Evidence map›Paper›PMID 30551974›Full record

ArticleThe Lancet. Public health2019

Funding and services needed to achieve universal health coverage: applications of global, regional, and national estimates of utilisation of outpatient visits and inpatient admissions from 1990 to 2016, and unit costs from 1995 to 2016.

Mark W Moses, Paola Pedroza, Ranju Baral, Sabina Bloom, Jonathan Brown, Abby Chapin, Kelly Compton, Erika Eldrenkamp, Nancy Fullman, John Everett Mumford and 8 more

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PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet. Public health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 56 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
56citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

56 citing papers in PubMed, 5 syntheses or guidelines pooled it.

  1. Pooled it
  2. A systematic review and narrative synthesis of physical activity referral schemes' components.The international journal of behavioral nutrition and physical activity · 2023
    Pooled it
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  19. Quantifying the Cost ofOpen forum infectious diseases · 2024
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

18 authors.

Mark W MosesInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Paola PedrozaInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Ranju BaralPATH, Seattle, WA, USA.
Sabina BloomInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Jonathan BrownInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Abby ChapinInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Kelly ComptonInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Erika EldrenkampInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Nancy FullmanInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
John Everett MumfordInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Vishnu NandakumarInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Katherine RosettieInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Nafis SadatInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Tom ShonkaInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Abraham FlaxmanInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Theo VosInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Chris J L MurrayInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Marcia R WeaverInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. Electronic address: mweaver@uw.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTo inform plans to achieve universal health coverage (UHC), we estimated utilisation and unit cost of outpatient visits and inpatient admissions, did a decomposition analysis of utilisation, and estimated additional services and funds needed to meet a UHC standard for utilisation.

methodsWe collated 1175 country-years of outpatient data on utilisation from 130 countries and 2068 country-years of inpatient data from 128 countries. We did meta-regression analyses of annual visits and admissions per capita by sex, age, location, and year with DisMod-MR, a Bayesian meta-regression tool. We decomposed changes in total number of services from 1990 to 2016. We used data from 795 National Health Accounts to estimate shares of outpatient and inpatient services in total health expenditure by location and year and estimated unit costs as expenditure divided by utilisation. We identified standards of utilisation per disability-adjusted life-year and estimated additional services and funds needed.

findingsIn 2016, the global age-standardised outpatient utilisation rate was 5·42 visits (95% uncertainty interval [UI] 4·88-5·99) per capita and the inpatient utilisation rate was 0·10 admissions (0·09-0·11) per capita. Globally, 39·35 billion (95% UI 35·38-43·58) visits and 0·71 billion (0·65-0·77) admissions were provided in 2016. Of the 58·65% increase in visits since 1990, population growth accounted for 42·95%, population ageing for 8·09%, and higher utilisation rates for 7·63%; results for the 67·96% increase in admissions were 44·33% from population growth, 9·99% from population ageing, and 13·55% from increases in utilisation rates. 2016 unit cost estimates (in 2017 international dollars [I$]) ranged from I$2 to I$478 for visits and from I$87 to I$22 543 for admissions. The annual cost of 8·20 billion (6·24-9·95) additional visits and 0·28 billion (0·25-0·30) admissions in low-income and lower-middle income countries in 2016 was I$503·12 billion (404·35-605·98) or US$158·10 billion (126·58-189·67).

interpretationUHC plans can be based on utilisation and unit costs of current health systems and guided by standards of utilisation of outpatient visits and inpatient admissions that achieve the highest coverage of personal health services at the lowest cost.

fundingBill & Melinda Gates Foundation.

Indexed as

AdolescentAdultAgedAged, 80 and overAge FactorsBayes TheoremChildChild, PreschoolFemaleGlobal HealthHealth Care CostsHospitalizationHumansInfantInfant, NewbornInpatients

Identifiers

PMID30551974
PMCPMC6323358

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.