A Refined Evaluation Analysis of Global Healthcare Accessibility Based on the Healthcare Accessibility Index Model and Coupling Coordination Degree Model

Abstract

Healthcare accessibility (HCA) is directly related to the general well-being of citizens, and the HCA index model is widely used in HCA evaluation. However, the evaluation results of the HCA index model are rough and potentially misleading because it cannot measure the coordination of a country’s performance across the various evaluation dimensions. This study aimed to introduce a coupling coordination degree model to remedy this defect of the HCA index model, conduct a more meticulous evaluation for the global HCA development over the past two decades, present a panorama of global HCA current status, and further contribute precise strategies to enhance global HCA development. Combining the HCA index model and the coupling coordination model, we used the Global Health Observatory (GHO) data to evaluate the development levels of HCA in 186 countries across the world from 2000 to 2018. The results showed that, first, global HCA development has shown a slow upward trend over the past two decades. Second, of the selected 60 representative countries in 2018, the HCA in 86.7% of high-income countries belonged to the optimum development type, the HCA in 73.4% of upper-middle-income countries was in the antagonism-coordination stage of the transition development category, and the HCA in 66.7% of low-income and lower-middle-income countries (LMICs) was in the inferior and worst development forms. Third, the Spearman’s correlation coefficient between HCA index and HCA coupling coordination degree was 0.787 (p < 0.001). The above results indicate that the dilemma of HCA development in LMICs lies not only in the poor healthcare resources, but also in weak ability to allocate healthcare resources effectively. As the lack of healthcare resources cannot be alleviated in a short time, LMICs ought to prioritize effective healthcare resources allocation, such as developing new basic healthcare kits adapted to low-resource setting.