A concise, health service coverage index for monitoring progress towards universal health coverage

Ghana has made significant stride towards universal health coverage (UHC) by implementing the National Health Insurance Scheme (NHIS) in 2003. This paper investigates the progress of UHC indicators in Ghana from 1995 to 2030 and makes future predictions up to 2030 to assess the probability of achieving UHC targets. National representative surveys of Ghana were used to assess health service coverage and financial risk protection. The analysis estimated the coverage of 13 prevention and four treatment service indicators at the national level and across wealth quintiles. In addition, this analysis calculated catastrophic health payments and impoverishment to assess financial hardship and used a Bayesian regression model to estimate trends and future projections as well as the probabilities of achieving UHC targets by 2030. Wealth-based inequalities and regional disparities were also assessed. At the national level, 14 out of the 17 health service indicators are projected to reach the target of 80% coverage by 2030. Across wealth quintiles, inequalities were observed amongst most indicators with richer groups obtaining more coverage than their poorer counterparts. Subnational analysis revealed while all regions will achieve the 80% coverage target with high probabilities for prevention services, the same cannot be applied to treatment services. In 2015, the proportion of households that suffered catastrophic health payments and impoverishment at a threshold of 25% non-food expenditure were 1.9% (95%CrI: 0.9-3.5) and 0.4% (95%CrI: 0.2-0.8), respectively. These are projected to reduce to less than 0.5% by 2030. Inequality measures and subnational assessment revealed that catastrophic expenditure experienced by wealth quintiles and regions are not equal. Significant improvements were seen in both health service coverage and financial risk protection as a result of NHIS. However, inequalities across wealth quintiles and at the subnational level continue to be cause of concerns. Further efforts are needed to narrow these inequality gaps.

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Monitoring Progress towards Universal Health Coverage at Country and Global Levels

PLoS Medicine ◽

10.1371/journal.pmed.1001731 ◽

2014 ◽

Vol 11 (9) ◽

pp. e1001731 ◽

Cited By ~ 104

Author(s):

Ties Boerma ◽

Patrick Eozenou ◽

David Evans ◽

Tim Evans ◽

Marie-Paule Kieny ◽

...

Keyword(s):

Universal Health Coverage ◽

Health Coverage ◽

Universal Health ◽

Monitoring Progress

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Advancing universal health coverage in China and Vietnam: lessons for other countries

BMC Public Health ◽

10.1186/s12889-020-09925-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Wenhui Mao ◽

Yuchen Tang ◽

Tra Tran ◽

Michelle Pender ◽

Phuong Nguyen Khanh ◽

...

Keyword(s):

Health Insurance ◽

National Health ◽

Universal Health Coverage ◽

Secondary Data ◽

World Health ◽

Health Coverage ◽

Political Commitment ◽

Population Coverage ◽

Service Coverage ◽

Universal Health

Abstract Background China and Vietnam have made impressive progress towards universal health coverage (UHC) through government-led health insurance reforms. We compared the different pathways used to achieve UHC, to identify the lessons other countries can learn from China and Vietnam. Methods This was a mixed method study which included a literature review, in-depth interviews and secondary data analysis. We conducted a literature search in English and Chinese databases, and reviewed policy documents from internal contacts. We conducted semi-structured interviews with 16 policy makers, government bureaucrats, health insurance scholars in China and Vietnam. Secondary data was collected from National Health Statistics Reports, Health Insurance Statistical Reports and National Health Household Surveys carried out in both countries. We used population insurance coverage, insurance policies, reimbursement rates, number of households experiencing catastrophic heath expenditure (CHE) and incidence of impoverishment due to health expenditure (IHE) to measure the World Health Organization’s three dimensions of UHC: population coverage, service coverage, and financial coverage. Results China has increased population coverage through strong political commitment and extensive government financial subsidies to expand coverage. Vietnam expanded population coverage gradually, by prioritizing the poor and the near-poor in an incremental way. In China, insurance service packages varied across regions and schemes and were greatly determined by financial contributions, resulting in limited service coverage in less developed areas. Vietnam focused on providing a comprehensive and universal service packages for all enrollees thereby approaching UHC in a more equitable manner. CHE rate decreased in Vietnam but increased in China between 2003 and 2008. While Vietnam has decreased the CHE gap between urban and rural populations, China suffers from persistent disparities among population income levels and geographic location. CHE and CHE rates were still high in lower income groups. Conclusion Political commitment, sustainable financial sources and administrative capacity are strong driving factors in achieving UHC through health insurance reform. Health insurance schemes need to consider covering essential health services for all beneficiaries and providing government subsidies for vulnerable populations’ in order to help achieve health for all.

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Equity and determinants in universal health coverage indicators in Iraq, 2000–2030: a national and subnational study

International Journal for Equity in Health ◽

10.1186/s12939-021-01532-0 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Hiroko Taniguchi ◽

Md Mizanur Rahman ◽

Khin Thet Swe ◽

Md Rashedul Islam ◽

Md Shafiur Rahman ◽

...

