Year

2024

Degree Name

Doctor of Philosophy

Department

School of Business

Abstract

Universal health coverage (UHC) has gained prominence as a vital means of ensuring health and wellbeing for all, aiming to provide quality healthcare services whilst mitigating financial burdens of catastrophic healthcare expenditures. This study explores the multifaceted impacts of UHC, with a particular focus on its influence on people's subjective wellbeing, social inequality, and fertility patterns across a variety of countries over time.

Using a cross-country analysis, I employ a multidimensional measure of health known as the Wellbeing Adjusted Life Years (WALYs), incorporating life satisfaction data from the integrated European Values Study and World Values Survey (1990–2014). The findings reveal that, whilst UHC programs have a positive impact on health and wellbeing, their overall impact on WALYs is relatively modest, accounting only 20 percent. Therefore, the results suggest a balanced approach to fully realise the full benefits of these programs. This approach includes emphasising mental and social wellbeing (non-objective measure of health) alongside physical health, aligning with the broader goals of healthcare programs and the evaluation tools used to assess their performance. Developing a comprehensive framework for evaluating the effectiveness of public health programs is essential for advancing the development of robust UHC programs.

Moreover, this study examines into the relationship between UHC and subjective wellbeing inequality, using a measure that extends beyond the conventional income-centric approach. The results demonstrate a negative association between UHC programs and subjective wellbeing inequality. UHC programs exhibit an inequality-reduction property, particularly in countries with low levels of inequality, but their effectiveness diminishes in the presence of extreme inequality. In addition, they do not contribute to the existing subjective wellbeing inequality gap between developed and developing countries. To improve health and wellbeing for all and promote a more inclusive society, strengthening both service coverage and financial protection aspects of UHC program is recommended.

Finally, this study unpacks the complex roles UHC plays in fertility decisions and patterns. I find that UHC has a twofold impact, encouraging fertility and delaying it through the contraceptive effect. By analysing data from the European Values Study (EVS), the World Values Survey (WVS), and the United Nations, I observe a negative correlation between UHC and total fertility rate (TFR), indicating that contraceptive effect dominates over pro-fertility effect. Furthermore, employing a heteroscedasticity-based identification strategy to establish the impact of UHC on fertility outcomes, I find that an improvement in UHC performance can reduce TFR by approximately 0.5, which aligns with the observed global fertility decline. Notably, the decomposition analysis highlights the significance of UHC programs in closing the fertility gap between developed and developing countries, indicating a convergence phenomenon.

These results emphasise the potential of public health programs to address health and other social issues. They offer valuable insights into the complex relationship between UHC, subjective wellbeing, inequality, and fertility choices or outcomes. These findings highlight the necessity of developing robust and comprehensive healthcare programs or policies that can effectively meet the evolving needs of societies. Furthermore, it is crucial to proactively address the challenges associated with ensuring the longevity of these intergenerational welfare programs.

FoR codes (2008)

1402 APPLIED ECONOMICS, 140208 Health Economics, 160508 Health Policy, 160510 Public Policy

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Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.