Global survey finds most people think their health systems are not functioning well

December 13, 2023 The first step in improving a health system is understanding how it works. Governments often focus their evaluations on metrics such as the number of providers or health facilities, but that approach is limited, said a group of health policy researchers at the Harvard T.H. Chan School of Public Health. Drawing on survey data from 15 countries, they aimed to fill a critical gap in many health system evaluations – the opinions of health care consumers.

In a series of six papers published online December 12 in The Lancet Global Health, researchers compared various aspects of global health system performance, including confidence in health systems, perceptions of the quality of care received, coverage Inequalities in scope and quality, and the association between health system quality and COVID-19 vaccination rates.

The studies used data from more than 25,000 adults in 15 countries in 2022 and 2023: Argentina, Colombia, Ethiopia, Greece, India, Italy, Kenya, Laos, Mexico, Peru, South Africa, South Korea, UK, US, and Uruguay. Participants were contacted through the People’s Voice Survey, a new tool designed by the Quality Evidence in Health Systems Transformation (QuEST) network, a multinational research consortium of the Harvard Chan School of Business.

Todd Lewis, an associate research fellow in the Department of Global Health and Population, co-author of several papers, and director of surveys for People’s Voice, said that through survey data, researchers can better understand how health systems are actually functioning. While many surveys focus on recent patient experiences, our analysis examines the perspectives of an entire population. This provides a more comprehensive overview of people’s views on the health system and can provide powerful information for policymakers.

The overarching message from the survey is that people around the world have little confidence that their health systems can meet their needs. Only a quarter of respondents said their system worked well, and less than half believed that, even in countries with universal insurance systems, they would be able to access and afford quality health insurance if they got sick. care.

Margaret Kruk, professor of health systems and director of the QuEST network, said the level of dissatisfaction among health systems in high-income countries was surprising. For example, 70% of Ethiopians believe their healthcare system has improved over the past two years, compared with only 6% of Britons and 15% of Americans. Crook, who is also a co-author of several papers and lead researcher on the People’s Voice survey, believes this is partly due to dissatisfaction with the government’s response to the pandemic, as well as other factors such as staffing issues for health workers.

Other key findings from the series:

  • Women and those with higher education, and in some countries younger people, are more pessimistic about their health systems than less educated respondents, men and people over 30 years old.
  • People who recently received high-quality care and reported confidence in their health system were more likely to receive a COVID-19 vaccine, while people with unmet health needs or who experienced discrimination from health care providers were less likely to receive it.
  • In countries with public primary care systems, only four in 10 people use public primary care as their usual provider. Others rely on private health providers and secondary care settings such as hospitals.
  • Providing public health insurance in Africa and Asia does not necessarily lead to greater access to vital preventive services. For example, people with public insurance were no more likely to have a blood pressure check than people without insurance, and were less likely to have a blood pressure check than people with private insurance.
  • In Latin America, where health insurance coverage is high, inequalities in health care persist. Although people reported greater access to care, only one-third of respondents had a high-quality source of care. Only a quarter of respondents said their mental health needs were being met.

Crook said the pessimism expressed by people with higher incomes, better education and younger people across countries bodes poorly for future support for publicly funded insurance, including universal health coverage efforts, because these groups are A significant contributor to any such initiative. She and her colleagues suggest that governments need to gain the people’s trust before pushing for changes to the health system.

Other Harvard Chan School authors include: Catherine Arsenault, Rodrigo Bazua-Lobato, Kevin Croke, Rashmi Dayalu, Neena Kapoor, Gillian SteelFisher, and Katherine Wright.

Amy Lord

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