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AuthorRafael, Lozano
AuthorFullman, Nancy
AuthorMumford, John Everett
AuthorKnight, Megan
AuthorBarthelemy, Celine M
AuthorAbbafati, Cristiana
AuthorAbbastabar, Hedayat
AuthorAbd-Allah, Foad
AuthorAbdollahi, Mohammad
AuthorAbedi, Aidin
AuthorAbolhassani, Hassan
AuthorAbosetugn, Akine Eshete
AuthorAbreu, Lucas Guimarães
AuthorAbrigo, Michael R M
AuthorAbu Haimed, Abdulaziz Khalid
AuthorAbushouk, Abdelrahman I
AuthorAdabi, Maryam
AuthorAdebayo, Oladimeji M
AuthorAdekanmbi, Victor
AuthorAdelson, Jaimie
AuthorAdetokunboh, Olatunji O
AuthorAdham, Davoud
AuthorAdvani, Shailesh M
AuthorAfshin, Ashkan
AuthorAgarwal, Gina
AuthorAgasthi, Pradyumna
AuthorAghamir, Seyed Mohammad Kazem
AuthorAgrawal, Anurag
AuthorAhmad, Tauseef
AuthorAkinyemi, Rufus Olusola
AuthorAlahdab, Fares
AuthorAl-Aly, Ziyad
AuthorAlam, Khurshid
AuthorAlbertson, Samuel B
AuthorAlemu, Yihun Mulugeta
AuthorAlhassan, Robert Kaba
AuthorAli, Muhammad
AuthorAli, Saqib
AuthorAlipour, Vahid
AuthorAljunid, Syed Mohamed
AuthorAlla, François
AuthorAlmadi, Majid Abdulrahman Hamad
AuthorAlmasi, Ali
AuthorAlmasi-Hashiani, Amir
AuthorAlmasri, Nihad A
AuthorAl-Mekhlafi, Hesham M
AuthorAlmulhim, Abdulaziz M
AuthorAlonso, Jordi
AuthorAl-Raddadi, Rajaa M
AuthorAltirkawi, Khalid A
AuthorAlvis-Guzman, Nelson
AuthorAlvis-Zakzuk, Nelson J
AuthorAmini, Saeed
AuthorAmini-Rarani, Mostafa
AuthorAmiri, Fatemeh
AuthorAmit, Arianna Maever L
AuthorAmugsi, Dickson A
AuthorAncuceanu, Robert
AuthorAnderlini, Deanna
AuthorAndrei, Catalina Liliana
AuthorAndroudi, Sofia
AuthorAnsari, Fereshteh
AuthorAnsari-Moghaddam, Alireza
AuthorAntonio, Carl Abelardo T
AuthorAntony, Catherine M
AuthorAntriyandarti, Ernoiz
AuthorAnvari, Davood
AuthorAnwer, Razique
AuthorArabloo, Jalal
AuthorArab-Zozani, Morteza
AuthorAravkin, Aleksandr Y
AuthorAremu, Olatunde
AuthorÄrnlöv, Johan
AuthorAsaad, Malke
AuthorAsadi-Aliabadi, Mehran
AuthorAsadi-Pooya, Ali A
AuthorAshbaugh, Charlie
AuthorAthari, Seyyed Shamsadin
AuthorAtout, Maha Moh'd Wahbi
AuthorAusloos, Marcel
AuthorAvila-Burgos, Leticia
AuthorAyala Quintanilla, Beatriz Paulina
AuthorAyano, Getinet
AuthorAyanore, Martin Amogre
AuthorAynalem, Yared Asmare
AuthorAynalem, Getie Lake
AuthorAyza, Muluken Altaye
AuthorAzari, Samad
AuthorAzzopardi, Peter S
AuthorB, Darshan B
AuthorBabaee, Ebrahim
AuthorBadiye, Ashish D
AuthorBahrami, Mohammad Amin
AuthorBaig, Atif Amin
AuthorBakhshaei, Mohammad Hossein
AuthorBakhtiari, Ahad
AuthorBakkannavar, Shankar M
AuthorBalachandran, Arun
AuthorBalassyano, Shelly
AuthorBanach, Maciej
AuthorBanerjee, Srikanta K
AuthorBanik, Palash Chandra
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AuthorBante, Simachew Animen
AuthorBarker-Collo, Suzanne Lyn
AuthorBärnighausen, Till Winfried
AuthorBarrero, Lope H
AuthorBassat, Quique
AuthorBasu, Sanjay
AuthorBaune, Bernhard T
AuthorBayati, Mohsen
AuthorBaye, Bayisa Abdissa
AuthorBedi, Neeraj
AuthorBeghi, Ettore
AuthorBehzadifar, Masoud
AuthorBekuma, Tariku Tesfaye Tesfaye
AuthorBell, Michelle L
AuthorBensenor, Isabela M
AuthorBerman, Adam E
AuthorBernabe, Eduardo
AuthorBernstein, Robert S
AuthorBhagavathula, Akshaya Srikanth
AuthorBhandari, Dinesh
AuthorBhardwaj, Pankaj
AuthorBhat, Anusha Ganapati
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AuthorBhattarai, Suraj
AuthorBhutta, Zulfiqar A
AuthorBijani, Ali
AuthorBikbov, Boris
AuthorBilano, Ver
AuthorBiondi, Antonio
AuthorBirihane, Binyam Minuye
AuthorBockarie, Moses John
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AuthorBrady, Oliver J
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AuthorBriggs, Andrew M
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AuthorBusse, Reinhard
