One of our time’s main success stories in healthcare. Medical science has advanced rapidly, extending life expectancy around the world. However, as people live longer, healthcare systems face increased demand, rising costs, and a workforce that is struggling to meet the needs of their patients. Although health outcomes in low and middle-income countries (LMICs) have improved in recent decades, a new reality is on the horizon. Changing health needs, rising public expectations, and ambitious new health goals are all pushing health systems to deliver better health outcomes and social value. However, continuing on our current path will not be enough to meet these objectives. Population aging, changing patient expectations, a shift in lifestyle choices, and the never-ending cycle of innovation are just a few of the relentless forces driving demand. The consequences of an aging population stand out among these. By 2050, one in every four individuals in Europe and North America will be beyond the age of 65, putting more patients with complicated requirements on the healthcare system’s plate. Managing such patients is costly, and it necessitates a paradigm shift away from episodic treatment toward one that is considerably more proactive and focused on long-term care management. High-quality health systems are required to optimize health care in each setting by consistently providing care that improves or maintains health, being appreciated and trusted by all people, and reacting to changing population demands.
Universal health coverage can be a good place to start when it comes to enhancing health system quality. Along with extending coverage and financial protection, improving quality should be a key component of UHC activities. Governments should begin by developing a national quality guarantee for health services, outlining the expected level of competence and user experience. To guarantee that everyone benefits from improved services, the poor and their health needs should be prioritized from the start. Effective (quality-corrected) coverage should be used to gauge UHC progress.
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In LMICs, high-quality health systems have the potential to save almost 8 million lives per year.
Every year, more than 8 million individuals in LMICs die from diseases that could be treated by the health system. These fatalities resulted roughly $6 trillion in economic losses in 2015. Poor-quality care is increasingly posing a greater threat to mortality reduction than a lack of access. Poor-quality care is responsible for 60% of deaths from illnesses treatable by health care, while non-use of the system is responsible for the other 40%. Every year, high-quality health systems could avoid 25.5 million deaths from cardiovascular disease, 1 million infant deaths, 900,000 tuberculosis fatalities, and half of all maternal deaths. As the use of health systems grows and the burden of disease moves to more complicated disorders, quality of care will become an increasingly more important driver of population health. The high death rates in LMICs for preventable diseases such as accidents and surgical conditions, maternity and infant complications, cardiovascular disease, and vaccine-preventable diseases demonstrate the breadth and complexity of the healthcare quality challenge. Other negative consequences of poor care include avoidable health-related pain, persistent symptoms, loss of function, and a lack of faith and confidence in healthcare systems. Poor-quality health systems have economic consequences such as resource waste and catastrophic expenses. As a result, only one-quarter of individuals in LMICs believe their health systems are functioning properly.
People care about competent care, user experience, health outcomes, and system confidence, thus health systems should assess and report on these things. Measurement is critical for accountability and progress, but many of the processes and results that matter most to people are not captured by current measurements. Simultaneously, data systems provide a plethora of indicators that provide insufficient insight at a significant financial and time expense. Inputs like drugs and equipment, for example, are frequently counted in surveys, although they are only weakly related to the quality of care that people receive. Indicators like the proportion of births with skilled attendants do not reflect the quality of birthing care and can lead to a false sense of security regarding maternal and newborn health progress. A Commission recommends that at the national and subnational levels, fewer but better measures of health system quality be developed and deployed. Countries should employ a dashboard of essential metrics (e.g., health outcomes, people’s faith in the system, system competency, and user experience) as well as financial protection and equitable measures to report health system performance to the public on an annual basis. Good performance evaluation requires robust vital registries and reliable routine health information systems. Countries require flexible new surveys and real-time population and health facility measurements that represent today’s health systems rather than those of the past.
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The built environment Wherever possible, healthcare facilities, especially hospitals, should be incorporated into the larger community to improve accessibility, societal buy-in, and overall well-being. To ensure that patients and relatives can easily traverse all hospital services, there should be simple access, vehicle parking, and transportation facilities, as well as clear signs throughout the hospital and hospital grounds. New hospital facilities should be built at a high standard, with particular concepts reflected in their design, such as space flexibility to keep services adaptable and revenue expenses low. To encourage a patient-friendly and healing atmosphere, wards and patient areas should have as much room, light, and nice views as feasible. In addition, enough space between beds should be available for operations, clinical activities, and infection control. Separate access routes for employees, patients, and the public towards and services, as well as co-location of relevant services, benefit efficiency, and timeliness of services.
A variety of amenities, such as meals, stores, a restaurant, postage, IT facilities, telephone, TV/radio access, and chaplains, boost patient and worker wellbeing, while regular childcare services support personnel working seven days a week. Importantly, neither patients nor services should be confined by the physical environment; rather, the environment should be built to be fit-for-purpose, hygienic, and flexible enough to serve all patients, including the physically and mentally challenged. Existing structures may need to be reconfigured to promote seamless and efficient healthcare, with specific services in specific locations; for example, acute care services on one site, intermediate community care, outpatients, mental health, rehabilitation, integrated therapy, and social services on another, as well as daycare and hospice care. Integrated medical, nursing and multi-professional healthcare services should support such provision across the whole healthcare route.
To minimize injustices and broaden the right to decent health care, health systems should prioritize poor and vulnerable sectors of society through progressive universalism. Countries can begin on this route by increasing coverage related to a national quality guarantee as part of the UHC movement. These quality standards can be upheld with the help of legal and social accountability measures. Accountability is based on knowledge about the existing state of the healthcare system.
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