Association between health systems and universal health coverage and COVID-19 testing rates in 194 countries: Cross-sectional ecological study

Background The COVID-19 pandemic exposed the vulnerabilities of health systems worldwide, underscoring the critical need for robust and resilient healthcare infrastructure in effectively responding to disease outbreaks. This study aimed to address this need by examining the impact of health system indicators and universal health coverage (UHC) on COVID-19 testing rates. Method The study used secondary data from international organizations, peer-reviewed journals, and statistical portals. The primary outcome measure was COVID-19 testing rates, and the independent variables encompassed various health system indicators, including healthcare workforce density, the Healthcare Access and Quality Index (HAQ), UHC Coverage Index, and UHC Effective Coverage. The statistical analyses included simple and multiple regression models to determine the effects of these variables on COVID-19 testing rates while accounting for potential covariates. Findings: The findings revealed positive associations between health system indicators, UHC, and COVID-19 testing rates. Notably, the HAQ index exhibited the strongest positive correlation with COVID-19 testing rates. Multiple regression models further confirmed the positive relationships between UHC and health system indicators, and COVID-19 testing rates. Conclusion The study interpreted the results and underscored the significance of well-functioning health systems and UHC in achieving higher COVID-19 testing rates. This suggests that countries with well-structured health systems, advanced infrastructure, and adequate healthcare workforce are better equipped to conduct efficient testing. Moreover, the study emphasized the link between UHC and COVID-19 testing rates, noting that countries with greater UHC tend to exhibit higher testing rates. These findings contribute to our understanding of the association between health systems, UHC, and diagnostic testing for infectious diseases like COVID-19.