Table 4.

Comparison of universal health coverage costing studies since 2015

	Stenberg et al, 201711	Moses et al, 201922	Current study, 2020
Definition of UHC	Achievement of normative levels of health workforce and facility density and high coverage (eg, 95% in the most ambitious scale-up scenario) of 187 health interventions	Achievement of target rates of utilisation of inpatient and outpatient services, relative to country disease burden	Achievement of 80% coverage of 218 essential health interventions in a model HBP
Countries included in analysis	67 LICs and MICs representing 95% of the total population of these country income groups	188 countries for which utilisation rates and health spending were modelled as part of the Global Burden of Disease Study 2016	83 LICs and lower-MICs (total population of these two income groups; costs estimated separately for each income group)
Costing method	Microcosting (ingredients approach for all health interventions and related programmes)	Gross costing (ie, average expenditure per outpatient or inpatient visit as calculated from NHA data	Mixed: unit costs for direct service delivery taken from microcosting studies, with health system costs added from gross costing studies
Included costs	Direct service delivery costs of interventions and related health system strengthening costs, including costs of reaching target workforce and facility density	All components of care measured in outpatient and inpatient expenditure per NHA data (including ancillary services); frontier analysis used to identify most efficient spending per visit	Direct service delivery costs of interventions and related health system strengthening costs
Time horizon; currency-year	Scale-up of services from current levels to target levels over 2016–30; 2014 US dollars	Counterfactual estimate for 2016 applying unit cost data (from frontier analysis) to all countries; 2017 international dollars	Counterfactual estimate for 2015 (cost of 80% coverage vs actual coverage); 2016 US dollars
Main findings	In the scenario with greatest progress towards UHC, an additional US$370 billion annually would be required across all LICs and MICs, or population-weighted mean total health-care spending of US$270 per capita	161 countries would require a total of Int$580 billion to Int$1·2 trillion (depending on choice of country standard) to meet target utilisation rates	An additional US$310 billion annually would be required across LICs and lower-MICs, or population-weighted mean total cost of US$120 per capita

UHC=universal health coverage. HBP=health benefits package. LIC=low-income country. Lower-MIC=lower-middle-income country. NHA=US National Health Accounts.