Funding and services needed to achieve universal health coverage: applications of global, regional, and national estimates of utilisation of outpatient visits and inpatient admissions from 1990 to 2016, and unit costs from 1995 to 2016  Mark W Moses, MHS, Paola Pedroza, MPH, Ranju Baral, PhD, Sabina Bloom, BA, Jonathan Brown, MAIS, Abby Chapin, BA, Kelly Compton, BS, Erika Eldrenkamp, MPH, Nancy Fullman, MPH, John Everett Mumford, BA, Vishnu Nandakumar, BS, Katherine Rosettie, MPH, Nafis Sadat, MA, Tom Shonka, BA, Abraham Flaxman, PhD, Theo Vos, PhD, Chris J L Murray, DPhil, Marcia R Weaver, PhD  The Lancet Public Health  Volume 4, Issue 1, Pages e49-e73 (January 2019) DOI: 10.1016/S2468-2667(18)30213-5 Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 1 Annual outpatient visits per capita, age-standardised and for both sexes combined, by location, 2016 Map displays the age-standardised estimated annual number of outpatient visits per capita in 2016 for all ages and both sexes combined. The rate ranged from 2·5 to 7·0 visits per person for the majority of countries, and the key shows 0·5 visit increments in this range to present differences among these countries. ATG=Antigua and Barbuda. FSM=Federated States of Micronesia. Isl=Islands. LCA=Saint Lucia. TTO=Trinidad and Tobago. TLS=Timor-Leste. VCT=Saint Vincent and the Grenadines. The Lancet Public Health 2019 4, e49-e73DOI: (10.1016/S2468-2667(18)30213-5) Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 2 Annual inpatient admissions per capita, age-standardised and for both sexes combined, by location, 2016 Map displays the age-standardised estimated annual number of inpatient admissions per capita in 2016 for all ages and both sexes combined. ATG=Antigua and Barbuda. FSM=Federated States of Micronesia. Isl=Islands. LCA=Saint Lucia. TTO=Trinidad and Tobago. TLS=Timor-Leste. VCT=Saint Vincent and the Grenadines. The Lancet Public Health 2019 4, e49-e73DOI: (10.1016/S2468-2667(18)30213-5) Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 3 Decomposition of the percentage change in volume of outpatient visits and inpatient admissions for all ages and both sexes summarised by GBD super-region and by region and country, 1990–2016 Changes in the volume of outpatient visits and inpatient admissions from 1990 to 2016 were decomposed into changes in four factors: age-sex-specific utilisation rates, total population, the share of the population in each age category, and the share of the population of each sex within each age category. The black dots represent the overall percentage change in volume of each service. Colours represent the percentage that each factor contributed to overall percentage change. Bars to the left of zero show that the factor contributed to a decrease and bars to the right show an increase. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. *UK data are an aggregate of the data from the four constituent countries displayed below. †Results extend off the scale. For east Asia, change due to age-sex utilisation rates is 357%, contributing to a total percentage change of 443%. For China, change due to age-sex utilisation rates is 404%, contributing to a total percentage change of 497%. The Lancet Public Health 2019 4, e49-e73DOI: (10.1016/S2468-2667(18)30213-5) Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 3 Decomposition of the percentage change in volume of outpatient visits and inpatient admissions for all ages and both sexes summarised by GBD super-region and by region and country, 1990–2016 Changes in the volume of outpatient visits and inpatient admissions from 1990 to 2016 were decomposed into changes in four factors: age-sex-specific utilisation rates, total population, the share of the population in each age category, and the share of the population of each sex within each age category. The black dots represent the overall percentage change in volume of each service. Colours represent the percentage that each factor contributed to overall percentage change. Bars to the left of zero show that the factor contributed to a decrease and bars to the right show an increase. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. *UK data are an aggregate of the data from the four constituent countries displayed below. †Results extend off the scale. For east Asia, change due to age-sex utilisation rates is 357%, contributing to a total percentage change of 443%. For China, change due to age-sex utilisation rates is 404%, contributing to a total percentage change of 497%. The Lancet Public Health 2019 4, e49-e73DOI: (10.1016/S2468-2667(18)30213-5) Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 3 Decomposition of the percentage change in volume of outpatient visits and inpatient admissions for all ages and both sexes summarised by GBD super-region and by region and country, 1990–2016 Changes in the volume of outpatient visits and inpatient admissions from 1990 to 2016 were decomposed into changes in four factors: age-sex-specific utilisation rates, total population, the share of the population in each age category, and the share of the population of each sex within each age category. The black dots represent the overall percentage change in volume of each service. Colours represent the percentage that each factor contributed to overall percentage change. Bars to the left of zero show that the factor contributed to a decrease and bars to the right show an increase. