Arhin Kwadwo, Oteng-Abayie Eric Fosu, Novignon Jacob
Department of Economics, Ghana Institute of Management and Public Administration, Accra, Ghana.
Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Health Econ Rev. 2023 May 2;13(1):25. doi: 10.1186/s13561-023-00433-y.
Universal health coverage (UHC) is a major pathway to save many people from catastrophic and impoverishing healthcare spending and address the inequality in health and healthcare. The objective of this paper is to assess the efficiency with which health systems in sub-Saharan Africa (SSA) are utilizing healthcare resources to progress towards achieving the UHC goal by 2030.
The study followed the guidelines proposed by the World Health Organization (WHO) and World Bank joint UHC monitoring framework and the computational operationalization approach proposed by Wagstaff et al. (2015) to estimate the UHC index for each of the 30 selected SSA countries. The bootstrapping output-oriented data envelopment analysis (DEA) was used to estimate the bias-corrected technical efficiency scores and examine the environmental factors that influence health system efficiency.
The estimated UHC levels ranged from a minimum of 52% to a maximum of 81% [Formula: see text] with a median coverage of 66%. The average bias-corrected efficiency score was 0.81 [Formula: see text]. The study found that education, governance quality, public health spending, external health funding, and prepayment arrangements that pool funds for health had a positive significant effect on health system efficiency in improving UHC, while out-of-pocket payment had a negative impact.
The results show that health systems in SSA can potentially enhance UHC levels by at least 19% with existing healthcare resources if best practices are adopted. Policymakers should aim at improving education, good governance, and healthcare financing architecture to reduce out-of-pocket payments and over-reliance on donor funding for healthcare to achieve UHC.
全民健康覆盖（UHC）是使许多人免于灾难性和致贫性医疗支出并解决健康与医疗保健方面不平等问题的主要途径。本文的目的是评估撒哈拉以南非洲（SSA）地区的卫生系统利用医疗资源朝着在2030年实现全民健康覆盖目标迈进的效率。
该研究遵循世界卫生组织（WHO）和世界银行联合全民健康覆盖监测框架提出的指南以及Wagstaff等人（2015年）提出的计算操作方法，以估算30个选定的撒哈拉以南非洲国家中每个国家的全民健康覆盖指数。采用面向产出的自抽样数据包络分析（DEA）来估算经偏差校正的技术效率得分，并考察影响卫生系统效率的环境因素。
估算的全民健康覆盖水平最低为52%，最高为81%[公式：见正文]，中位数覆盖率为66%。经偏差校正的平均效率得分为0.81[公式：见正文]。研究发现，教育、治理质量、公共卫生支出、外部卫生资金以及为卫生事业筹集资金的预付安排对改善全民健康覆盖的卫生系统效率有积极显著影响，而自付费用则有负面影响。
结果表明，如果采用最佳做法，撒哈拉以南非洲地区的卫生系统利用现有医疗资源可将全民健康覆盖水平至少提高19%。政策制定者应致力于改善教育、善治和医疗融资架构，以减少自付费用并减少医疗保健对捐助资金的过度依赖，从而实现全民健康覆盖。
