The Economic Consequences Of Mortality Amenable To High-Quality Health Care In Low- And Middle-Income Countries

Abstract

We estimated deaths amenable to high-quality health care globally and then modeled the macroeconomic impact in low- and middle-income countries using two macroeconomic perspectives: a value-of-lost-output approach to project gross domestic product (GDP) losses annually for the period 2015-30, and a value-of-lost-welfare approach to estimate the present value of total economic welfare losses in 2015. We estimated that eight million amenable deaths occurred in 2015, 96 percent of them in low- and middle-income countries. The value of lost output resulted in a projected cumulative loss of $11.2 trillion in these countries during 2015-30, with a potential economic output loss of up to 2.6 percent of GDP in low-income countries by 2030, compared to 0.9 percent in upper-middle-income countries. The value-of-lost-welfare approach estimated welfare losses of $6.0 trillion in 2015. Inadequate access to high-quality health care results in significant mortality and imposes a macroeconomic burden that is inequitably distributed, with the largest relative burden falling on low-income countries. Given that these deaths are unnecessary and the projected GDP losses are avoidable, there is a strong ethical and economic case for promoting high-quality health care as an essential component of universal health coverage.

High-quality health systems in the Sustainable Development Goals era: time for a revolution

“…In 2015 alone, poor access to quality care resulted in an estimated $6•0 trillion of losses in 130 LMICs. 95 Upper-middle-income regions lost the least, whereas losses in sub-Saharan Africa accounted for more than 15% of GDP. This analysis shows that poor-quality care can result in a great macroeconomic burden that is inequitably distributed across countries.…”

“…An analysis done with similar methods for a shorter list of conditions found that, globally, 8•0 million deaths could be averted with access to high-quality care. 95 Maternal and newborn deaths are a particularly sensitive measure of health system quality, because many deaths stemming from labour complications can be averted with appropriate treatment. 96 Figure 6 shows the comparison of rates of maternal and newborn deaths in countries with similar, high coverage of skilled attendants during birth (80-90% of births).…”

“…This economic output loss was greatest in low-income countries, costing 2•6% of their GDP compared with 0•9% in upper-middle-income countries. 95 The second approach estimated the current value of total economic welfare losses on the basis of the concept of a statistical life, which attempts to capture the value placed on good health in and of itself. In 2015 alone, poor access to quality care resulted in an estimated $6•0 trillion of losses in 130 LMICs.…”

Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries

“…The authors noted large gaps between observed health system performance in many countries and the best performing comparators. Alkire and colleagues 36 reported amenable mortality of 8 million deaths for 38 conditions in 198 countries, 96·3% of which occurred in LMICs, using somewhat different methods (reducing amenable mortality by attributable risk factors rather than differences in incidence). They estimated that this mortality would result in US$11·2 trillion in lost economic output between 2015 and 2020 in LMICs.…”

“…They estimated that this mortality would result in US$11·2 trillion in lost economic output between 2015 and 2020 in LMICs. 36 Nolte and McKee have tracked deaths due to conditions amenable to timely and effective health care in Europe and other Organisation for Economic Co-operation and Development countries for the past 15 years. 37 , 38 , 39 Our findings cannot be directly compared with their work because we adjusted incidence or prevalence for all conditions to exclude deaths that could have been prevented outside the health system, whereas Nolte and McKee only exclude a portion (50% of cardiovascular deaths).…”