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AuthorCaetano dos Santos, Florentino Luciano
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AuthorCarrero, Juan J
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AuthorChang, Angela Y
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AuthorChin, Ken Lee
AuthorCho, Daniel Youngwhan
AuthorChoi, Jee-Young Jasmine
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AuthorChu, Dinh-Toi
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AuthorDamiani, Giovanni
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AuthorDávila-Cervantes, Claudio Alberto
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AuthorDias da Silva, Diana
AuthorDiaz, Daniel
AuthorDippenaar, Ilse N
AuthorDo, Hoa Thi
AuthorDorostkar, Fariba
AuthorDoshmangir, Leila
AuthorDuncan, Bruce B
AuthorDuraes, Andre Rodrigues
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AuthorEdvardsson, David
AuthorEl Sayed, Iman
AuthorEl Tantawi, Maha
AuthorElgendy, Islam Y
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AuthorEskandarieh, Sharareh
AuthorEsmaeilnejad, Saman
AuthorEsteghamati, Alireza
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AuthorFarahmand, Mohammad
AuthorFaraon, Emerito Jose A
AuthorFarinha, Carla Sofia e Sá
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AuthorFaris, Pawan Sirwan
AuthorFaro, Andre
AuthorFazlzadeh, Mehdi
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AuthorFisher, James L
AuthorFlor, Luisa Sorio
AuthorFoigt, Nataliya A
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AuthorFukumoto, Takeshi
AuthorFurtado, João M
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AuthorGardner, William M
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AuthorGoulart, Bárbara Niegia Garcia
AuthorGubari, Mohammed Ibrahim Mohialdeen
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AuthorGupta, Rahul
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AuthorHafiz, Abdul
AuthorHaile, Teklehaimanot Gereziher
AuthorHamadeh, Randah R
AuthorHameed, Sajid
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AuthorHan, Hannah
AuthorHandiso, Demelash Woldeyohannes
AuthorHanif, Asif
AuthorHankey, Graeme J
AuthorHaro, Josep Maria
AuthorHasaballah, Ahmed I
AuthorHasan, Md Mehedi
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AuthorHassan, Shoaib
AuthorHassan, Amr
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AuthorHay, Simon I
AuthorHayat, Khezar
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AuthorHird, Thomas R
AuthorHo, Hung Chak
AuthorHole, Michael K
AuthorHolla, Ramesh
AuthorHollingsworth, Bruce
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AuthorHosseinzadeh, Mehdi
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AuthorHostiuc, Sorin
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AuthorHu, Guoqing
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AuthorHwang, Bing-Fang
AuthorIavicoli, Ivo
AuthorIbitoye, Segun Emmanuel
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AuthorIlesanmi, Olayinka Stephen
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AuthorIlic, Milena D
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AuthorIrvine, Caleb Mackay Salpeter
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AuthorIwu, Chinwe Juliana
AuthorIwu, Chidozie C D
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AuthorJadidi-Niaragh, Farhad
AuthorJafarinia, Morteza
AuthorJahagirdar, Deepa
AuthorJahani, Mohammad Ali
AuthorJahanmehr, Nader
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AuthorJanjani, Hosna
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AuthorJayatilleke, Achala Upendra
AuthorJenabi, Ensiyeh
AuthorJha, Ravi Prakash
