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

67 Pages Posted: 20 Apr 2016

See all articles by Adam Wagstaff

Adam Wagstaff

World Bank - Development Research Group (DECRG)

Daniel Cotlear

World Bank - Health, Nutrition and Population

Patrick Hoang-Vu Eozenou

World Bank - Health, Nutrition and Population

Leander Buisman

Erasmus University Rotterdam (EUR) - Institute of Health Policy and Management

Date Written: November 3, 2015

Abstract

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 improvedtheir 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.

Keywords: Reproductive Health, Health Economics & Finance

Suggested Citation

Wagstaff, Adam and Cotlear, Daniel and Eozenou, Patrick and Buisman, Leander, Measuring Progress Towards Universal Health Coverage: With an Application to 24 Developing Countries (November 3, 2015). World Bank Policy Research Working Paper No. 7470. Available at SSRN: https://ssrn.com/abstract=2685980

Adam Wagstaff (Contact Author)

World Bank - Development Research Group (DECRG) ( email )

1818 H. Street, N.W.
MSN3-311
Washington, DC 20433
United States

HOME PAGE: http://econ.worldbank.org/staff/awagstaff

Daniel Cotlear

World Bank - Health, Nutrition and Population ( email )

United States

Patrick Eozenou

World Bank - Health, Nutrition and Population ( email )

United States

Leander Buisman

Erasmus University Rotterdam (EUR) - Institute of Health Policy and Management

Netherlands

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