Háskólinn í ReykjavíkReykjavik UniversityLozano, RafaelFullman, NancyMumford, John EverettKnight, MeganBarthelemy, Celine MAbbafati, CristianaAbbastabar, HedayatAbd-Allah, FoadAbdollahi, MohammadAbedi, AidinAbolhassani, HassanAbosetugn, Akine EsheteAbreu, Lucas GuimarãesAbrigo, Michael R MAbu Haimed, Abdulaziz KhalidAbushouk, Abdelrahman IAdabi, MaryamAdebayo, Oladimeji MAdekanmbi, VictorAdelson, JaimieAdetokunboh, Olatunji OAdham, DavoudAdvani, Shailesh MAfshin, AshkanAgarwal, GinaAgasthi, PradyumnaAghamir, Seyed Mohammad KazemAgrawal, AnuragAhmad, TauseefAkinyemi, Rufus OlusolaAlahdab, FaresAl-Aly, ZiyadAlam, KhurshidAlbertson, Samuel BAlemu, Yihun MulugetaAlhassan, Robert KabaAli, MuhammadAli, SaqibAlipour, VahidAljunid, Syed MohamedAlla, FrançoisAlmadi, Majid Abdulrahman HamadAlmasi, AliAlmasi-Hashiani, AmirAlmasri, Nihad AAl-Mekhlafi, Hesham MAlmulhim, Abdulaziz MAlonso, JordiAl-Raddadi, Rajaa MAltirkawi, Khalid AAlvis-Guzman, NelsonAlvis-Zakzuk, Nelson JAmini, SaeedAmini-Rarani, MostafaAmiri, FatemehAmit, Arianna Maever LAmugsi, Dickson AAncuceanu, RobertAnderlini, DeannaAndrei, Catalina LilianaAndroudi, SofiaAnsari, FereshtehAnsari-Moghaddam, AlirezaAntonio, Carl Abelardo TAntony, Catherine MAntriyandarti, ErnoizAnvari, DavoodAnwer, RaziqueArabloo, JalalArab-Zozani, MortezaAravkin, Aleksandr YAremu, OlatundeÄrnlöv, JohanAsaad, MalkeAsadi-Aliabadi, MehranAsadi-Pooya, Ali AAshbaugh, CharlieAthari, Seyyed ShamsadinAtout, Maha Moh'd WahbiAusloos, MarcelAvila-Burgos, LeticiaAyala Quintanilla, Beatriz PaulinaAyano, GetinetAyanore, Martin AmogreAynalem, Yared AsmareAynalem, Getie LakeAyza, Muluken AltayeAzari, SamadAzzopardi, Peter SB, Darshan BBabaee, EbrahimBadiye, Ashish DBahrami, Mohammad AminBaig, Atif AminBakhshaei, Mohammad HosseinBakhtiari, AhadBakkannavar, Shankar MBalachandran, ArunBalassyano, ShellyBanach, MaciejBanerjee, Srikanta KBanik, Palash ChandraBante, Agegnehu BanteBante, Simachew AnimenBarker-Collo, Suzanne LynBärnighausen, Till WinfriedBarrero, Lope HBassat, QuiqueBasu, SanjayBaune, Bernhard TBayati, MohsenBaye, Bayisa AbdissaBedi, NeerajBeghi, EttoreBehzadifar, MasoudBekuma, Tariku Tesfaye TesfayeBell, Michelle LBensenor, Isabela MBerman, Adam EBernabe, EduardoBernstein, Robert SBhagavathula, Akshaya SrikanthBhandari, DineshBhardwaj, PankajBhat, Anusha GanapatiBhattacharyya, KrittikaBhattarai, SurajBhutta, Zulfiqar ABijani, AliBikbov, BorisBilano, VerBiondi, AntonioBirihane, Binyam MinuyeBockarie, Moses JohnBohlouli, SomayehBojia, Hunduma AmensisaBolla, Srinivasa Rao RaoBoloor, ArchithBrady, Oliver JBraithwaite, DejanaBriant, Paul SvitilBriggs, Andrew MBriko, Nikolay IvanovichBurugina Nagaraja, SharathBusse, ReinhardButt, Zahid ACaetano dos Santos, Florentino LucianoCahuana-Hurtado, LuceroCámera, Luis AlbertoCárdenas, RosarioCarreras, GiuliaCarrero, Juan JCarvalho, FelixCastaldelli-Maia, Joao MauricioCastañeda-Orjuela, Carlos ACastelpietra, GiulioCastro, FranzCatalá-López, FerránCausey, KateCederroth, Christopher RCercy, Kelly MCerin, EsterChandan, Joht SinghChang, Angela YCharan, JaykaranChattu, Vijay KumarChaturvedi, SarikaChin, Ken LeeCho, Daniel YoungwhanChoi, Jee-Young