Paul Pavitra, Nguemdjo Ulrich, Ngami Armel, Kovtun Natalia and Ventelou Bruno (2022): “Do Efficiency and Equity move together? – Cross-dynamics of Health System Performance and Universal Health Coverage”, Humanities & Social Sciences Communications 9(293)

Pavitra Paul, an associate researcher at CSH and visiting professor, Dept. of Public Health, Yerevan State Medical University, Yerevan, Armenia has co-written an article with Nguemdjo Ulrich (Aix-Marseille Université, CNRS, AMSE), Ngami Armel (Aix-Marseille Université, CNRS, AMSE), Kovtun Natalia(Department of Statistics and Demography, Taras Shevchenko National University of Kyiv) and Ventelou Bruno (Aix-Marseille Université, CNRS, AMSE) entitled “Do efficiency and equity move together? Cross-dynamics of Health System performance and Universal Health Coverage”. The article has been published by Humanities & Social Sciences Communications, on 26 August 2022.

The article can be found at:

Abstract: Efficiency within the health system is well recognised as key for achieving Universal Health Coverage (UHC). However, achieving equity and efficiency simultaneously is often seen as a conflicting effort. Using 12 years of data (2003–2014) from the selection of a number of low- and lower middle-income countries (Afghanistan, Bangladesh, Burkina Faso, Ghana, Indonesia, Mongolia, Mozambique, Tajikistan, Togo, Uzbekistan and Yemen Republic), we compute an index of Universal health coverage (UHC), measure the health system’s per- formance (HSp) and, finally, investigate the cross-dynamics of the resulting HSp and the UHC previously obtained. We find that, with the few exceptions over the statistical sample, the causality between performances of the national health system and the universal health coverage is typically bidirectional. From an empirical standpoint, our findings challenge the idea from economic orthodoxy that efficiency must precede equity in healthcare services. Rather, our findings support the view of simultaneous efforts to improve expansion of the coverage and efficiency of the health system, directing attention towards the importance of organization of the health system in the country context.

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