World: First-ever global study finds massive healthcare inequity within and between countries

“What we have found about health care access and quality is disturbing,” said Christopher Murray, senior author of the study and Director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. “Having a strong economy does not guarantee good health care. Having great medical technology doesn't either. We know this because people are not getting the care that should be expected for diseases with established treatments.”

On a scale of 1 to 100 for health care access and quality, Norway and Australia each scored 90 overall, among the highest in the world. However, Norway scored 65 in its treatment of testicular cancer, and Australia scored 52 for treating non-melanoma skin cancer.

“In the majority of cases, both of these cancers can be treated effectively,” Murray said. “Shouldn’t it cause serious concern that people are dying of these causes in countries that have the resources to address them?”

The top-ranked nation was Andorra with an overall score of 95; its lowest treatment score was for Hodgkin’s lymphoma at 70. The lowest-ranked was Central African Republic at 29; its highest treatment score was for diphtheria at 65.

Martin McKee, of the London School of Hygiene & Tropical Medicine, said, “Using deaths that could be avoided as a measure of the quality of a health system is not new, but what makes this study so important is its scope, drawing on the vast data resources assembled by the Global Burden of Disease team to go beyond earlier work in rich countries to cover the entire world in great detail, as well as the development of a means to assess what a country should be able to achieve, recognising that not all are at the same level of development.”

The US with an overall score of 81, tied with Estonia and Montenegro. As with many other nations, the US scored 100 in treating common vaccine-preventable diseases, such as diphtheria, tetanus, and measles. But the US had nine treatment categories in which it scored in the 60s: lower respiratory infections (60), neonatal disorders (69), non-melanoma skin cancer (68), Hodgkin’s lymphoma (67), ischemic heart disease (62), hypertensive heart disease (64), diabetes (67), chronic kidney disease (62), and the adverse effects of medical treatment itself (68).

This is an embarrassment, given the US spends more than $9,000 per person on health care annually, more than any other country, Murray said. “Anyone with a stake in the current health care debate, including elected officials at the federal, state, and local levels, should take a look at where the US is falling short.”

The study, published last Thursday (18 May) in The Lancet, represents the first effort to assess access and quality of services in 195 countries from 1990 to 2015. Researchers used a Healthcare Access and Quality (HAQ) Index, based on death rates from 32 causes that could be avoided by timely and effective medical care.

Scores were based on estimates from the annual Global Burden of Diseases, Injuries, and Risk Factors study (GBD), a systematic, scientific effort to quantify the magnitude of health loss from all major diseases, injuries, and risk factors by age, sex, and population. With more than 2,300 collaborators in 132 countries and 3 non-sovereign locations, GBD examines 300-plus diseases and injuries.

The paper does offer some encouraging signs of improvement in health care access and quality. Since 1990, several countries have achieved progress that met or surpassed levels reached by other nations of similar development, including Turkey, Peru, South Korea, the Maldives, Niger, Jordan, Switzerland, Spain, and France.

‘Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015.’

DOI: http://dx.doi.org/10.1016/S0140-6736(17)30818-8