☆ 4.4 Article

Evidenced Formal Coverage Index and universal healthcare enactment: A prospective longitudinal study of economic, social, and political predictors of 194 countries

HEALTH POLICY (2013)

Journal

HEALTH POLICY

Volume 113, Issue 1-2, Pages 50-60

Publisher

ELSEVIER IRELAND LTD

DOI: 10.1016/j.healthpol.2013.06.009

Keywords

Universal healthcare; Coverage; Access; Health systems; Economic growth; GDP; Educational attainment; Political determinants

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Community support

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Community support

Abstract

Determinants of universal healthcare (UHC) are poorly empirically understood. We undertook a comprehensive study of UHC development using a novel Evidenced Formal Coverage (EFC) index that combines three key UHC elements: legal framework, population coverage, and accessibility. Applying the EFC index measures (legislation, >= 90% skilled birth attendance, >= 85% formal coverage) to 194 countries, aggregating time-varying data from 1880-2008, this study investigates which macro-economic, political, and social indicators are major longitudinal predictors of developing EFC globally, and in middle-income countries. Overall, 75 of 194 countries implemented legal-text UHC legislation, of which 51 achieved EFC. In a country-year prospective longitudinal analysis of EFC prediction, higher GDP-percapita (per GDP-per-capita doubling, relative risk [RR] = 1.77, 95% CI: 1.49-2.10), higher primary school completion (per +20% completion, RR = 2.30, 1.65-3.21), and higher adult literacy were significantly associated with achieving EFC. Results also identify a GDP-percapita of I$5000 as a minimum level for development of EFC. GDP-per-capita and education were each robust predictors in middle-income countries, and education remained significant even controlling for time-varying GDP growth. For income-inequality, the GINI coefficient was suggestive in its role in predicting EFC (p = 0.024). For social and political indicators, a greater degree of ethnic fractionalization (per +25%, RR= 0.51, 0.38-0.70), proportional electoral system (RR= 2.80, 1.22-6.40), and dictatorships (RR= 0.10, 0.05-0.27) were further associated with EFC. The novel EFC index and this longitudinal prospective study together indicate that investment in both economic growth and education should be seen of equal importance for development of UHC. Our findings help in understanding the social and political drivers of universal healthcare, especially for transitioning countries. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

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Making districts functional for universal health coverage attainment: lessons from Ghana

Humphrey Cyprian Karamagi, Sokona Sy, Hillary Kipruto, Bertha Kembabazi, Solyana Ngusbrhan Kidane, Thandekile Ntombikayise Moyo, Regina Titi-Ofei, Dominic Atweam, Cornelius Debpuur, Anthony Ofosu, Francis Chisaka Kasolo

Summary: Ensuring effective functioning of sub national level in the health system is crucial for achieving health results in countries. However, the current health agenda lacks prioritization of how districts can use their existing resources efficiently to maximize equity and effectiveness. Ghana conducted a self-assessment to understand district functionality in delivering health results, highlighting the need for specific improvements in investments, access to services, and management architecture to achieve Universal Health Care. The study revealed a lack of correlation between functionality and performance as currently defined in Ghana, with higher functionality in oversight capacity compared to service provision or management capacities.

FRONTIERS IN PUBLIC HEALTH (2023)