When the health care does not work well, better not have?

Andreu Segura

Almost twenty years ago, the report of the Institute of Medicine “To err is human" estimated that medical errors caused more annual deaths than AIDS, breast cancer or traffic accidents. A few days ago, at The Lancet, Margaret Kruk and her Harvard global health team warned us that poor health care is causing five times more deaths than AIDS in countries with fewer resources. Even more deaths than those of people who die without being able to access health.

It is obvious that to be useful, health activities must have a positive effect on the health of the people served. In health and survival or, even more precisely, in survival in good health. Elementary. As it is also to think that this value depends largely on doing things right. And it is not enough to have facilities, equipment and health personnel. They need to work properly.

The study by Kruk et al. analyses the mortality corresponding to a set of 61 causes of death that can be treated successfully by health services and, therefore, avoidable. The population investigated is from 137 countries of low and medium economic level and the lethality observed has been compared with what would be expected to occur due to these same causes in a reference population constituted in 21 countries with a high economic level.

It is estimated that in 2016 in these 137 countries there were 15.6 million more deaths than those that would have occurred due to the same causes in the reference population. Of these, 7 million could have been avoided with only public health measures, so if we exclude them, the remaining 8.6 million are potentially preventable deaths with standard medical and health care. The fact is that 3.6 million of these deaths correspond to people who did not access any kind of assistance, while 5 million (58% of the dead) did receive health care. That is 1.4 million more deaths among those treated than among those not attending. And if we consider that the number of people killed by potentially susceptible causes of effective care was just over 15 million, it turns out that inadequate assistance is associated with almost 10% of preventable deaths.

Although the results have been obtained through sophisticated assumptions, the authors have carried out some sensitivity analyses that do not contradict the conclusions obtained, and although it is very likely that in many cases the causes of therapeutic failure were deficiencies, in the sense of insufficiency, doing nothing was better for survival. So, mere accessibility to any type of medical and health care is not enough. It must work well. A conclusion that seems obvious. Also, it is better to be able to direct patients who need care to a hospital that works as opposed to a closer less efficient one.


Reference

(1) Kruk ME, Gage AD, Joseph NT, Goodarz D, García-Saisó S, Salomon YA. Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries. Lancet published online September 5, 2018. doi.org/10.1016/s0140-6736(18)31668