The Healthcare Universalism Index: Measuring Coverage, Generosity and Equity of Healthcare across the World

Exemplified in the "Leaving No One Behind" promise of the United Nations 2030 Agenda for Sustainable Development and tragically highlighted by the Covid-19 pandemic, a growing international consensus recognises that states should provide comprehensive access to high-quality social services and benefits for the entire population. While traditionally, such universalism in social policies has been associated with specific welfare regimes in the Global North, recent research has expanded the concept to the Global South – with a particular focus on healthcare.

Despite the growing emphasis on universalism, there have been few systematic efforts to measure its performance across different regions globally. This paper addresses this gap by introducing the Healthcare Universalism Index (HUI), a novel composite indicator to measure universal healthcare for 195 countries from 1995 to 2020. In accounting for ‘varieties of universalisms’ across the globe, the HUI comprises three dimensions of policy outputs: Coverage (measured by effective universal health coverage), Generosity (public health spending), and Equity (the level of healthcare privatisation).

Our findings reveal notable improvements in universalism across most regions from 1995 to 2020, driven by significant expansions in Coverage and Equity – especially in low-income countries in South Asia and Sub-Saharan Africa. In contrast, growth in high-income countries has been primarily driven by increased public investment in healthcare. Despite these positive trends, substantial inequalities persist between countries of the Global North and South, largely due to disparities in healthcare spending capacity.

Building on these findings, we propose a new global typology of healthcare regimes that categorises countries based on their performance across the three dimensions of the HUI. This typology highlights diverse pathways to achieving healthcare universalism, revealing both unexpected convergence among different regions and persistent structural disparities. The paper aims to stimulate further research on global healthcare regimes and inform debates on achieving equitable healthcare worldwide.