Healthcare must be Affordable and Accessible, but also High Quality

This post, authored by Valerie Shelly (ACCESS Health International), Susann Roth (Asian Development Bank) and Kirthi Ramesh (Asian Development Bank), originally appeared on the Asian Development Bank blog.

Universal health coverage must be high quality to improve patients’ health outcomes

Shakina lives in a developing country. Although there is a public hospital near her home, she chooses to travel four hours by bus to go to a well-liked, private hospital in the city. She has heard from her friends and neighbors that they were pleased with the care they received at this hospital and to her they seem healthier and happier when they get back. She has heard bad stories from other friends who went to the closer, more affordable, public hospital – they returned home sicker than when they left.

Shakina’s story reminds us that all people, regardless of socioeconomic class and means, want high-quality healthcare and that they will often choose higher quality care even if it is more expensive and less accessible.

Under the World’s Health Organization’s definition of universal health coverage, all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.

The concept of quality has only recently been built into universal health coverage policies and has not yet been sufficiently addressed. If health investments are to lead to the emergence of more productive and equitable societies and economies, countries need to focus on improving quality.

The three priorities of health care delivery – cost, quality, and access – need not be at odds with each other. Greater use of health care facilities due to lower costs and shorter distances to travel will only lead to better health outcomes if quality of care is guaranteed. Therefore, we must make high-quality healthcare services affordable and accessible in order to effectively implement universal health coverage. Simply providing access for more people to lower quality care won’t achieve universal health coverage.

Poor-quality care is wasteful, costly, and dangerous. It is estimated that between 5.7 million and 8.4 million people die each year in low- and middle-income countries due to poor-quality care. In other words, in many countries, a person has a greater chance of dying from receiving poor quality care than from going without care entirely.

In addition to the human cost, poor quality also has an economic cost. Poor productivity and wastefulness, resulting from poor quality of health care, costs these countries around $1.4 trillion to $1.6 trillion per year. Poor-quality care proves costly for societies when unhealthy adults are less productive at work and unhealthy children cannot perform well at school.

High-quality care is cost-effective and leads to an earlier and higher return on investment. Approximately 15% of hospital expenditures in high-income countries are used to correct preventable complications of care and patient harm. This is a price that is an inconvenience to high-income economies and completely unaffordable for low- to middle-income countries. In addition, poor-quality care affects the poor and vulnerable disproportionately. While investing in higher quality health systems costs more upfront, costs are lowered over the long-term through more efficient workflow; fewer medical errors and preventable complications; elimination of ineffective treatments and procedures; fewer duplicated services; and less waste overall.

Even during a crisis or epidemic, resilient health systems can deliver high-quality services

Quality health services make health systems resilient. They are prepared for anything, can maintain core functions amongst changing situations, and are informed by lessons learned, constantly adapting and improving. Even in a crisis during times of political unrest, or during an epidemic, resilient health systems can rely on their basic processes to deliver high-quality services.

Secondly, quality health services make health systems trustworthy and transparent. Poor- quality care, even when taken to the far reaches of the world, erodes trust, puts patients at risk, and is completely unsustainable. High-quality care builds trust in the health system, nourishes a culture of respect towards individuals, improves patient safety and produces better patient outcomes. A truly transparent healthcare organization is open and honest about successes as well as failures, ensuring care is based best practice clinical protocols, building complete trust and long-lasting relationships with their patients.

Finally, quality health services make health systems patient-centered. A central feature of quality health services is that they are patient-centered and give great consideration to the patient’s individual needs, culture, and beliefs. Patient-centered care is vital to the implementation of universal health coverage, as we know that people who are engaged in their own care suffer fewer complications and enjoy better health and overall happiness. A central aspect to achieving patient-centered care is seeking feedback on patients’ care experience.

Improving quality requires a holistic approach. Countries that want to improve quality of care need to consider interventions across different domains (leadership, information, patient and population engagement, regulation and standards, organizational capacity, models of care) across different levels of the health care system. Building a national strategy for quality is an important first step to agree on a clear set of goals, define suitable interventions and tools and align different stakeholders’ efforts to improve quality of care.

Shakina chose to travel a long distance for high-quality care instead of taking her chances on accessible, poor-quality care. We need to make it easier for Shakina to receive the high-quality care she deserves, at a reasonable distance from her home, from a skilled health professional that puts her at the center of her care. By doing this, we will see that in the end, high-quality care really does pay off.