Assessing health systems' efficiency in achieving universal health coverage in Southeast and South Asia

Purpose This study assesses the health systems' technical efficiency in attaining the Universal Health Coverage (UHC) target in 16 Southeast and South Asian countries. The study uses an output-oriented Data Envelopment Analysis (DEA) to evaluate the health systems' technical efficiency. The UHC Service Coverage Index, which assesses the service coverage and financial protection, is applied to the output variable. In contrast, major input variables comprise the per capita health expenditure, and physician density, nurses and midwifes density and hospital bed density, reflecting available resources for service delivery. This approach enables an in-depth evaluation of how efficiently health systems utilize available resources to achieve better UHC Service Coverage Index outcomes. Design/methodology/approach The study applies a Tobit regression model to gain deeper insights, provide valuable recommendations for policymakers, and understand the role of socio-economic and environmental factors linked to efficiency assessments and in shaping health system performance. Findings The study reveals that many South and Southeast Asian countries operate at high technical efficiency. However, notable inefficiencies persist, particularly in Southeast Asia. Overall, health systems in South Asia are more effective in utilizing resources to achieve progress toward UHC than those in Southeast Asia. Indonesia, Sri Lanka and Brunei Darussalam demonstrate lower efficiency levels, implying the need to enhance resource allocation and health system governance rather than exclusively boost health investments. Variations in efficiency across countries highlight the significance of adopting customized health system policies. Originality/value With increasing global emphasis on UHC, assessing health systems' efficiency is critical. This research highlights disparities, identifies key efficiency drivers and underscores the role of governance and resource optimization – providing valuable evidence to guide region-specific policies for achieving equitable and sustainable UHC.