# Cross-national disparities in non-communicable disease: a universal health coverage-based service coverage index perspective, 2000–2021

## TL;DR

This study examines global inequalities in health coverage for non-communicable diseases from 2000 to 2021 and suggests ways to improve coverage equality.

## Contribution

The study introduces a UHC-based service coverage index to analyze NCD disparities and identifies key factors influencing coverage inequality.

## Key findings

- Global NCD service coverage improved from the 50s to the 60s between 2000 and 2021.
- Government health expenditure significantly impacts NCD coverage, while physician density does not.
- Income disparities and health expenditure differences drive coverage gaps between countries.

## Abstract

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.

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.

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.

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.