Funding and services needed to achieve universal health coverage: applications of global, regional, and national estimates of utilisation of outpatient visits and inpatient admissions from 1990 to 2016, and unit costs from 1995 to 2016

Summary: Background: To inform plans to achieve universal health coverage (UHC), we estimated utilisation and unit cost of outpatient visits and inpatient admissions, did a decomposition analysis of utilisation, and estimated additional services and funds needed to meet a UHC standard for utilisati...

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Main Authors: Mark W Moses, MHS, Paola Pedroza, MPH, Ranju Baral, PhD, Sabina Bloom, BA, Jonathan Brown, MAIS, Abby Chapin, BA, Kelly Compton, BS, Erika Eldrenkamp, MPH, Nancy Fullman, MPH, John Everett Mumford, BA, Vishnu Nandakumar, BS, Katherine Rosettie, MPH, Nafis Sadat, MA, Tom Shonka, BA, Abraham Flaxman, PhD, Theo Vos, PhD, Chris J L Murray, DPhil, Marcia R Weaver, PhD
Format: Article
Language:English
Published: Elsevier 2019-01-01
Series:The Lancet Public Health
Online Access:http://www.sciencedirect.com/science/article/pii/S2468266718302135
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author Mark W Moses, MHS
Paola Pedroza, MPH
Ranju Baral, PhD
Sabina Bloom, BA
Jonathan Brown, MAIS
Abby Chapin, BA
Kelly Compton, BS
Erika Eldrenkamp, MPH
Nancy Fullman, MPH
John Everett Mumford, BA
Vishnu Nandakumar, BS
Katherine Rosettie, MPH
Nafis Sadat, MA
Tom Shonka, BA
Abraham Flaxman, PhD
Theo Vos, PhD
Chris J L Murray, DPhil
Marcia R Weaver, PhD
spellingShingle Mark W Moses, MHS
Paola Pedroza, MPH
Ranju Baral, PhD
Sabina Bloom, BA
Jonathan Brown, MAIS
Abby Chapin, BA
Kelly Compton, BS
Erika Eldrenkamp, MPH
Nancy Fullman, MPH
John Everett Mumford, BA
Vishnu Nandakumar, BS
Katherine Rosettie, MPH
Nafis Sadat, MA
Tom Shonka, BA
Abraham Flaxman, PhD
Theo Vos, PhD
Chris J L Murray, DPhil
Marcia R Weaver, PhD
Funding and services needed to achieve universal health coverage: applications of global, regional, and national estimates of utilisation of outpatient visits and inpatient admissions from 1990 to 2016, and unit costs from 1995 to 2016
The Lancet Public Health
author_facet Mark W Moses, MHS
Paola Pedroza, MPH
Ranju Baral, PhD
Sabina Bloom, BA
Jonathan Brown, MAIS
Abby Chapin, BA
Kelly Compton, BS
Erika Eldrenkamp, MPH
Nancy Fullman, MPH
John Everett Mumford, BA
Vishnu Nandakumar, BS
Katherine Rosettie, MPH
Nafis Sadat, MA
Tom Shonka, BA
Abraham Flaxman, PhD
Theo Vos, PhD
Chris J L Murray, DPhil
Marcia R Weaver, PhD
author_sort Mark W Moses, MHS
title Funding and services needed to achieve universal health coverage: applications of global, regional, and national estimates of utilisation of outpatient visits and inpatient admissions from 1990 to 2016, and unit costs from 1995 to 2016
title_short Funding and services needed to achieve universal health coverage: applications of global, regional, and national estimates of utilisation of outpatient visits and inpatient admissions from 1990 to 2016, and unit costs from 1995 to 2016
title_full Funding and services needed to achieve universal health coverage: applications of global, regional, and national estimates of utilisation of outpatient visits and inpatient admissions from 1990 to 2016, and unit costs from 1995 to 2016
title_fullStr Funding and services needed to achieve universal health coverage: applications of global, regional, and national estimates of utilisation of outpatient visits and inpatient admissions from 1990 to 2016, and unit costs from 1995 to 2016
title_full_unstemmed Funding and services needed to achieve universal health coverage: applications of global, regional, and national estimates of utilisation of outpatient visits and inpatient admissions from 1990 to 2016, and unit costs from 1995 to 2016
title_sort funding and services needed to achieve universal health coverage: applications of global, regional, and national estimates of utilisation of outpatient visits and inpatient admissions from 1990 to 2016, and unit costs from 1995 to 2016
publisher Elsevier
series The Lancet Public Health
issn 2468-2667
publishDate 2019-01-01
description Summary: Background: To inform plans to achieve universal health coverage (UHC), we estimated utilisation and unit cost of outpatient visits and inpatient admissions, did a decomposition analysis of utilisation, and estimated additional services and funds needed to meet a UHC standard for utilisation. Methods: We collated 1175 country-years of outpatient data on utilisation from 130 countries and 2068 country-years of inpatient data from 128 countries. We did meta-regression analyses of annual visits and admissions per capita by sex, age, location, and year with DisMod-MR, a Bayesian meta-regression tool. We decomposed changes in total number of services from 1990 to 2016. We used data from 795 National Health Accounts to estimate shares of outpatient and inpatient services in total health expenditure by location