http://researchonline.federation.edu.au/vital/access/manager/Index ${session.getAttribute("locale")} 5 http://researchonline.federation.edu.au/vital/access/manager/Repository/vital:17110 Wed 11 Jan 2023 17:10:33 AEDT ]]> http://researchonline.federation.edu.au/vital/access/manager/Repository/vital:14579 Wed 07 Apr 2021 14:02:40 AEST ]]> http://researchonline.federation.edu.au/vital/access/manager/Repository/vital:14566 Wed 07 Apr 2021 14:02:39 AEST ]]> http://researchonline.federation.edu.au/vital/access/manager/Repository/vital:14533 Wed 07 Apr 2021 14:02:37 AEST ]]> http://researchonline.federation.edu.au/vital/access/manager/Repository/vital:14505 Wed 07 Apr 2021 14:02:35 AEST ]]> http://researchonline.federation.edu.au/vital/access/manager/Repository/vital:7078 Wed 07 Apr 2021 13:46:35 AEST ]]> http://researchonline.federation.edu.au/vital/access/manager/Repository/vital:4956 Wed 07 Apr 2021 13:44:33 AEST ]]> http://researchonline.federation.edu.au/vital/access/manager/Repository/vital:14903 = 65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0-100 based on the 2.5th and 97.5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target-1 billion more people benefiting from UHC by 2023-we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45.8 (95% uncertainty interval 44.2-47.5) in 1990 to 60.3 (58.7-61.9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2.6% [1.9-3.3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010-2019 relative to 1990-2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0.79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388.9 million (358.6-421.3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3.1 billion (3.0-3.2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968.1 million [903.5-1040.3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people-the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close-or how far-all populations are in benefiting from UHC. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd. **Please note that there are multiple authors for this article therefore only the name of the Federation University Australia affiliate is provided in this record**]]> Thu 21 Oct 2021 14:59:32 AEDT ]]> http://researchonline.federation.edu.au/vital/access/manager/Repository/vital:18711 Thu 14 Dec 2023 12:17:12 AEDT ]]> http://researchonline.federation.edu.au/vital/access/manager/Repository/vital:17221 Mon 13 Feb 2023 10:00:25 AEDT ]]>