Massive Healthcare Inequity, Says First Global Study

A first-ever global study finds massive inequity of access to and quality of healthcare among and within countries, and concludes people are dying from causes with well-known treatments.

“What we have found about healthcare access and quality is disturbing,” said Dr. 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 healthcare. 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.”

For example, on a scale of 1 to 100 for healthcare access and quality, Norway and Australia each scored 90 overall, among the highest in the world. However, Norway scored 65 in its treatment for 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 nation was Central African Republic at 29; its highest treatment score was for diphtheria at 65.

Professor Martin McKee, from the London School of Hygiene & Tropical Medicine, who participated in the study, commented: “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.”

  Tracking Progress

As world governments move ahead to implement the goal of universal health coverage, these data will provide a necessary baseline from which they can track progress, he said.

The United States had 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).

“America’s ranking is an embarrassment, especially considering the US spends more than $9,000 per person on health care annually, more than any other country,” Murray said.

The study was published in the international medical journal The Lancet, and 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, known as “amenable mortality.”

With more than 2,300 collaborators in 132 countries the team examined 300-plus diseases and injuries.