AuthorJha, Vivekanand
AuthorJi, John S
AuthorJia, Peng
AuthorJohn-Akinola, Yetunde O
AuthorJonas, Jost B
AuthorJoukar, Farahnaz
AuthorJozwiak, Jacek Jerzy
AuthorJürisson, Mikk
AuthorKabir, Zubair
AuthorKalankesh, Leila R
AuthorKalhor, Rohollah
AuthorKamath, Aruna M
AuthorKanchan, Tanuj
AuthorKapoor, Neeti
AuthorKarami Matin, Behzad
AuthorKaranikolos, Marina
AuthorKarimi, Seyed M
AuthorKassebaum, Nicholas J
AuthorKatikireddi, Srinivasa Vittal
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AuthorKeiyoro, Peter Njenga
AuthorKhader, Yousef Saleh
AuthorKhammarnia, Mohammad
AuthorKhan, Maseer
AuthorKhan, Ejaz Ahmad
AuthorKhang, Young-Ho
AuthorKhatab, Khaled
AuthorKhater, Amir M
AuthorKhater, Mona M
AuthorKhatib, Mahalaqua Nazli
AuthorKhayamzadeh, Maryam
AuthorKhubchandani, Jagdish
AuthorKianipour, Neda
AuthorKim, Young-Eun
AuthorKim, Yun Jin
AuthorKimokoti, Ruth W
AuthorKinfu, Yohannes
AuthorKisa, Adnan
AuthorKissimova-Skarbek, Katarzyna
AuthorKivimäki, Mika
AuthorKneib, Cameron J
AuthorKocarnik, Jonathan M
AuthorKochhar, Sonali
AuthorKohler, Stefan
AuthorKopec, Jacek A
AuthorKorotkova, Anna V
AuthorKorshunov, Vladimir Andreevich
AuthorKosen, Soewarta
AuthorKotlo, Anirudh
AuthorKoul, Parvaiz A
AuthorKoyanagi, Ai
AuthorKrishan, Kewal
AuthorKrohn, Kris J
AuthorKugbey, Nuworza
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AuthorKumar, G Anil
AuthorKumar, Nithin
AuthorKumar, Manasi
AuthorKurmi, Om P
AuthorKusuma, Dian
AuthorKyu, Hmwe Hmwe
AuthorLa Vecchia, Carlo
AuthorLacey, Ben
AuthorLal, Dharmesh Kumar
AuthorLalloo, Ratilal
AuthorLandires, Iván
AuthorLansingh, Van Charles
AuthorLarsson, Anders O
AuthorLasrado, Savita
AuthorLau, Kathryn Mei-Ming
AuthorLauriola, Paolo
AuthorLazarus, Jeffrey V
AuthorLedesma, Jorge R
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AuthorLee, Shaun Wen Huey
AuthorLeever, Andrew T
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AuthorLeigh, James
AuthorLeonardi, Matilde
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AuthorLim, Stephen S
AuthorLim, Lee-Ling
AuthorLiu, Xuefeng
AuthorLogroscino, Giancarlo
AuthorLopez, Alan D
AuthorLopukhov, Platon D
AuthorLotufo, Paulo A
AuthorLu, Alton
AuthorMa, Jianing
AuthorMadadin, Mohammed
AuthorMahasha, Phetole Walter
AuthorMahmoudi, Morteza
AuthorMajeed, Azeem
AuthorMalagón-Rojas, Jeadran N
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AuthorMeretoja, Atte
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AuthorMirzaei-Alavijeh, Mehdi
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AuthorMohammed, Jemal Abdu
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AuthorNguyen, Diep Ngoc
AuthorNguyen, Huong Lan Thi
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AuthorNomura, Shuhei
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AuthorNoubiap, Jean Jacques
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AuthorOgbo, Felix Akpojene
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AuthorOmar Bali, Ahmed
AuthorOmer, Muktar Omer
AuthorOng, Kanyin L
AuthorOnwujekwe, Obinna E
AuthorOrtega-Altamirano, Doris V V
AuthorOrtiz, Alberto
AuthorOstojic, Sergej M
AuthorOtstavnov, Nikita
AuthorOtstavnov, Stanislav S
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AuthorPalladino, Raffaele
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AuthorPatton, George C
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AuthorPeden, Amy E
AuthorPennini, Alyssa
AuthorPeprah, Emmanuel K
AuthorPereira, Jeevan
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AuthorPiradov, Michael A
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AuthorPribadi, Dimas Ria Angga
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AuthorRawassizadeh, Reza