JasmineChristensen, HanneChu, Dinh-ToiChung, Michael TCiobanu, Liliana GCirillo, MassimoComfort, HaleyCompton, KellyCortesi, Paolo AngeloCosta, Vera MarisaCousin, EwertonDahlawi, Saad M ADamiani, GiovanniDandona, LalitDandona, RakhiDarega Gela, JiregnaDarwesh, Aso MohammadDaryani, AhmadDash, Aditya PrasadDavey, GailDávila-Cervantes, Claudio AlbertoDavletov, KairatDe Neve, Jan-WalterDenova-Gutiérrez, EdgarDeribe, KebedeDervenis, NikolaosDesai, RupakDharmaratne, Samath DhammindaDhungana, Govinda PrasadDianatinasab, MostafaDias da Silva, DianaDiaz, DanielDippenaar, Ilse NDo, Hoa ThiDorostkar, FaribaDoshmangir, LeilaDuncan, Bruce BDuraes, Andre RodriguesEagan, Arielle WilderEdvardsson, DavidEl Sayed, ImanEl Tantawi, MahaElgendy, Islam YElyazar, Iqbal RFEskandari, KhalilEskandarieh, ShararehEsmaeilnejad, SamanEsteghamati, 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CPaudel, SagunPazoki Toroudi, HamidrezaPease, Spencer APeden, Amy EPennini, AlyssaPeprah, Emmanuel KPereira, JeevanPigott, David MPilgrim, ThomasPilz, Tessa MPinheiro, MarinaPiradov, Michael APirsaheb, MeghdadPokhrel, Khem NarayanPostma, Maarten JPourjafar, HadiPourmalek, FarshadPourmirza Kalhori, RezaPourshams, AkramPrada, Sergio IPribadi, Dimas Ria AnggaPupillo, ElisabettaQuazi Syed, ZahiruddinRadfar, AmirRafiee, AtaRafiei, AlirezaRaggi, AlbertoRahim, FakherRahman, Muhammad AzizRajabpour-Sanati, AliRana, Saleem MuhammadRanabhat, Chhabi LalRao, Sowmya JRasella, DavideRashedi, VahidRath, Goura KishorRathi, PriyaRawaf, SalmanRawaf, David LaithRawal, LalRawassizadeh, RezaRazo, ChristianRenjith, VishnuRenzaho, Andre M NReshmi, BhageerathyRezaei, NimaRiahi, Seyed MohammadRibeiro, Daniel CuryRickard, JenniferRoberts, Nicholas L SRoever, LeonardoRomoli, MicheleRonfani, LucaRoshandel, GholamrezaRubagotti, EnricoRwegerera, Godfrey MSabour, SiamakSachdev, Perminder SSaddik, BasemaSadeghi, MasoumehSadeghi, EhsanSafari, YahyaSagar, RajeshSahebkar, AmirhosseinSahraian, Mohammad AliSajadi, S. MohammadSalahshoor, Mohammad RezaSalem, Marwa R RashadSalem, HosniSalomon, JoshuaSamadi Kafil, HosseinSamy, Abdallah MSanabria, JuanSantric-Milicevic, Milena MSaraswathy, Sivan Yegnanarayana IyerSarmiento-Suárez, RodrigoSartorius, BennSarveazad, ArashSathian, BrijeshSathish, ThirunavukkarasuSattin, DavideSavic, MilojeSawyer, Susan MSaxena, DeepakSbarra, Alyssa NSchaeffer, Lauren ESchiavolin, SilviaSchmidt, Maria InêsSchutte, Aletta ElisabethSchwebel, David CSchwendicke, FalkSeedat, SorayaSha, FengShahabi, SaeedShaheen, Amira AShaikh, Masood AliShamsizadeh, MortezaShannawaz, MohammedSharafi, KiomarsSharara, FablinaSharifi, HamidShaw, David HSheikh, AzizSheikhtaheri, AbbasShetty, B Suresh KumarShibuya, KenjiShiferaw, Wondimeneh ShibabawShigematsu, MikaShin, Jae IlShiri, RahmanShirkoohi, RezaShivakumar, K MShrime, Mark GShuval, KeremSiabani, SorayaSierpinski, RadoslawSigfúsdóttir, Inga DóraSigurvinsdottir, RannveigSilva, Diego Augusto SantosSilva, João PedroSimonetti, BiagioSimpson, Kyle ESingh, Jasvinder ASingh, PushpendraSinha, Dhirendra NarainSkryabin, Valentin YurievichSmith, Emma U RSoheili, AminSoltani, ShahinSoofi, MoslemSorensen, Reed J.D.Soriano, Joan