Understanding Universal Health Coverage success through Qualitative Comparative Analysis

[摘要] ENGLISH ABSTRACT: Goal 3 of the United Nations Sustainable Development Goals (SDGs) is to 'Ensure healthy lives and promote well-beingfor all at all ages. More specifically, this goal is to 'Achieve universal health coverage, including financial riskprotection, access to quality essential health-care services and access to safe, effective, quality and affordable essentialmedicines and vaccines for all. In 2016 all the UN member states agreed to attempt to achieve universal health coverage(UHC) by 2030.For many countries, achieving UHC is a daunting task, for which they will have to transform their whole health system.It is therefore crucial for policy-makers and participants in the implementation of UHC to understand which conditionsin a country influence the success of UHC outcomes.The aim of this study is to contribute to the research on how better to implement UHC in a country through understandingthe conditions that influence UHC outcomes by using a structured engineering approach.This was done by first determine which methods can help in this understanding of universal health coverage, and thenselecting the most appropriate comparative causal research method – which in this case was found to be QualitativeComparative Analysis (QCA). The QCA methodology is then described step-by-step; and in order to show QCA'scapability each step is also applied to an example. In applying the QCA method, country conditions were used as modelcondition variables and UHC service coverage index were used as model outcomes.Results from the QCA example indicated that that the combination of high employment to population ratio, high healthspending as a percentage of GDP, and being a highly developed country is sufficient for a positive UHC outcome.The results are cross-validated in two steps: applying regression analysis on the raw data to understand the predictivepower of the conditions on the UHC service coverage index. This was followed by doing within case investigations oncountries showing strong links between the condition variables (those presented in the findings of the QCA analysis) andUHC outcomes.The regression analysis highlighted that a high employment to population ratio and a more developed countryclassification are good predictors of UHC outcomes.The within-case investigations indicated that the countries included in the findings of the QCA were mostly high-incomeEuropean countries with high GDP per capita. The case investigations also highlighted that these countries mostly hadcompulsory and statutory health systems, and that revenue was often raised by some form of income taxation. It alsohighlighted that hospitals were mostly publicly owned, that primary health facilities were mostly owned privately, andthat most countries included in the study still had some level of out-of-pocket expenditure (OOP). From the applicationof the example it is suggested that the QCA method proposed in this research inquiry could be useful to provide decisionsupport to policy makers of UHC in countries.

[发布机构] Stellenbosch University