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AuthorShaheen, Amira A
AuthorShaikh, Masood Ali
AuthorShamsizadeh, Morteza
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AuthorSharafi, Kiomars
AuthorSharara, Fablina
AuthorSharifi, Hamid
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AuthorSheikh, Aziz
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AuthorShetty, B Suresh Kumar
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AuthorShirkoohi, Reza
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AuthorSiabani, Soraya
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AuthorSilva, João Pedro
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AuthorSkryabin, Valentin Yurievich
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AuthorStein, Caroline
AuthorStokes, Mark A
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AuthorSuleria, Hafiz Ansar Rasul
AuthorSultan, Iyad
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AuthorTabuchi, Takahiro
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AuthorTaddele, Biruk Wogayehu
AuthorTadesse, Degena Bahrey
AuthorTaherkhani, Amir
AuthorTamiru, Animut Tagele
AuthorTanser, Frank C
AuthorTareque, Md Ismail
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AuthorTefera, Yonas Getaye Getaye
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AuthorTopouzis, Fotis
AuthorTovani-Palone, Marcos Roberto Roberto
AuthorTran, Bach Xuan
AuthorTravillian, Ravensara
AuthorTroeger, Christopher E
AuthorTudor Car, Lorainne
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AuthorUllah, Irfan
AuthorUmeokonkwo, Chukwuma David
AuthorUnnikrishnan, Bhaskaran
AuthorUpadhyay, Era
AuthorUthman, Olalekan A
AuthorVacante, Marco
AuthorValdez, Pascual R
AuthorVarughese, Santosh
AuthorVasankari, Tommi Juhani
AuthorVasseghian, Yasser
AuthorVenketasubramanian, Narayanaswamy
AuthorViolante, Francesco S
AuthorVlassov, Vasily
AuthorVollset, Stein Emil
AuthorVongpradith, Avina
AuthorVos, Theo
AuthorWaheed, Yasir
AuthorWalters, Magdalene K
AuthorWamai, Richard G
AuthorWang, Haidong
AuthorWang, Yuan-Pang
AuthorWeintraub, Robert G
AuthorWeiss, Jordan
AuthorWerdecker, Andrea
AuthorWesterman, Ronny
AuthorWilner, Lauren B
AuthorWoldu, Gebremariam
AuthorWolfe, Charles D A
AuthorWu, Ai-Min
AuthorWulf Hanson, Sarah
AuthorXie, Yang
AuthorXu, Rixing
AuthorYahyazadeh Jabbari, Seyed Hossein
AuthorYamagishi, Kazumasa
AuthorYano, Yuichiro
AuthorYaya, Sanni
AuthorYazdi-Feyzabadi, Vahid
AuthorYearwood, Jamal A
AuthorYeshitila, Yordanos Gizachew
AuthorYip, Paul
AuthorYonemoto, Naohiro
AuthorYounis, Mustafa Z
AuthorYousefi, Zabihollah
AuthorYousefinezhadi, Taraneh
AuthorYusefzadeh, Hasan
AuthorZadey, Siddhesh
AuthorZahirian Moghadam, Telma
AuthorZaidi, Syed Saoud
AuthorZaki, Leila
AuthorZaman, Sojib Bin
AuthorZamani, Mohammad
AuthorZamanian, Maryam
AuthorZandian, Hamed
AuthorZastrozhin, Mikhail Sergeevich
AuthorZewdie, Kaleab Alemayehu
AuthorZhang, Yunquan
AuthorZhao, Xiu-Ju George
AuthorZhao, Yingxi
AuthorZheng, Peng
AuthorZhu, Cong
AuthorZiapour, Arash
AuthorZlavog, Bianca S
AuthorZodpey, Sanjay
AuthorMurray, Christopher J L
Available date2023-08-28T10:34:04Z
Publication Date2020-10-23
Publication NameThe Lancet
Identifierhttp://dx.doi.org/10.1016/S0140-6736(20)30750-9
ISSN01406736
URIhttps://www.sciencedirect.com/science/article/pii/S0140673620307509
URIhttp://hdl.handle.net/10576/46848
AbstractBackground Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. MethodsBased on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. FindingsGlobally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. InterpretationThe present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC. FundingBill & Melinda Gates Foundation.
