken down into
prevention and treatment, and financial protection into
impoverishment and catastrophic spending; nationally
representative household survey data are used to adjust
population averages to capture inequalities between the poor
and better off; nonlinear tradeoffs are allowed between and
within the two dimensions of the UHC index; and all
indicators are expressed such that scores run from 0 to 100,
and higher scores are better. In a sample of 24 countries
for which there are detailed information on UHC-inspired
reforms, a cluster of high-performing countries emerges with
UHC scores of between 79 and 84 (Brazil, Colombia, Costa
Rica, Mexico and South Africa) and a cluster of
low-performing countries emerges with UHC scores in the
range 35–57 (Ethiopia, Guatemala, India, Indonesia and
Vietnam). Countries have mostly improved their UHC scores
between the earliest and latest years for which there are
data—by about 5 points on average; however, the improvement
has come from increases in receipt of key health
interventions, not from reductions in the incidence of
out-of-pocket payments on welfare.
Palabras clave
LIVING STANDARDS, CHILD HEALTH, EMPLOYMENT, PAYMENTS FOR HEALTH CARE, PEOPLE, VACCINATION, HEALTH EXTENSION, FINANCING, ANTENATAL CARE, HEALTH REFORMS, INCOME, HEALTH CARE UTILIZATION, PREVENTION, LAWS, HEALTH EXPENDITURES, DOCTORS, HEALTH ECONOMICS, COMMUNITY HEALTH, PRIMARY CARE, COST-EFFECTIVENESS, MONITORING, HEALTH INSURANCE, HEALTH CARE, FINANCIAL PROTECTION, CERVICAL CANCER, INCENTIVES, NATIONAL HEALTH INSURANCE, HEALTH, ECONOMIC POLICY, POLICY DISCUSSIONS, BREAST CANCER, POCKET PAYMENTS, HYPERTENSION, HEALTH FACILITIES, PUBLIC HEALTH, HOSPITALIZATION, HEALTH SECTOR, CAPITATION, CHOICE, DIABETES, EXERCISES, HEALTH STATUS, COSTS, IMMUNIZATION, PATIENTS, PATIENT, INTERVENTION, PROBABILITY, HEALTH SYSTEMS, PUBLIC HOSPITALS, HEALTH CENTERS, IMPACT EVALUATIONS, HEALTH CARE SERVICES, HEALTH INSURANCE SCHEME, HOSPITAL ADMISSIONS, ACCESS TO HEALTH SERVICES, USE OF HEALTH SERVICES, MEDICAL CARE, HOSPITAL CARE, TUBERCULOSIS, HEALTH ORGANIZATION, SCREENING, HEALTH CARE COVERAGE, HIV/AIDS, INSURANCE COVERAGE, MORTALITY, MEDICAL TREATMENT, COST OF CARE, COSTS OF HEALTH CARE, HEALTH SPENDING, COSTS OF CARE, EQUITY, CHILDBIRTH, HEALTH PLAN, WORKERS, SOCIAL HEALTH INSURANCE, AGED, HEALTH CARE PROVISION, CARE, HEALTH POLICY, BUDGETS, DEMAND, HEALTH OUTCOMES, HEALTH SERVICES USE, INCOME DISTRIBUTION, FAMILY PLANNING, EXPENDITURES, MEASUREMENT, NUTRITION, HEALTH POSTS, ADOLESCENTS, HEALTH COVERAGE, PRIMARY HEALTH CARE, NATIONAL HEALTH, HEALTH SYSTEM, INSURANCE, OUTPATIENT CARE, WEIGHT, PREGNANT WOMEN, HEALTH CARE DELIVERY, CARDIOVASCULAR DISEASES, CHILDREN, HOSPITAL SUPPLY, CLINICS, EVALUATION, RISK, INPATIENT CARE, HUMAN RESOURCES, HEALTH PROVIDERS, POVERTY, INTEGRATION, HEALTH EXPENDITURE, ILLNESS, INCIDENCE, POPULATION, POLICY RESEARCH, HEALTH CARE FINANCE, FINANCIAL RISK, STRATEGY, FEES, EPIDEMIOLOGY, FAMILIES, MEDICINES, HEALTH FINANCING, HOSPITALS, HEALTH INTERVENTIONS, HEALTH CARE SYSTEMS, BIRTH ATTENDANT, HEALTH SERVICE, HEALTH SERVICES, HOUSEHOLD EXPENDITURE, IMPLEMENTATION, PREGNANCY, HEALTH STRATEGY, BREASTFEEDING, HUMAN DEVELOPMENT