BOSTON, Mass. -- Poor-quality health care is a leading, preventable killer of people around the globe, two new reports show. The National Academies of Science, Engineering and Medicine (NASEM) and the Lancet Global Health Commission on High-Quality Health Systems (HQSS) have each published comprehensive reports outlining the significant human and economic cost of poor-quality health care.
Produced independently by different research groups at Harvard University, the two reports deliver striking evidence that challenges our fundamental understanding of what it takes to combat unnecessary deaths in low- and middle-income countries.
It is now clear: Providing access to care for all -- Universal Health Care, the current paradigm in global health -- is not enough. Between 5 and 8 million people die every year even though they do have access to health care -- but the care they receive is ineffective and often does more harm than good.
In fact, poor-quality care is now a bigger barrier to reducing mortality than insufficient access to care. It kills three times as many people annually than HIV and Malaria combined.
Both reports base their findings on research conducted at Harvard University.
The NASEM report Crossing the Global Quality Chasm, based on an analysis conducted by the Harvard Global Health Institute, found that between 5.7 and 8.4 million deaths occur each year from poor quality of care in low- and middle-income countries (LMICs). The resulting cost of lost productivity alone amounts to between $1.4 and $1.6 trillion annually.
Using data from multiple international databases and over 31,000 published articles, researchers assessed healthcare quality in low and middle income countries using 25 indicators. This comprehensive process took almost three years. Among the findings are:
Ineffective care was responsible, on average, for 25% of deaths caused by the conditions examined. This means that many individuals suffering from HIV, TB and mental illnesses are getting access – but the quality of the care is so poor that they are dying from that substandard care.
Nearly 1 in 5 hospitalized patients who went to the hospital to get better were, instead, harmed in the process. Overall, 134 million adverse hospital events occurred, leading to approximately 2.6 million preventable hospital deaths annually.
Even when treatment coverage is high for a condition, harm may come from the treatment itself. For example, over 120 thousand HIV patients who are connected to treatment end up dying from substandard and falsified medicines every year.
The Lancet HQSS Commision report "High-quality health systems in the Sustainable Development Goals era: time for a revolution", led by a team at the Harvard T.H. Chan School of Public Health, used a different approach to estimating the lives lost: They calculated excess mortality in LMICs versus well performing health systems and subtracted deaths that could have been prevented through public health. They found that 8.6 million people die from conditions treatable by high quality health systems. Of these, 5 million deaths are due to poor quality of care and 3.6 million to lack of access to care.
High-quality health systems, the Lancet authors write, could prevent 2-5 million deaths from cardiovascular disease, 1 million newborn deaths, 900,000 deaths from tuberculosis and half of all maternal deaths each year.
“We have often taken quality for granted, assuming if people have access and there are enough resources, quality will be sufficient. These reports build on years of work that now lays that assumption to rest. Poor-quality care is a leading, preventable killer of people around the globe and we must prioritize it if we are going to improve people’s health” said Ashish Jha, Director of HGHI and a member of the NASEM panel that produced the NASEM report.
"We found that providers do not follow basic clinical guidelines and omit routine screenings. Primary care visits last 5-8 minutes, which is not enough time for a thorough assessment, providing counselling or detecting problems," says Margaret Kruk, lead author of the Lancet report and an Associate Professor of Global Health at the Harvard T.H. Chan School of Public Health. “The system as a whole is failing people. There are huge delays in diagnosing and starting treatment for emergency conditions but also for cancer and TB. One in three people have negative care experiences, such as poor communication or rude providers.”
The global health community, both reports conclude, must rally around providing not just health care but high-quality health care to people around the world.
DOWNLOAD the full NASEM report or just HGHI's chapter here.
DOWNLOAD the Lancet HQSS Commission report here .