and year and estimated unit costs as expenditure divided by utilisation. We identified standards of utilisation per disability-adjusted life-year and estimated additional services and funds needed. Findings: In 2016, the global age-standardised outpatient utilisation rate was 5·42 visits (95% uncertainty interval [UI] 4·88–5·99) per capita and the inpatient utilisation rate was 0·10 admissions (0·09–0·11) per capita. Globally, 39·35 billion (95% UI 35·38–43·58) visits and 0·71 billion (0·65–0·77) admissions were provided in 2016. Of the 58·65% increase in visits since 1990, population growth accounted for 42·95%, population ageing for 8·09%, and higher utilisation rates for 7·63%; results for the 67·96% increase in admissions were 44·33% from population growth, 9·99% from population ageing, and 13·55% from increases in utilisation rates. 2016 unit cost estimates (in 2017 international dollars [I$]) ranged from I$2 to I$478 for visits and from I$87 to I$22 543 for admissions. The annual cost of 8·20 billion (6·24–9·95) additional visits and 0·28 billion (0·25–0·30) admissions in low-income and lower-middle income countries in 2016 was I$503·12 billion (404·35–605·98) or US$158·10 billion (126·58–189·67). Interpretation: UHC plans can be based on utilisation and unit costs of current health systems and guided by standards of utilisation of outpatient visits and inpatient admissions that achieve the highest coverage of personal health services at the lowest cost. Funding: Bill & Melinda Gates Foundation.
url http://www.sciencedirect.com/science/article/pii/S2468266718302135
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spelling doaj-d067a5ef5bda454aae9f418e9a4e83da2020-11-25T01:56:43ZengElsevierThe Lancet Public Health2468-26672019-01-0141e49e73Funding and services needed to achieve universal health coverage: applications of global, regional, and national estimates of utilisation of outpatient visits and inpatient admissions from 1990 to 2016, and unit costs from 1995 to 2016Mark W Moses, MHS0Paola Pedroza, MPH1Ranju Baral, PhD2Sabina Bloom, BA3Jonathan Brown, MAIS4Abby Chapin, BA5Kelly Compton, BS6Erika Eldrenkamp, MPH7Nancy Fullman, MPH8John Everett Mumford, BA9Vishnu Nandakumar, BS10Katherine Rosettie, MPH11Nafis Sadat, MA12Tom Shonka, BA13Abraham Flaxman, PhD14Theo Vos, PhD15Chris J L Murray, DPhil16Marcia R Weaver, PhD17Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAPATH, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Correspondence to: Prof Marcia R Weaver, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USASummary: Background: To inform plans to achieve universal health coverage (UHC), we estimated utilisation and unit cost of outpatient visits and inpatient admissions, did a decomposition analysis of utilisation, and estimated additional services and funds needed to meet a UHC standard for utilisation. Methods: We collated 1175 country-years of outpatient data on utilisation from 130 countries and 2068 country-years of inpatient data from 128 countries. We did meta-regression analyses of annual visits and admissions per capita by sex, age, location, and year with DisMod-MR, a Bayesian meta-regression tool. We decomposed changes in total number of services from 1990 to 2016. We used data from 795 National Health Accounts to estimate shares of outpatient and inpatient services in total health expenditure by location and year and estimated unit costs as expenditure divided by utilisation. We identified standards of utilisation per disability-adjusted life-year and estimated additional services and funds needed. Findings: In 2016, the global age-standardised outpatient utilisation rate was 5·42 visits (95% uncertainty interval [UI] 4·88–5·99) per capita and the inpatient utilisation rate was 0·10 admissions (0·09–0·11) per capita. Globally, 39·35 billion (95% UI 35·38–43·58) visits and 0·71 billion (0·65–0·77) admissions were provided in 2016. Of the 58·65% increase in visits since 1990, population growth accounted for 42·95%, population ageing for 8·09%, and higher utilisation rates for 7·63%; results for the 67·96% increase in admissions were 44·33% from population growth, 9·99% from population ageing, and 13·55% from increases in utilisation rates. 2016 unit cost estimates (in 2017 international dollars [I$]) ranged from I$2 to I$478 for visits and from I$87 to I$22 543 for admissions. The annual cost of 8·20 billion (6·24–9·95) additional visits and 0·28 billion (0·25–0·30) admissions in low-income and lower-middle income countries in 2016 was I$503·12 billion (404·35–605·98) or US$158·10 billion (126·58–189·67). Interpretation: UHC plans can be based on utilisation and unit costs of current health systems and guided by standards of utilisation of outpatient visits and inpatient admissions that achieve the highest coverage of personal health services at the lowest cost. Funding: Bill & Melinda Gates Foundation.http://www.sciencedirect.com/science/article/pii/S2468266718302135