Despite Improving Global Healthcare Access, Quality, Progress Slowed or Stalled for Some Countries

Improvements in low- and middle-income countries in sub-Saharan Africa and Southeast Asia have driven healthcare access and quality improvements around the world—the average score increased from 42.4 points (out of 100) in 2000 to 54.4 points in 2016—but some countries saw progress slow or stall, and disparities between countries remained similar, according to a study in The Lancet.

The researchers used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 to assess access and quality for 195 countries and territories. In addition, they also analyzed access and quality by region within 7 countries: Brazil, China, England, India, Japan, Mexico, and the United States.

They used 32 causes of death that should be preventable with effective care to measure quality and accessibility of healthcare. Countries, territories, and regions assessed were scored between 0 and 100, with 100 being the best.

The global average was 54.4 in 2016, which was up from 42.4 points in 2000. Iceland had highest score (97.1), followed by Norway (96.6), the Netherlands (96.1), Luxembourg (96), and Finland and Australia (both 95.9). The Central African Republic had the lowest score (18.6), followed by Somalia (19), Guinea-Bissau (23.4), Chad (25.4), and Afghanistan (25.9).

The United States ranked 29 out of 195 with a score of 88.7 points. The regional analysis found that the United States had a gap of 11 points between the highest-performing state (Massachusetts, 92.5) and the lowest-performing state (Mississippi, 81.5). Interestingly, the report found that while the country’s score improved by 8 points between 1990 and 2016, and inequalities between states have shrunk by 5.7 points, there has been little progress between 2000 and 2016.

“These results emphasize the urgent need to improve both access to and quality of healthcare, otherwise health systems could face widening gaps between the health services they provide and the disease burden in their population,” senior author of the study, Rafael Lozano, MD, MSc, of the Institute of Health Metrics and Evaluation at the University of Washington, said in a statement. “Now is the time to invest to help deliver health systems for the next generation and accelerate progress in the Sustainable Development Goal era.”

Overall, the researchers found that many countries in the low and middle quintiles of the sociodemographic index, a measurement of overall development, need more policy actions and investments focused on improving healthcare access and quality, especially to address noncommunicable diseases, such as cancer, cardiovascular disease, and diabetes.

Historically, global health priorities have focused on health services like vaccine coverage and treatment of infectious diseases. The rise of noncommunicable diseases means some health systems need to change to meet the new needs of their populations, according to the report. Poor access to or poor quality of risk management and treatment of noncommunicable diseases “could explain slower gains or minimal advances” in many countries, wrote the authors.

Additionally, the authors noted that populations living longer with a higher disease burden will escalate healthcare challenges for countries that have not moved their models of care to a more proactive system.

“To strengthen and deliver health systems for the next generation, national and international health agencies alike must focus on improving healthcare access and quality across health service areas and reaffirm their commitment to accelerating progress for the world's poorest populations,” the authors concluded.

References

GBD 2016 Healthcare Access and Quality Collaborators. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016. [published online May 23, 2018]. The Lancet. doi.org/10.1016/S0140-6736(18)30994-2.