Richer Countries Have Far More Doctors, Dentists and Nurses, Global Analysis Finds

A cross-sectional ecological study of 189 countries has found substantial pro-rich inequalities in access to health-care resources around the world, with the widest gaps seen in the distribution of dentists and pharmacists. The research, published in Cost Effectiveness and Resource Allocation, analyzed international data collected between 2020 and 2022 to measure how access to health workers, hospital beds and universal health coverage services varies with countries’ economic and social status.

The researchers compiled three groups of indicators. Access to health services was measured through the density of beds, doctors, dentists, pharmacists and nurses per 10,000 population, together with the universal health coverage (UHC) service coverage index. Need for health services was captured using death rates and the Disability-Adjusted Life Years (DALY) rate per 100,000 population. Socio-economic status was represented by the Human Development Index (HDI) and Gross Domestic Product (GDP). All data came from international databases, and the analysis was performed in Stata version 17.

To quantify inequality, the team estimated the Concentration Index, the Concentration Curve and the Horizontal Inequity (HI) index for every access indicator under four scenarios.

The descriptive findings showed a consistent pattern: average densities of doctors, dentists, pharmacists and nurses, as well as UHC service coverage, were higher in high-income and very high HDI countries. One of the starkest contrasts involved nursing staff. High-income countries reported a nurse density of 92.50 per 10,000 population, compared with just 7.96 per 10,000 in low-income countries, a more than tenfold difference in the health workers who deliver much of frontline care.

Service coverage showed a similar gradient. The UHC service coverage index reached 77.51 in countries with very high HDI, against 44.50 in low HDI countries.

The inequality indices confirmed that these gaps go beyond simple differences in need. When the DALY rate served as the need variable, the highest horizontal inequity was observed for dentist density based on HDI, at 0.5477 (95% CI: 0.4669–0.6285), followed by pharmacist density at 0.5232 (95% CI: 0.4430–0.6033). When GDP was used as the ranking variable, the highest HI was again seen for pharmacist density, at 0.2451 (95% CI: 0.1535–0.3366).

The choice of need variable changed the ranking of some indicators. When the death rate was used instead of the DALY rate, the highest horizontal inequity was again found for dentist density based on HDI, at 0.4152 (95% CI: 0.3456–0.4848). The lowest statistically significant inequality in that scenario was for UHC service coverage based on GDP, at 0.0618 (95% CI: 0.0311–0.0925), suggesting that essential service coverage, while still pro-rich, is more evenly distributed than the health workforce itself.

Hospital bed density showed comparatively lower levels of inequality than the workforce indicators, according to the authors’ conclusions. Even so, they characterize the overall picture as one of substantial pro-rich horizontal inequalities in access to health-care resources across countries, meaning that wealthier countries command disproportionately larger shares of doctors, dentists, pharmacists and nurses relative to their populations’ health needs.

The authors conclude that strengthening health workforce planning, increasing investments in health systems and promoting equitable allocation strategies may help reduce global disparities in access to health care. As an ecological, cross-sectional analysis covering 189 countries over 2020–2022, the study describes country-level patterns rather than individual experiences, and its inequality estimates depend on the need variable and socio-economic indicator chosen. Nevertheless, the consistently pro-rich direction of the findings across scenarios underscores that achieving universal health coverage at the global level, as the authors note in their introduction, requires equitable access by different countries to health-care facilities.

Subject of Research: Cross-sectional ecological analysis of socioeconomic inequality in access to health-care resources across 189 countries

Article Title: 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

Article References: Bayati, M., Askari, M. S., Hadipour, A., & Mojtabaeian, S. M. (2026). 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. Cost Effectiveness and Resource Allocation. https://doi.org/10.1186/s12962-026-00853-7

Image Credits: AI Generated

DOI: 10.1186/s12962-026-00853-7

Keywords: health inequality, universal health coverage, health workforce, horizontal inequity, concentration index, dentist density, pharmacist density, UHC service coverage index, cross-sectional ecological study, global health, Global, horizontal