Ranabhat Chhabi Lal, Jakovljevic Mihajlo, Dhimal Meghnath, Kim Chun-Bae
Policy Research Institute, Kathmandu, Nepal.
Department of Public Health, Manmohan Memorial Institute of Health Science, Kathmandu, Nepal.
Front Public Health. 2020 Jan 21;7:414. doi: 10.3389/fpubh.2019.00414. eCollection 2019.
Demography, politics, economy, and governance appear to be the major structural factors for health and well-being. These factors have a significant role to play in achieving universal health coverage (UHC). The majority of previous studies did not highlight those factors. The aim of this study is to explore the basic structural factors (political stability, demography, gross national income, governance, and transparency) associated with a UHC index of low- and middle-income countries because for a long time there has be a stagnation achieving universal health coverage. This study was a cross-sectional study applying multiple indices as variables. Low- and middle-income countries' selected indicators were the study variables. Data concerned the current political stability, sociodemographic status, gross national income (GNI), and governance status as independent variables and the UHC index of the countries as the dependent variable. Mean and standard deviations were used for the average values of the variables, a raw correlation was shown among variables and a hierarchical linear regression model was used for multi variate analysis. Government health expenditure is 6% out of the total budget in upper middle countries (UMIC) and ~5% in lower middle countries (LMIC) and low-income countries (LIC), population below poverty line is more than 2-fold higher in LIC in comparison with high income countries, UHC index, and socio-demographic index (SDI) index is similar in LMIC and LIC and slightly higher in UMIC. There is a positive association between government health expenditure, governance index, stability index, the SDI index, and GNI per capita and a negative association between populations below poverty line with UHC index. According to our full regression analysis model, governance, stability, and SDI index were associated with a significantly increased UHC index by 0.33, 0.41, and 0.57 ( < 0.05). To achieve UHC, good governance, political stability, and demographic balance are prerequisites and addressing these factors would help to meet by 2030 across countries.
人口统计学、政治、经济和治理似乎是影响健康与福祉的主要结构性因素。这些因素在实现全民健康覆盖（UHC）方面发挥着重要作用。此前的大多数研究并未突出这些因素。本研究的目的是探讨与低收入和中等收入国家全民健康覆盖指数相关的基本结构性因素（政治稳定、人口统计学、国民总收入、治理和透明度），因为长期以来在实现全民健康覆盖方面一直存在停滞。本研究是一项横断面研究，将多个指数用作变量。低收入和中等收入国家的选定指标为研究变量。数据涉及当前的政治稳定、社会人口状况、国民总收入（GNI）和治理状况作为自变量，以及这些国家的全民健康覆盖指数作为因变量。变量的平均值使用均值和标准差表示，变量之间显示了原始相关性，并使用分层线性回归模型进行多变量分析。高收入中等国家（UMIC）政府卫生支出占总预算的6%，中低收入国家（LMIC）和低收入国家（LIC）约为5%，LIC中生活在贫困线以下的人口比高收入国家高出两倍多，LMIC和LIC的全民健康覆盖指数与社会人口指数（SDI）相似，UMIC略高。政府卫生支出、治理指数、稳定指数、SDI指数与人均GNI之间存在正相关，生活在贫困线以下的人口与全民健康覆盖指数之间存在负相关。根据我们的全回归分析模型，治理、稳定和SDI指数与全民健康覆盖指数显著增加相关，分别增加0.33、0.41和0.57（<0.05）。要实现全民健康覆盖，良好的治理、政治稳定和人口平衡是先决条件，解决这些因素将有助于各国到2030年实现这一目标。
