New Index Reveals Gap between Rhetoric and Reality on Universal Health Coverage

November 18, 2015


From left to right: Adam Wagstaff, Asli Demirgüç-Kunt, Timothy Evans

  • Current approaches to measuring health coverage fail to include many key aspects of the performance of healthcare systems.
  • A new Universal Health Coverage Index that measures both the extent of service coverage and financial protection provides a more complete picture and can track countries’ progress over time.
  • Despite the rhetoric, no developing country has yet achieved universal health coverage.

With pervasive ill-health and disease continuing to both cause and drive poverty for millions of families worldwide, government leaders, health ministries, development agencies, CSO groups, and many others are working to achieve the goal of universal health coverage (UHC).

However, inconsistent definitions of UHC and how to measure it have muddied country-by-country analysis of progress and the evaluation of the effectiveness of policy reforms. To address these difficulties, Adam Wagstaff, a Research Manager in the World Bank’s Research Department, together with several coauthors, has proposed a new index that assesses countries’ progress towards UHC in one ranking.

In our latest Policy Research Talk Wagstaff discusses the various limitations of existing measurements of universal health coverage, and suggests a new scoring system that measures coverage of services as well as financial protection.

The index is based on a definition of UHC that emphasizes two dimensions: everyone receives the care they need, irrespective of their ability to pay, and no one experiences undue financial hardship as a result. By measuring UHC across two vital criteria, the new index examines access to healthcare through the lens of less poverty and resilience.

" Contrary to some of the rhetoric, all developing countries are still working on attaining universal health coverage. "

Adam Wagstaff

Research Manager

“Investing in health is essential to eradicating poverty and improving people’s welfare,” said Research Director Asli Demirgüç-Kunt. “Universal health coverage also cushions the impact of shocks on communities and fosters more productive, cohesive, and equal communities,” she said.

Wagstaff applied the index, which evaluates countries on a scale of 1-100, to 24 developing countries. Brazil, Colombia, Costa Rica, Mexico, and South Africa received scores ranging from 79-82, while lower-performing countries including Cambodia, Indonesia, and Ethiopia had scores in the 22-47 range.

“Contrary to some of the rhetoric, all developing countries are still working on achieving universal health coverage,” said Wagstaff.


In addition to assessing country progress towards UHC, the index can also help evaluate the impact of government programs and reforms. While the index has ticked up in countries following reforms like the introduction of performance-based financing or insurance schemes, improvements have been modest and have come largely from an increase in health interventions, rather than a lowering of the costs borne by patients.

“100 million people annually are tipped into poverty because of the precarious way that health coverage is financed,” said Discussant Timothy Evans, Senior Director for the Health, Nutrition, and Population Global Practice. He described the new index as “the 21st century frontier of measurement. Its success will depend on how well we understand how to get and incorporate” better measurement and data.