SponsorLucas Guimarães Abreu acknowledges support from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (Capes) - Finance Code 001, Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG). Olatunji O Adetokunboh acknowledges South African Department of Science & Innovation, and National Research Foundation. Anurag Agrawal acknowledges support from the Wellcome Trust DBT India Alliance Senior Fellowship IA/CPHS/14/1/501489. Rufus Olusola Akinyemi acknowledges Grant U01HG010273 from the National Institutes of Health (NIH) as part of the H3Africa Consortium. Rufus Olusola Akinyemi is further supported by the FLAIR fellowship funded by the UK Royal Society and the African Academy of Sciences. Syed Mohamed Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. Marcel Ausloos, Claudiu Herteliu, and Adrian Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. Till Winfried Bärnighausen acknowledges support from the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. Juan J Carrero was supported by the Swedish Research Council (2019-01059). Felix Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. Vera Marisa Costa acknowledges support from grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e a Tecnologia (FCT), IP, under the Norma Transit? 3 ria DL57/2016/CP1334/CT0006. Jan-Walter De Neve acknowledges support from the Alexander von Humboldt Foundation. Kebede Deribe acknowledges support by Wellcome Trust grant number 201900/Z/16/Z as part of his International Intermediate Fellowship. Claudiu Herteliu acknowledges partial support by a grant co-funded by European Fund for Regional Development through Operational Program for Competitiveness, Project ID P_40_382. Praveen Hoogar acknowledges the Centre for Bio Cultural Studies (CBiCS), Manipal Academy of Higher Education(MAHE), Manipal and Centre for Holistic Development and Research (CHDR), Kalghatgi. Bing-Fang Hwang acknowledges support from China Medical University (CMU108-MF-95), Taichung, Taiwan. Mihajlo Jakovljevic acknowledges the Serbian part of this GBD contribution was co-funded through the Grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. Aruna M Kamath acknowledges funding from the National Institutes of Health T32 grant (T32GM086270). Srinivasa Vittal Katikireddi acknowledges funding from the Medical Research Council (MC_UU_12017/13 & MC_UU_12017/15), Scottish Government Chief Scientist Office (SPHSU13 & SPHSU15) and an NRS Senior Clinical Fellowship (SCAF/15/02). Yun Jin Kim acknowledges support from the Research Management Centre, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/0001). Kewal Krishan acknowledges support from the DST PURSE grant and UGC Center of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University, Chandigarh, India. Manasi Kumar acknowledges support from K43 TW010716 Fogarty International Center/NIMH. Ben Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. Iván Landires is a member of the Sistema Nacional de Investigaci? 3 n (SNI), which is supported by the Secretaría Nacional de Ciencia Tecnología e Innovación (SENACYT), Panamá. Jeffrey V Lazarus acknowledges support by a Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III/ESF, European Union [CP18/00074]). Peter T N Memiah acknowledges CODESRIA; HISTP. Subas Neupane acknowledges partial support from the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital. Shuhei Nomura acknowledges support from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (18K10082). Alberto Ortiz acknowledges support by ISCIII PI19/00815, DTS18/00032, ISCIII-RETIC REDinREN RD016/0009 Fondos FEDER, FRIAT, Comunidad de Madrid B2017/BMD-3686 CIFRA2-CM. These funding sources had no role in the writing of the manuscript or the decision to submit it for publication. George C Patton acknowledges support from a National Health & Medical Research Council Fellowship. Marina Pinheiro acknowledges support from FCT for funding through program DL 57/2016 - Norma transit? 3 ria. Alberto Raggi, David Sattin, and Silvia Schiavolin acknowledge support by a grant from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4 - Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). Daniel Cury Ribeiro acknowledges support from the Sir Charles Hercus Health Research Fellowship - Health Research Council of New Zealand (18/111). Perminder S Sachdev acknowledges funding from the NHMRC Australia. Abdallah M Samy acknowledges support from a fellowship from the Egyptian Fulbright Mission Program. Milena M Santric-Milicevic acknowledges support from the Ministry of Education, Science and Technological Development of the Republic of Serbia (Contract No. 175087). Rodrigo Sarmiento-Suárez acknowledges institutional support from University of Applied and Environmental Sciences in Bogota, Colombia, and Carlos III Institute of Health in Madrid, Spain. Maria Inês Schmidt acknowledges grants from the Foundation for the Support of Research of the State of Rio Grande do Sul (IATS and PrInt) and the Brazilian Ministry of Health. Sheikh Mohammed Shariful Islam acknowledges a fellowship from the National Heart Foundation of Australia and Deakin University. Aziz Sheikh acknowledges support from Health Data Research UK. Kenji Shibuya acknowledges Japan Ministry of Education, Culture, Sports, Science and Technology. Joan B Soriano acknowledges support by Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Rafael Tabarés-Seisdedos acknowledges partial support from grant PI17/00719 from ISCIII-FEDER. Santosh Kumar Tadakamadla acknowledges support from the National Health and Medical Research Council Early Career Fellowship, Australia. Marcello Tonelli acknowledges the David Freeze Chair in Health Services Research at the University of Calgary, AB, Canada.
Languageen
PublisherElsevier
SubjectGlobal Burden of Disease
Health Expenditures
Humans
Universal Health Insurance
World Health Organization
TitleMeasuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
TypeArticle
Pagination1250-1284
Issue Number10258
Volume Number396
Open Access user License http://creativecommons.org/licenses/by/4.0/
dc.accessType Open Access


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