Journal of Rare Cardiovascular Diseases
ISSN: 2299-3711 (Print)
e-ISSN: 2300-5505 (Online)
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Investigating the Determinants of Universal Health Coverage (UHC): A Cross-National Analysis of Sustainability and Governance Factors in 194 Countries
Dr.Sally Mohamed Abdel Raouf
Prof.Dr.Iman Moheb Zaki
Prof.Dr.Amr Youssef
Prof.Dr.Wael Nabil Abdelsalam
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1
Egypt Healthcare Authority, Egypt and Arab Academy for Science, Technology and Maritime Transport, Alexandria, Egypt
2
Arab Academy for Science, Technology and Maritime Transport, Alexandria, Egypt
3
Beirut Arab University, Beirut, Lebanon and Alexandria University, Alexandria, Egypt
Received: 2026-04-01
Revised: 2026-04-16
Accepted: 2026-05-02
Published: 2026-05-16
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Abstract
Universal Health Coverage (UHC) is of utmost significance as it guarantees that every individual can access essential healthcare services of adequate quality without facing financial hardship, thereby fostering health equity and economic stability. The COVID-19 pandemic has highlighted the importance of UHC by exposing substantial deficiencies in healthcare systems and the severe repercussions of insufficient health protection. UHC also plays a fundamental role in attaining the Sustainable Development Goals (SDGs), including SDG 3, which seeks to guarantee optimal health and well-being for all ages.This study is anchored in theories of health equity and governance, emphasizing the interconnections between sustainability dimensions and institutional quality. It explores how environmental, social, and economic sustainability, political stability, government effectiveness, and health expenditure (as a share of GDP) are associated with the achievement of UHC in 194 countries. Using secondary data from World Bank (2023) and a correlational design, regression analysis were performed in SPSS 23, supplemented with correlation matrices and multicollinearity tests (VIF) to enhance robustness.Findings indicate that social and economic sustainability show the strongest associations with UHC, while environmental sustainability and government effectiveness display moderate links, and political stability and health expenditures as a percentage of GDP demonstrate weaker effects. Multivariate linear regression analysis revealed that the Social Sustainability, Economic Sustainability, and Environmental Sustainability are highly significant predictors of change in the Universal Health Coverage. The presence of potential, not serious multicollinearity among economic sustainability, social sustainability and government effectiveness On the other hand, environmental sustainability, political stability, and health expenditure demonstrate acceptable VIF values, indicating no multicollinearity concerns for these variables. The study contributes by providing an exploratory understanding of structural factors correlated with UHC performance, offering practical insights for policymakers to strengthen health system sustainability
Keywords
Universal health coverage, Society sustainability index, Social sustainability, Economic sustainability, Environmental sustainability, political stability, government effectiveness, health expenditures as % of GDP
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Keywords
Classification of Rare Cardiovascular Diseases
anticoagulation
atrial fibrillation
atrial septal defect
cardiomyopathy
computed tomography
congenital heart disease
echocardiography
electrocardiogram
electrocardiography
heart failure
implantable cardioverter‑defibrillator
magnetic resonance imaging
pregnancy
pulmonary arterial hypertension
pulmonary hypertension
rare cardiovascular disease
rare disease
right heart catheterization
right ventricular failure
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