Keyword(s):

Health Service ◽

Health Services ◽

Antenatal Care ◽

Universal Health Coverage ◽

National Level ◽

Health Coverage ◽

Reconstruction Process ◽

Targeted Interventions ◽

Increased Risk ◽

Universal Health

Abstract Background Equity is one of three dimensions of universal health coverage (UHC). However, Iraq has had capital-focused health services and successive conflicts and political turmoil have hampered health services around the country. Iraq has embarked on a new reconstruction process since 2018 and it could be time to aim for equitable healthcare access to realise UHC. We aimed to examine inequality and determinants associated with Iraq’s progress towards UHC targets. Methods We assessed the progress toward UHC in the context of equity using six nationally representative population-based household surveys in Iraq in 2000–2018. We included 14 health service indicators and two financial risk protection indicators in our UHC progress assessment. Bayesian hierarchical regression model was used to estimate the trend, projection, and determinant analyses. Slope and relative index of inequality were used to assess wealth-based inequality. Results In the national-level health service indicators, inequality indices decreased substantially from 2000 to 2030. However, the wide inequalities are projected to remain in DTP3, measles, full immunisations, and antenatal care in 2030. The pro-rich inequality gap in catastrophic health expenditure increased significantly in all governorates except Sulaimaniya from 2007 to 2012. The higher increases in pro-rich inequality were found in Missan, Karbala, Erbil, and Diala. Mothers’ higher education and more antenatal care visits were possible factors for increased coverage of health service indicators. The higher number of children and elderly population in the households were potential risk factors for an increased risk of catastrophic and impoverishing health payment in Iraq. Conclusions To reduce inequality in Iraq, urgent health-system reform is needed, with consideration for vulnerable households having female-heads, less educated mothers, and more children and/or elderly people. Considering varying inequity between and within governorates in Iraq, reconstruction of primary healthcare across the country and cross-sectoral targeted interventions for women should be prioritised.

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Universal Health Coverage: Assessing Service Coverage and Financial Protection for All

American Journal of Public Health ◽

10.2105/ajph.2016.303375 ◽

2016 ◽

Vol 106 (10) ◽

pp. 1780-1781 ◽

Cited By ~ 5

Author(s):

John E. Ataguba ◽

Marie-Gloriose Ingabire

Keyword(s):

Universal Health Coverage ◽

Financial Protection ◽

Health Coverage ◽

Service Coverage ◽

Universal Health

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FILLING THE GAP: DEVELOPING INDICATORS FOR EFFECTIVE SERVICE COVERAGE OF NONCOMMUNICABLE DISEASES IN THE CONTEXT OF UNIVERSAL HEALTH COVERAGE

International Journal of Public Health and Clinical Sciences ◽

10.32827/ijphcs.6.5.144 ◽

2019 ◽

Vol 6 (5) ◽

Keyword(s):

Universal Health Coverage ◽

Noncommunicable Diseases ◽

Health Coverage ◽

Service Coverage ◽

Effective Service ◽

Universal Health

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Best Practices in Achieving Universal Health Coverage: A Scoping Review

10.21203/rs.3.rs-23418/v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Jalil Koohpayehzadeh ◽

Saber Azami-Aghdash ◽

Naser Derakhshani ◽

Aziz Rezapour ◽

Riaz Alaei Kalajahi ◽

...

Keyword(s):

Best Practices ◽

Universal Health Coverage ◽

Scoping Review ◽

Lessons Learned ◽

Cochrane Library ◽

Financial Protection ◽

Health Coverage ◽

Population Coverage ◽

Service Coverage ◽

Universal Health

Abstract Background: Universal health coverage (UHC) is a very important and effective policy in the health system of countries worldwide. Using the experiences and learning from the best practices of successful countries in the UHC can be very helpful. Therefore, the aim of the present study is to provide a scoping review of successful global interventions and practices in achieving UHC.Methods: The present study is a scoping review study has conducted using the Arkesy and O'Malley framework. To gather information the databases of Embase, PubMed, The Cochrane Library, Scopus, SID and MagIran have searched using the keywords of Universal health coverage, Universal healthcare coverage, Universal health care coverage, Strength*, Transfer*, interventions, improve*, program*, innovations, initiative, Financing, "Service delivery", Stewardship, "Resource generation", from 2000 to 2019. Content-Analysis was also used to analyze the data.Results: Out of 4257 articles, 57 evidence finally included in the study. The results showed that of the 40 countries that had successful interventions, most were Asian. The interventions were financial protection (40 interventions that categorized to 14 items), service coverage (31 interventions that categorized to 7 items), population coverage (36 interventions that categorized to 9 items) and quality (18 interventions that categorized to 7 items) respectively. Also, the successful result were conducted financial protection (14 items), service coverage (7 items), population coverage (9 items) and quality (7 items)) respectively.Conclusion: This study provides a comprehensive and clear view of successful interventions in achieving to UHC. Therefore, with consideration to lessons learned from successful interventions, policymakers can be designing appropriate interventions to their country.

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