Embracing delivery science for universal health coverage

Title Embracing delivery science for universal health coverage
Year 2013
Author A. Mulley, J. Wennberg, J. Weinstein, E. Fisher and A. Binagwaho
DOI http://dx.doi.org/10.1016/S0140-6736(13)61523-8
URL http://www.sciencedirect.com/science/article/pii/S0140673613615238
Journal The Lancet
Document Type Journal Article
Document Availability Abstract
Classification Policy
Abstract We welcome the growing support for universal health coverage (UHC) as a unifying post-2015 health goal. However, unless UHC is associated with a commensurate commitment to apply health-care delivery science, improvements in coverage risk hitting the target while missing the point. The point of health care is to sustain or improve people’s health. Research has shown wide variations in many countries in delivery rates of specific services and their outcomes. In regions with high-rate high-cost delivery, health outcomes are not always better, and can be worse. Variation is often the consequence of a mismatch between system capacity to deliver services and people’s needs and wants. This mismatch distorts care, resulting in harm to patients and waste that consumes 20–40% of health resources worldwide. Jeanette Vega1 rightly stresses the need for indicators to measure progress towards universal financial risk protection and access to services. Equally important are data and transparent reporting on the value of interventions, and patient-reported measures as indicators of needs and wants to guide investment in capacity. These will require engaging individuals and populations in decisions about their own care, a fundamental human right also envisioned in the primary health-care agenda. Doing things right in health care requires learning from variation in health-care delivery and from those who live with the consequences. Embracing delivery science is essential if UHC is to increase access to high-quality services that sustain or improve health, and to prevent the waste and harm prevalent in health systems today.


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