The Lancet Global Health Commission on High Quality Health Systems 1 year on: progress on a global imperative

摘要

In September, 2018, The Lancet Global Health Commissionon High Quality Health Systems (HQSS Commission)detailed the state of health system quality in low-incomeand middle-income countries.1 The Commission foundthat nearly 9 million lives are lost each year from treatableconditions for lack of good quality care and that a startling60% of the deaths were among people who actuallyobtained access to care. This “access” outcome has thusfar topped every government’s health agenda and theglobal community’s efforts, as demonstrated by thesheer number of coverage indicators in the MillenniumDevelopment Goals and now Sustainable DevelopmentGoals. But for these people—for the baby born in aclinic who became infected with streptococcus beforedischarge, for the woman with myocardial infarctionmisdiagnosed with heartburn, and for the grandfathertold that his glucose is high but who is then promptlyforgotten by the health system—having access to healthcare is plainly not enough. Unsurprisingly, we found thatJulian Tudor Hart’s law of inverse care was alive and well:good quality care was most available to the rich.