Frontiers in public health · 2026
Cross-national disparities in non-communicable disease: a universal health coverage-based service coverage index perspective, 2000-2021.
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Zhou Mingzhu, Jiang Ying, Zhu Jiaying, Li Zhiyong, Sun Hong, Gao Fangfang, Weng Kaiyuan
Аннотация
BACKGROUND: Universal Health Coverage (UHC) has garnered widespread attention since its inception. However, systematic research on the dynamic inequalities in UHC for Non-Communicable Diseases (NCDs) remains limited.
METHODS: This study investigates the inequalities in UHC for NCDs from 2000 to 2021, offering evidence and policy recommendations to promote global UHC equality for NCDs. Using multiple cross-national datasets, this study examines UHC inequality for NCDs. A panel fixed-effects model analyzes influencing factors, while the Gini coefficient and other indices measure inequality. The Oaxaca-Blinder decomposition method identifies sources of inequality differences among countries with varying income levels.
RESULTS: During this period, the global Non-Communicable Diseases Service Coverage Index (NCD-SCI) increased from the 50s to the 60s, while the Gini coefficient decreased from 0.115 to 0.095. Government health expenditure as a percentage of GDP significantly positively impacted NCD-SCI (β = 0.24, p < 0.01), whereas physician density per 10,000 people did not (95% CI included 0). The interaction between resource endowment and return rate contributed up to 53.26% to the SCI gap compared to low-income countries. Higher national income reduced the contribution of resource endowment differences to the SCI gap while increasing interaction effects. Differences between high-income and upper-middle-income countries were mainly due to health expenditure (contribution rate 116.67%), while those with low-income countries were driven by medical resource endowment.
CONCLUSION: This study reveals long-term trends in UHC for NCDs amid global economic disparities and proposes measures to enhance UHC levels and promote equality in different regions.
METHODS: This study investigates the inequalities in UHC for NCDs from 2000 to 2021, offering evidence and policy recommendations to promote global UHC equality for NCDs. Using multiple cross-national datasets, this study examines UHC inequality for NCDs. A panel fixed-effects model analyzes influencing factors, while the Gini coefficient and other indices measure inequality. The Oaxaca-Blinder decomposition method identifies sources of inequality differences among countries with varying income levels.
RESULTS: During this period, the global Non-Communicable Diseases Service Coverage Index (NCD-SCI) increased from the 50s to the 60s, while the Gini coefficient decreased from 0.115 to 0.095. Government health expenditure as a percentage of GDP significantly positively impacted NCD-SCI (β = 0.24, p < 0.01), whereas physician density per 10,000 people did not (95% CI included 0). The interaction between resource endowment and return rate contributed up to 53.26% to the SCI gap compared to low-income countries. Higher national income reduced the contribution of resource endowment differences to the SCI gap while increasing interaction effects. Differences between high-income and upper-middle-income countries were mainly due to health expenditure (contribution rate 116.67%), while those with low-income countries were driven by medical resource endowment.
CONCLUSION: This study reveals long-term trends in UHC for NCDs amid global economic disparities and proposes measures to enhance UHC levels and promote equality in different regions.