Does Progress on Universal Health Coverage Explain COVID Cases and Deaths?

RESEARCH OBJECTIVE: The trajectory of COVID‐19 pandemic has been different across different countries and regions, with varying number of per‐population cases and deaths. Such variation may be a function of a number of country‐specific factors such as population distribution, disease profile, non‐pharmaceutical interventions (e.g., lockdowns) undertaken at the wake of the pandemic, political leadership, and others. Our objective is to examine the extent to which a country's progress towards universal health coverage (UHC) explains COVID outcomes. We also measure how the effect of UHC varies across different levels of social capital. We proxy the UHC progress using service coverage index (SCI). The SCI is a broad‐based measure of UHC, and is tracked at the country level by the World Health Organization (WHO) and its collaborating partners. Our overall hypothesis is that the UHC‐SCI has a protective effect on health, and therefore, is negatively associated with the COVID outcomes (COVID cases and deaths per 100 k population). STUDY DESIGN: We use longitudinal data‐based generalized linear models (GLMs) to investigate the relationship between the outcome variable (COVID cases and deaths) and the key explanatory variables. We run cross‐country linear regressions, with month fixed effects and country‐level clustering. We run two sets of linear regressions. First, we regress each COVID outcome on the SCI. Second, we regress each COVID outcome on the SCI and the interaction term between SCI and social capital. Both sets of regressions include controls for GDP per capita, share of population above 65, stringency measures, and COVID testing rates. Our data for the SCI comes from the WHO while the longitudinal (monthly) data on COVID outcomes and other key variables come from “ourworldindata.org” (University of Oxford). The data on government trust is obtained from the social capital component of the Legatum Prosperity Index (LPI), 2019. POPULATION STUDIED: 173 countries. PRINCIPAL FINDINGS: Our findings show that there is a positive and strong association between UHC‐SCI and COVID outcomes. This is counterintuitive, and we suspect it is likely due to the dependency of testing for the actual ascertainment of cases and deaths. The coefficient on the interaction term (between SCI and social capital), however, is negative and statistically significant. CONCLUSIONS: The effect of UHC seems to be protective among countries that are characterized by high level of social capital. IMPLICATIONS FOR POLICY OR PRACTICE: The effect of UHC seems to be protective among countries that are characterized by high level of social capital.