Influence of Universal Health Coverage on Health Outcomes

Abstract

There is a huge global disparity of health outcomes across countries as well as within each country. There are many responsible factors for the large gap and those factors are not only on the demand side (social biological and behavioral) but also on the supply side (the policy level). Millions of people are impoverished due to catastrophically insufficient health expenditure; there is poor access to health care and unfair distribution of and contribution to health resources. An appropriate health financing policy to achieve universal health coverage (UHC) could be the mile stone to mitigate inequalities and it is priority of World Health Organization (WHO) and a health goal in the sustainable development goals (SDGs). The aim of this study was to explore the influence of universal health coverage on health system index, healthy life years, adult mortality and infant mortality rate in the case of UN members states during the period of 2010- 2013. This is a multi-country analysis and data was adopted from different organizations. A database was created from data from the World Bank, United VI Nations Development Project (UNDP) education report, WHO country reports on youth tobacco prevalence and adult alcohol consumption per year. Moreover, health system index and universal health coverage status was adopted from Stuckler et.al and Tandan et.al, political stability, state religion status and 2 major economic country groups (G20) were adopted, and also the conflict and government state fragile report 2012, Robert J. study ‗which country has state religion‘ and Wikipedia using record linkage theory. The study hypothesis was formulated updating the Aron-Dine RAND theory of health insurance, PY Crémieux 1999, Fevzi Akinci 2014 and Vacillis Kontil 2014. The independent variables were composed of social determinants of health, disease prevention, health behavior and health financing and the dependent variables were health system index, health life years with adult and infant mortality rate. Descriptive statistics, linear regression, sub-group analysis, case studies and pathway analysis through structural equation modeling was performed using SPSS and AMOS when appropriate. For the normality, consistency and collinearity scatter plot diagram, Cronbach's alpha and variation inflation factors (VIF) were cross checked. Data for a total of 194 countries were available from multiple resources. The predictors; Social determinants of health (GDP growth, population growth, education enrollment), Disease prevention (vaccine and sanitation coverage), Health behavior (youth tobacco use and adult alcohol consumption per year), Health financing policies (universal health care, out-of-pocket payment, total health expenditure and government health expenditure) variables were associated with long term health outcomes (Health system index, healthy life years, adult and infant mortality rate).In direct association, health care financing policy i.e. Universal Health Coverage (UHC) had great influences on health outcomes (Health system index ~0.39, Healthy life years 0.40, Adult mortality ~ -0.40 and Infant mortality ~ -0.39) in the hierarchical linear regression. Likewise, child vaccination (DPT-3), sanitation coverage and population growth rate had less influence than UHC. In the pathway analysis, with UHC as the intermediate outcome, the influence power was higher than direct association (β>0.41, p<0.001). In sub group analysis, the health system index and VII healthy life expectancy was significantly higher and adult and infant mortality rate was significantly lower in countries those that had already achieved UHC.