Population confidence in the health system in 15 countries: results from the first round of the People's Voice Survey

Margaret E. Kruk, Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA. Electronic address: mkruk@hsph.harvard.edu.
Neena R. Kapoor, Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
Todd P. Lewis, Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
Catherine Arsenault, Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA.
Eleni C. Boutsikari, Division of Country Health Policies and Systems, WHO Athens Quality of Care Office, WHO Regional Office for Europe, Athens, Greece.
João Breda, Division of Country Health Policies and Systems, WHO Athens Quality of Care Office, WHO Regional Office for Europe, Athens, Greece.
Susanne Carai, Division of Country Health Policies and Systems, WHO Athens Quality of Care Office, WHO Regional Office for Europe, Athens, Greece.
Kevin Croke, Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
Rashmi Dayalu, Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
Günther Fink, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland.
Patricia J. Garcia, Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
Munir Kassa, Minister's Office, Ministry of Health, Addis Ababa, Ethiopia.
Sailesh Mohan, Public Health Foundation of India, New Delhi, India.
Mosa Moshabela, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
Jacinta Nzinga, Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
Juhwan Oh, Seoul National University College of Medicine, Seoul, South Korea.
Emelda A. Okiro, Population and Health Impact Surveillance Group, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Dorairaj Prabhakaran, Public Health Foundation of India, New Delhi, India.
Gillian K. SteelFisher, Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA.
Rosanna Tarricone, Department of Social and Political Science, Bocconi University, Milan, Italy.
Ezequiel Garcia-Elorrio, School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru; Health Care Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.

Document Type

Journal Article

Publication Date

1-1-2024

Journal

The Lancet. Global health

Volume

12

Issue

1

DOI

10.1016/S2214-109X(23)00499-0

Abstract

Population confidence is essential to a well functioning health system. Using data from the People's Voice Survey-a novel population survey conducted in 15 low-income, middle-income, and high-income countries-we report health system confidence among the general population and analyse its associated factors. Across the 15 countries, fewer than half of respondents were health secure and reported being somewhat or very confident that they could get and afford good-quality care if very sick. Only a quarter of respondents endorsed their current health system, deeming it to work well with no need for major reform. The lowest support was in Peru, the UK, and Greece-countries experiencing substantial health system challenges. Wealthy, more educated, young, and female respondents were less likely to endorse the health system in many countries, portending future challenges for maintaining social solidarity for publicly financed health systems. In pooled analyses, the perceived quality of the public health system and government responsiveness to public input were strongly associated with all confidence measures. These results provide a post-COVID-19 pandemic baseline of public confidence in the health system. The survey should be repeated regularly to inform policy and improve health system accountability.

Department

Global Health

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