Global horizontal inequity in the access to health-care resources: a cross-sectional ecological analysis on health workforce and bed density and UHC service coverage, 2020–2022

Introduction Achieving universal health coverage (UHC) at the global level requires equitable access of different countries to the health care facilities. Inconsistent evidence showed that access to health resources among different regions and countries of the world is influenced by their economic and social status. However, a comprehensive research in this field that examines all access indicators has not been done. Therefore, this research was conducted with the aim of investigating the horizontal inequity in access to health care resources among the countries. Methods This cross-sectional ecological study was conducted using data from 189 countries collected from international databases between 2020 and 2022. Indicators of access to health services (density of beds, doctors, dentists, pharmacists, and nurses per 10,000 population and UHC service coverage index), need for health services (death and the Disability-Adjusted Life Years (DALY) rate per 100,000 population), and the socio-economic status indicators (Human Development Index (HDI) and Gross Domestic Product (GDP) were collected from international databases. To investigate the socioeconomic inequality in access to health resources among the countries, Concentration Index (CI), Concentration Curve (CC), and Horizontal Inequity (HI) index were estimated for all access indicators based on four scenarios. Data analysis was performed by Stata version 17. Results Descriptive findings showed that the average density of doctors, dentists, pharmacists, and nurses and the UHC service coverage index were higher in high-income and very high HDI countries. For example, the density of nurses in high-income countries was 92.50 compared with 7.96 per 10,000 population in low-income countries, while the UHC service coverage index was 77.51 in very high HDI countries compared with 44.50 in low HDI countries. The highest HI was observed for dentist density based on DALY rate and HDI (0.5477; 95% CI: 0.4669–0.6285), followed by pharmacist density (0.5232; 95% CI: 0.4430–0.6033). Based on GDP, the highest HI was observed for pharmacist density (0.2451; 95% CI: 0.1535–0.3366). When death rate was used as the need variable, the highest HI was observed for dentist density based on HDI (0.4152; 95% CI: 0.3456–0.4848), whereas the lowest statistically significant HI was observed for UHC service coverage based on GDP (0.0618; 95% CI: 0.0311–0.0925). Conclusions The findings of this study demonstrate substantial pro-rich horizontal inequalities in access to health-care resources across countries. The greatest inequalities were observed in the distribution of dentists and pharmacists, whereas hospital bed density showed comparatively lower levels of inequality. Strengthening health workforce planning, increasing investments in health systems, and promoting equitable allocation strategies may help reduce global disparities in access to health care.