Limited Trust in Health Systems Hinders Universal Health Coverage


A series of papers in the Lancet Global Health published yesterday finds that only one-quarter of people thinks their health system works well. The People’s Voice Survey analysed people’s views and trust in the system in 15 countries, adding a missing component to how one evaluates health system performance. Swiss TPH contributed to these studies, which were led by the Harvard T.H. Chan School of Public Health and the Quality Evidence for Health System Transformation (QuEST) network.

Understanding people’s challenges and needs is key to reach Universal Health Coverage. (Photo: Olivier Brandenberg/Swiss TPH)

Many health systems globally are currently underperforming in terms of health outcomes, the quality of health services provided, and user experience. This leads to approximately five million deaths annually from treatable conditions. To assess the system's performance, traditionally mainly administrative aspects (such as the number of healthcare providers) or health outcomes have been in the focus. While these factors are crucial, information on people’s perceptions and their trust into health systems is often missing. The People’s Voice Survey (PVS) was designed to bridge this gap and bring a social voice to health system measurement.

The importance of people’s views

“We use the PVS to ask the population about its health system use, the main reasons for non-use, and about how respondents evaluate the care they receive in terms of quality and personal interactions as well as their trust in the system”, said Günther Fink, Head of the Household Economics and Health Systems Research unit at Swiss TPH and co-author of several of the papers. “One of the key reason why patients sometimes do not seek care is their lacking trust in the system. Understanding people’s challenges and needs is key to make meaningful changes to the health system and to ultimately reach Universal Health Coverage”. 

The Lancet Global Health series published on 11 December 2023 comprises six papers using PVS data from 15 countries, exploring quality, confidence in health systems, and people’s experiences with various health system initiatives. The studies were led by the Harvard T.H. Chan School of Public Health and the Quality Evidence for Health System Transformation (QuEST) network; Swiss TPH contributed to three out of the six papers. 

Only 25% of people believe their health system is functional

Results reveal that only one-quarter of people believe their health system functions effectively. Fewer than half were confident that they could get and afford good quality care if they were to become sick - even in countries with universal insurance systems. Health insurance was found to not necessarily guarantee access to essential services in Africa and Asia. And despite public primary care's intended role, only 4 in 10 people use it as their main point of contact with the health system, rather relying on hospitals and the private sector.

Participating countries in the studies included Argentina, Colombia, Ethiopia, Greece, India, Italy, Kenya, Laos, Mexico, Peru, South Africa, South Korea, United Kingdom, United States, and Uruguay.

Survey methodology could be applied elsewhere

The PVS aims to promote health system accountability to the population, track the impact of reforms and policies over time and promote benchmarking across countries and regions. “The PVS is an agile and very effective rapid survey that can be applied in both high and low income countries”, said Fink. “We now have data from 15 countries but are currently looking to expand the methodology to more countries, including Switzerland. Better data on people’s opinions can inform decision-makers and ultimately improve health systems.”

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