BSorrie, Muluken BekeleSoyiri, Ireneous NSpurlock, Emma ElizabethSreeramareddy, Chandrashekhar TStanaway, Jeffrey DSteel, NicholasStein, CarolineStokes, Mark ASufiyan, Mu'awiyyah BabaleSuleria, Hafiz Ansar RasulSultan, IyadSzumowski, ŁukaszTabarés-Seisdedos, RafaelTabuchi, TakahiroTadakamadla, Santosh KumarTaddele, Biruk WogayehuTadesse, Degena BahreyTaherkhani, AmirTamiru, Animut TageleTanser, Frank CTareque, Md IsmailTarigan, Ingan UkurTeagle, Whitney LTediosi, FabrizioTefera, Yonas Getaye GetayeTela, Freweini GebrearegayTessema, Zemenu TadesseThakur, BhaskarTitova, Mariya VladimirovnaTonelli, MarcelloTopor-Madry, RomanTopouzis, FotisTovani-Palone, Marcos Roberto RobertoTran, Bach XuanTravillian, RavensaraTroeger, Christopher ETudor Car, LorainneUddin, RiazUllah, IrfanUmeokonkwo, Chukwuma DavidUnnikrishnan, BhaskaranUpadhyay, EraUthman, Olalekan AVacante, MarcoValdez, Pascual RVarughese, SantoshVasankari, Tommi JuhaniVasseghian, YasserVenketasubramanian, NarayanaswamyViolante, Francesco SVlassov, VasilyVollset, Stein EmilVongpradith, AvinaVos, TheoWaheed, YasirWalters, Magdalene KWamai, Richard GWang, HaidongWang, Yuan-PangWeintraub, Robert GWeiss, JordanWerdecker, AndreaWesterman, RonnyWilner, Lauren BWoldu, GebremariamWolfe, Charles D AWu, Ai-MinWulf Hanson, SarahXie, YangXu, RixingYahyazadeh Jabbari, Seyed HosseinYamagishi, KazumasaYano, YuichiroYaya, SanniYazdi-Feyzabadi, VahidYearwood, Jamal AYeshitila, Yordanos GizachewYip, PaulYonemoto, NaohiroYounis, Mustafa ZYousefi, ZabihollahYousefinezhadi, TaranehYusefzadeh, HasanZadey, SiddheshZahirian Moghadam, TelmaZaidi, Syed SaoudZaki, LeilaZaman, Sojib BinZamani, MohammadZamanian, MaryamZandian, HamedZastrozhin, Mikhail SergeevichZewdie, Kaleab AlemayehuZhang, YunquanZhao, Xiu-Ju GeorgeZhao, YingxiZheng, PengZhu, CongZiapour, ArashZlavog, Bianca SZodpey, SanjayMurray, Christopher J L2021-04-232021-04-232020-10Lozano, R., Fullman, N., Mumford, J. E., Knight, M., Barthelemy, C. M., Abbafati, C., Abbastabar, H., Abd-Allah, F., Abdollahi, M., Abedi, A., Abolhassani, H., Abosetugn, A. E., Abreu, L. G., Abrigo, M. R. M., Abu Haimed, A. K., Abushouk, A. I., Adabi, M., Adebayo, O. M., Adekanmbi, V., … Murray, C. J. L. (2020). Measuring 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. Lancet, 396(10258), 1250–1284. https://doi.org/10.1016/S0140-6736(20)30750-90140-67361474-547X (eISSN)https://hdl.handle.net/20.500.11815/2551Publisher's version (útgefin grein)Background 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. Methods Based 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. Findings Globally, 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. Interpretation The 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.1250-1284eninfo:eu-repo/semantics/openAccessGeneral MedicinePublic healthMedical careMedical policyHealth systemsHealth services accessibilityMedical economicsWorld Health OrganizationHeilbrigðisvísindiLýðheilsaHeilbrigðisþjónustaHeilbrigðisstefnaHeilbrigðiskerfiHeilsuhagfræðiSjúkdómarAlþjóðaheilbrigðisstofnuninGlobal burden of diseaseHealth expendituresinfo:eu-repo/semantics/article10.1016/S0140-6736(20)30750-9