The goal of universal health coverage (UHC) requires that everyone receive needed health services, and that families who get needed services do not suffer undue financial hardship. ... See More + Tracking progress towards UHC requires measurement of both dimensions, and a way of trading them off. The authors measure service coverage (SC) by a weighted geometric average of four prevention and four treatment indicators, financial protection (FP) by the incidence of 'catastrophic' health expenditures (those exceeding ten percent of household consumption or income), and a country's UHC performance as a geometric average of the SC index and the complement of the incidence of catastrophic expenditures. They adjust SC for inequality, penalizing high-inequality countries. The authors obtain the bulk of our data from over 1,700 household surveys. A low incidence of catastrophic expenses sometimes reflects low SC (often in low-income countries) but sometimes occurs despite high SC (often in high-income countries). At a given level of SC, too, FP varies. UHC index scores are higher in higher-income countries, but there are variations within income groups. Adjusting the UHC index for inequality in SC makes little difference in some countries, but not all. Most countries have increased their UHC index, sometimes sharply, many by improving both UHC dimensions. Some have increased their UHC index despite reductions in FP by substantially increasing their SC. Some countries have seen their UHC index fall, mostly because FP has worsened with stagnant or declining SC. The SC and UHC index are significantly associated with GDP per capita and the share spent on health. Spending by social health insurance and government schemes is significantly associated with the SC index, FP and the UHC index, but spending by other schemes is not. It was concluded that the progress towards UHC can be tracked using an index that captures both SC and FP.  See Less -

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