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Working Paper

Measuring Progress towards Universal Health Coverage : With an Application to 24 Developing Countries

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
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World Bank, Washington, DC
Africa | East Asia and Pacific | South Asia
2015-12-17T23:00:20Z | 2015-12-17T23:00:20Z | 2015-11

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.

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