Citation, summary, key messages and a comment/question from me below.
CITATION: Population confidence in the health system in 15 countries: results from the first round of the People's Voice Survey
Kruk M et al. Lancet Global Health :December 11, 2023DOI:https://doi.org/10.1016/S2214-109X(23)00499-0
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(23)00499-0/fulltext
SUMMARY
Population confidence is essential to a well functioning health system. Using data from the People's Voice Survey — a novel population survey conducted in 15 low-income, middle-income, and high-income countries — we report health system confidence among the general population and analyse its associated factors. Across the 15 countries, fewer than half of respondents were health secure and reported being somewhat or very confident that they could get and afford good-quality care if very sick. Only a quarter of respondents endorsed their current health system, deeming it to work well with no need for major reform. The lowest support was in Peru, the UK, and Greece — countries experiencing substantial health system challenges. Wealthy, more educated, young, and female respondents were less likely to endorse the health system in many countries, portending future challenges for maintaining social solidarity for publicly financed health systems. In pooled analyses, the perceived quality of the public health system and government responsiveness to public input were strongly associated with all confidence measures. These results provide a post-COVID-19 pandemic baseline of public confidence in the health system. The survey should be repeated regularly to inform policy and improve health system accountability.
KEY MESSAGES
- On average fewer than half of surveyed individuals across 15 countries were confident that they could get and afford good-quality care if sick.
- Only a quarter of respondents across countries said their system worked well. The lowest endorsement was in countries with major recent health-care challenges: Greece, the UK, and Peru.
- Countries less affected by COVID-19 and low-income countries had greater support for the notion that the health system was improving in the past 2 years.
- Wealthier respondents were more confident they could get and afford needed care. Women and people with post-secondary education, and, in some countries, young people, were less likely to endorse the health system than respondents with lower education levels, men, and people older than 30 years.
- In countries with substantial private sectors, private health systems received higher ratings than public health systems.
- Primary care services for women and children were rated more highly than services for chronic and mental health conditions in most countries.
- In combined regression analysis, health security and endorsement were strongly associated with quality of the public health system and government responsiveness to public opinion.
Our findings have various policy implications. Countries should rethink their provision (and measurement) of quality mental health services, as the current population perception of quality probably reflects the reality of such care in many countries and could discourage people with needs from accessing care.85, 86 The divergent views of public and private health-care quality, along with low health system endorsement from more educated, wealthy, and younger respondents in many countries, signals a segmentation in support for public systems. This divide should be a call to action for governments to invest in publicly financed health care and to effectively communicate its value to the public. Governments and health authorities need to strengthen mechanisms for public input into health system design as this is linked to greater public confidence. Finally, the surprisingly low confidence in the health systems of middle-income and high-income countries should prompt a national dialogue about the future direction of health care, including societal funding trade-offs, policy innovation, and service delivery redesign, to maximise the value of health systems to users and non-users.
COMMENT (NPW): What is missing from this analysis is a comparison of public perceptions with actual quality of the health system in terms of health outcomes. Indeed, if there is any correlation it appears to be weak and inconsistent. Although public perceptions are important, arguably more important are actual health outcomes. What do you think?
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org
