Introduction: Maximising efficiency of resources is critical
to progressing towards universal health coverage (UHC) and
the sustainable development goal (SDG) for health. This study
estimates the technical efficiency of national health spending
in progressing towards UHC, and the environmental factors
associated with efficient UHC service provision.
Methods: A two-stage efficiency analysis using Simar
and Wilsonโs double bootstrap data envelopment analysis
investigates how efficiently countries convert health spending
into UHC outputs (measured by service coverage and financial
risk protection) for 172 countries. We use World Bank and
WHO data from 2015. Thereafter, the environmental factors
associated with efficient progress towards UHC goals are
identified.
Results: The mean bias-corrected technical efficiency score
across 172 countries is 85.7% (68.9% for low-income and
95.5% for high-income countries). High-achieving middleincome and low-income countries such as El Salvador,
Colombia, Rwanda and Malawi demonstrate that peer-relative
efficiency can be attained at all incomes. Governance capacity,
income and education are significantly associated with
efficiency. Sensitivity analysis suggests that results are robust
to changes.
Conclusion: We provide a 2015 baseline for cross-country
UHC technical efficiency scores. If countries wish to improve
their UHC outputs within existing budgets, they should identify
their current efficiency and try to emulate more efficient peers.
Policy-makers should focus on strengthening institutions
and implementing known best practices to replicate efficient
systems. Using resources more efficiently is likely to positively
impact UHC coverage goals and health outcomes, and without
addressing gaps in efficiency progress towards achieving the
SDGs will be impeded
