A country-level comparison of access to quality surgical and non-surgical healthcare from 1990-2016.

Autor: Wurdeman T; Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States of America.; Miller School of Medicine, University of Miami, Miami, FL, United States of America., Menon G; Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States of America.; Columbia University Medical Center Department of Surgery, New York, NY, United States of America., Meara JG; Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States of America.; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, United States of America., Alkire BC; Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States of America.; Department of Otolaryngology, Massachusetts Eye and Ear Institute, Boston, MA, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2020 Nov 03; Vol. 15 (11), pp. e0241669. Date of Electronic Publication: 2020 Nov 03 (Print Publication: 2020).
DOI: 10.1371/journal.pone.0241669
Abstrakt: Background: The Healthcare Access and Quality (HAQ) index, developed by the Institute for Health Metrics and Evaluation, uses estimates of amenable mortality to quantify health system performance over time. While much is known about general health system performance globally, few studies have portrayed the performance of surgical systems. In order to quantify access to quality surgical care, evaluate changes over time, and link these changes to health care investments, surgical and non-surgical Health Access and Quality sub-indices were developed.
Design: We categorized 32 amenable mortality causes as either surgical or non-surgical conditions. Using principal components analysis and scaled amenable mortality rates, we constructed a surgical and non-surgical Health Access and Quality sub-index. Using these sub-indices, relative improvement over time was compared. An expenditure model with country fixed effects was built to explore drivers of differences in relative improvement of sub-indices.
Results: Compared to low-income countries, high-income countries have been 2.77 times more effective at improving surgical care (p < .05). Government expenditure on healthcare has a larger effect on improving surgical Health Access and Quality (p < 0.05) while development assistance for health has a larger effect on improving non-surgical Health Access and Quality (p < 0.05).
Conclusions and Relevance: Global health investment must prioritize strengthening health systems as opposed to the historically favored vertical programming. In order to achieve health equity in low-income countries, more focus should be placed on domestic financing of surgical systems. Health Access and Quality sub-indices can be used by countries to identify targets, monitor progress, and evaluate interventions aimed at improving access to quality surgical healthcare.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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