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

Background

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

Methods

We collated 1,175 country-years of outpatient data on utilization from 130 countries and 2,068 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 utilization. We identified standards of utilization per disability-adjusted life year and estimated additional services and funds needed.

Findings

In 2016, the global age-standardized outpatient utilization rate was 5.42 visits (95% uncertainty interval [UI] 4.88–5.99) per capita and the inpatient utilization 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 aging for 8.09%, and higher utilization rates for 7.63%; results for the 67.96% increase in admissions were 44.33% from population growth, 9.99% from population aging, and 13.55% from increases in utilization 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 utilization and unit costs of current health systems and guided by standards of utilization of outpatient visits and inpatient admissions that achieve the highest coverage of personal health services at the lowest cost.