Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries.
Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries.
复制标题
DOI：
10.1016/s0140-6736(18)31668-4
复制
发表时间：
2018-11-17
期刊：
影响因子：
--
通讯作者：
Salomon JA
中科院分区：
文献类型：
--
作者：
Kruk ME;Gage AD;Joseph NT;Danaei G;García-Saisó S;Salomon JA
全民健康覆盖已被提议作为改善低收入和中等收入国家健康状况的一项战略。然而，这取决于能否提供高质量的保健。我们估计了可持续发展目标（SDG）中针对的可接受医疗保健的疾病的超额死亡率，以及137个中低收入国家由于医疗质量差而导致的超额死亡率的比例，其中超额死亡率是指在强大的卫生系统环境中本可以避免的死亡。使用2016年全球疾病负担研究的数据，我们通过比较每个LMIC与23个具有强大卫生系统的高收入参考国家的相应数字之间的病死率，计算了61个SDG条件下适合个人卫生保健的死亡率。我们使用人口调查中的卫生保健利用率数据，分别估计了不利用卫生保健与接受低质量保健的可治愈死亡率的比例。2016年，中低收入国家因61种疾病死亡的人数增加了1560万。在排除了可以通过公共卫生措施预防的死亡后，860万多的死亡是可以接受医疗保健的，其中500万估计是由于接受了质量差的医疗保健，360万是由于没有利用医疗保健。保健质量差是各种疾病死亡率过高的主要原因，从心血管疾病和伤害到新生儿和传染性疾病。可持续发展目标条件下的全民健康覆盖每年可以避免860万人死亡，但前提是扩大服务覆盖面的同时要投资于高质量的卫生系统。比尔和梅林达·盖茨基金会。
Universal health coverage has been proposed as a strategy to improve health in low-income and middle-income countries (LMICs). However, this is contingent on the provision of good-quality health care. We estimate the excess mortality for conditions targeted in the Sustainable Development Goals (SDG) that are amenable to health care and the portion of this excess mortality due to poor-quality care in 137 LMICs, in which excess mortality refers to deaths that could have been averted in settings with strong health systems. Using data from the 2016 Global Burden of Disease study, we calculated mortality amenable to personal health care for 61 SDG conditions by comparing case fatality between each LMIC with corresponding numbers from 23 high-income reference countries with strong health systems. We used data on health-care utilisation from population surveys to separately estimate the portion of amenable mortality attributable to non-utilisation of health care versus that attributable to receipt of poor-quality care. 15·6 million excess deaths from 61 conditions occurred in LMICs in 2016. After excluding deaths that could be prevented through public health measures, 8·6 million excess deaths were amenable to health care of which 5·0 million were estimated to be due to receipt of poor-quality care and 3·6 million were due to non-utilisation of health care. Poor quality of health care was a major driver of excess mortality across conditions, from cardiovascular disease and injuries to neonatal and communicable disorders. Universal health coverage for SDG conditions could avert 8·6 million deaths per year but only if expansion of service coverage is accompanied by investments into high-quality health systems. Bill & Melinda Gates Foundation.