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. *UK data are an aggregate of the data from the four constituent countries displayed below. †Results extend off the scale. For east Asia, change due to age-sex utilisation rates is 357%, contributing to a total percentage change of 443%. For China, change due to age-sex utilisation rates is 404%, contributing to a total percentage change of 497%. The Lancet Public Health 2019 4, e49-e73DOI: (10.1016/S2468-2667(18)30213-5) Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 3 Decomposition of the percentage change in volume of outpatient visits and inpatient admissions for all ages and both sexes summarised by GBD super-region and by region and country, 1990–2016 Changes in the volume of outpatient visits and inpatient admissions from 1990 to 2016 were decomposed into changes in four factors: age-sex-specific utilisation rates, total population, the share of the population in each age category, and the share of the population of each sex within each age category. The black dots represent the overall percentage change in volume of each service. Colours represent the percentage that each factor contributed to overall percentage change. Bars to the left of zero show that the factor contributed to a decrease and bars to the right show an increase. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. *UK data are an aggregate of the data from the four constituent countries displayed below. †Results extend off the scale. For east Asia, change due to age-sex utilisation rates is 357%, contributing to a total percentage change of 443%. For China, change due to age-sex utilisation rates is 404%, contributing to a total percentage change of 497%. The Lancet Public Health 2019 4, e49-e73DOI: (10.1016/S2468-2667(18)30213-5) Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 3 Decomposition of the percentage change in volume of outpatient visits and inpatient admissions for all ages and both sexes summarised by GBD super-region and by region and country, 1990–2016 Changes in the volume of outpatient visits and inpatient admissions from 1990 to 2016 were decomposed into changes in four factors: age-sex-specific utilisation rates, total population, the share of the population in each age category, and the share of the population of each sex within each age category. The black dots represent the overall percentage change in volume of each service. Colours represent the percentage that each factor contributed to overall percentage change. Bars to the left of zero show that the factor contributed to a decrease and bars to the right show an increase. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. *UK data are an aggregate of the data from the four constituent countries displayed below. †Results extend off the scale. For east Asia, change due to age-sex utilisation rates is 357%, contributing to a total percentage change of 443%. For China, change due to age-sex utilisation rates is 404%, contributing to a total percentage change of 497%. The Lancet Public Health 2019 4, e49-e73DOI: (10.1016/S2468-2667(18)30213-5) Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 4 Comparison of 2008 IHME unit cost estimates to 2008 WHO-CHOICE estimates for outpatients and inpatients The figure shows scatter plots of the unit costs by country, where the horizontal axis reports the WHO-CHOICE estimates and the vertical axis reports our estimates. The diagonal line represents where the points would lie if the two estimates were identical. For outpatient visits, most points were higher and to the left of the diagonal line, showing that our estimates were higher. All unit costs are in 2010 international dollars (I$). ARE=United Arab Emirates. BHR=Bahrain. CAN=Canada. CHE=Switzerland. CUB=Cuba. DNK=Denmark. ESP=Spain. GRC=Greece. IRL=Ireland. IRQ=Iraq. JPN=Japan. KOR=Korea. KWT=Kuwait. LUX=Luxembourg. MLT=Malta. NLD=Netherlands. NOR=Norway. OMN=Oman. PRT=Portugal. QAT=Qatar. RUS=Russia. SAU=Saudi Arabia. SGP=Singapore. TTO=Trinidad and Tobago. USA=United States. IHME=Institute for Health Metrics and Evaluation. WHO-CHOICE=WHO Choosing Interventions that are Cost-Effective. The Lancet Public Health 2019 4, e49-e73DOI: (10.1016/S2468-2667(18)30213-5) Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions