Comparative health system performance in six middle-income countries: cross-sectional analysis using World Health Organization study of global ageing and health

Abstract

Objective To assess and compare health system performance across six middle-income countries that are strengthening their health systems in pursuit of universal health coverage. Design Cross-sectional analysis from the World Health Organization Study on global AGEing and adult health, collected between 2007 and 2010. Setting Six middle-income countries: China, Ghana, India, Mexico, Russia and South Africa. Participants Nationally representative sample of adults aged 50 years and older. Main outcome measures We present achievement against key indicators of health system performance across effectiveness, cost, access, patient-centredness and equity domains. Results We found areas of poor performance in prevention and management of chronic conditions, such as hypertension control and cancer screening coverage. We also found that cost remains a barrier to healthcare access in spite of insurance schemes. Finally, we found evidence of disparities across many indicators, particularly in the effectiveness and patient centredness domains. Conclusions These findings identify important focus areas for action and shared learning as these countries move towards achieving universal health coverage.

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“…Additionally, despite being diagnosed, many patients are untreated or undertreated for conditions such as HIV, tuberculosis, hypertension, diabetes, and depression. [58][59][60][61][62][63] In LMICs where data are available, only 68% of people aware of their HIV status are on antiretroviral therapy, and only 5% of people with a diagnosis of major depressive disorder receive minimally adequate treatment (figure 3, appendix 2). Individuals in severe pain are also systematically undertreated in LMICs.…”

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“…Comparisons are almost always made between the countries of the Organization for Economic Development Cooperation (OECD); in some situations, there are comparisons between middle-income countries 18 . Most of the time, countries with universal systems or national health insurance (United Kingdom, Nordic Countries, Iberian Peninsula, Italy, Canada, Australia and New Zealand), social health insurance (Germany and Switzerland), or state social insurance (France, Belgium, the Netherlands, Eastern European Countries, South Korea, and Japan) are compared 14 .…”

“…In the most recent approach between effectiveness and equity, the USA (26.7%), Belgium and the Netherlands (13.3% each) stand out; the remaining countries reached 6.7% each: Brazil, Canada, Cuba, Spain, Malaysia, New Zealand and the United Kingdom. Less than 10% of the studies showed a solid association between the three dimensions, more frequent in studies that addressed the performance of health systems 18,21 .…”