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Peer-reviewedCC BYPLOS Global Public Health

Associations between the universal health coverage service coverage index and the human development index: A country-level longitudinal panel study

  • Akira Hayasaka1
  • Yasuhiro Nakanishi2
  • Marika Nomura3,4
  • Eri Osawa5
5 affiliations
  1. 1Graduate School of Data Science, Yokohama City University, Yokohama, Kanagawa, Japan.
  2. 2Department of Health and Welfare Services, National Institute of Public Health, Wako, Saitama, Japan.
  3. 3Human Development Department, Japan International Cooperation Agency (JICA), Chiyoda-ku, Tokyo, Japan.
  4. 4School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
  5. 5Department of Public Health Policy, National Institute of Public Health, Wako, Saitama, Japan.
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Abstract

Universal health coverage (UHC) and human development are closely linked, but whether this relationship differs across UHC domains remains unclear. We conducted a retrospective country-level longitudinal panel study using publicly available data from 2000 to 2021 to examine associations of the UHC service coverage index (SCI) and its four sub-indices with the Human Development Index (HDI) and its component indices for gross national income (GNI), education, and life expectancy. We also quantified differences in the UHC SCI, its sub-indices, and the HDI across World Bank income groups and World Health Organization regions using population-averaged generalized estimating equation models. UHC service coverage improved over time across income groups and regions, but progress was uneven. Persistent income-group disparities were observed for the overall UHC SCI, infectious diseases (IDs), service capacity and access (SCA), and the HDI, whereas disparities were smaller for reproductive, maternal, newborn, and child health (RMNCH) and less pronounced for noncommunicable diseases (NCDs). After covariate adjustment, regional differences were generally smaller than income-group disparities; RMNCH showed little regional variation, whereas SCA remained significantly lower in the African Region. Higher HDI was associated with better UHC performance, with adjusted increases of 6.8 points (95% CI 5.6–8.1) for the UHC SCI, 11.7 (95% CI 9.2–14.1) for SCA, 6.2 (95% CI 4.2–8.1) for ID, and 4.9 (95% CI 3.2–6.7) for RMNCH per 0.1-unit increase, whereas the increase for NCD was smaller (2.2 points, 95% CI 0.4–4.0). Among HDI components, the education index was not associated with NCD after adjustment, whereas the GNI and life expectancy indices were positively associated with NCD, although the estimated increases were smaller than those for most other sub-indices. These findings may help policymakers interpret the UHC SCI and its sub-indices in the context of their countries’ broader development trajectories.

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Cite

BibTeXRIS
BibTeX
@article{hayasaka2026associations,
  title = {{Associations between the universal health coverage service coverage index and the human development index: A country-level longitudinal panel study}},
  author = {Akira Hayasaka and Yasuhiro Nakanishi and Marika Nomura and Eri Osawa},
  journal = {PLOS Global Public Health},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pgph.0007328},
  url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007328},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Associations between the universal health coverage service coverage index and the human development index: A country-level longitudinal panel study
AU  - Akira Hayasaka
AU  - Yasuhiro Nakanishi
AU  - Marika Nomura
AU  - Eri Osawa
PY  - 2026
DA  - 2026/10/28
JO  - PLOS Global Public Health
DO  - 10.1371/journal.pgph.0007328
UR  - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007328
AB  - Universal health coverage (UHC) and human development are closely linked, but whether this relationship differs across UHC domains remains unclear. We conducted a retrospective country-level longitudinal panel study using publicly available data from 2000 to 2021 to examine associations of the UHC service coverage index (SCI) and its four sub-indices with the Human Development Index (HDI) and its component indices for gross national income (GNI), education, and life expectancy. We also quantified differences in the UHC SCI, its sub-indices, and the HDI across World Bank income groups and World Health Organization regions using population-averaged generalized estimating equation models. UHC service coverage improved over time across income groups and regions, but progress was uneven. Persistent income-group disparities were observed for the overall UHC SCI, infectious diseases (IDs), service capacity and access (SCA), and the HDI, whereas disparities were smaller for reproductive, maternal, newborn, and child health (RMNCH) and less pronounced for noncommunicable diseases (NCDs). After covariate adjustment, regional differences were generally smaller than income-group disparities; RMNCH showed little regional variation, whereas SCA remained significantly lower in the African Region. Higher HDI was associated with better UHC performance, with adjusted increases of 6.8 points (95% CI 5.6–8.1) for the UHC SCI, 11.7 (95% CI 9.2–14.1) for SCA, 6.2 (95% CI 4.2–8.1) for ID, and 4.9 (95% CI 3.2–6.7) for RMNCH per 0.1-unit increase, whereas the increase for NCD was smaller (2.2 points, 95% CI 0.4–4.0). Among HDI components, the education index was not associated with NCD after adjustment, whereas the GNI and life expectancy indices were positively associated with NCD, although the estimated increases were smaller than those for most other sub-indices. These findings may help policymakers interpret the UHC SCI and its sub-indices in the context of their countries’ broader development trajectories.
SN  - 2767-3375
ER  -