Measuring health and economic well being in the Sustainable Development Goals era: development of a poverty-free life expectancy metric and estimates for 90 countries

The purpose of this article published in The Lancet is to propose a poverty-free life expectancy (PFLE) as a new metric to provide a composite measure of population health and economic well-being. As part of the Sustainable Development Goals, which emphasize the link between health and development policies, it responds to a need of having a monitoring tool that incorporate measures of both health and economic status. The authors computed the PFLE for 90 countries and interpreted the results. 

SUMMARY

Background

The Sustainable Development Goals (SDGs), adopted in September, 2015, emphasise the link between health and economic development policies. Despite this link, and the multitude of targets and indicators in the SDGs and other initiatives, few monitoring tools explicitly incorporate measures of both health and economic status. Here we propose poverty-free life expectancy (PFLE) as a new metric that uses widely available data to provide a composite measure of population health and economic wellbeing.

Methods

We developed a population-level measure of PFLE and computed this summary measure for 90 countries with available data. Specifically, we used Sullivan's method, as in many health expectancy measures, to incorporate the prevalence of poverty by age and sex from household economic surveys into demographic life tables based on mortality rates from the 2015 Global Burden of Disease Study (GBD). For comparison, we also recalculated all PFLE measures using life tables from WHO and the UN. PFLE estimates for each country, stratified by sex, are the average number of poverty-free years a person could expect to live if exposed to current mortality rates and poverty prevalence in that country.

Findings

The average PFLE in the 90 countries
Read more: Measuring Health and Economic well being in the Sustainable Development Goals Era

Hospitals in Europe face many challenges, including cost pressures, technological changes, an evolving burden of disease, growing patient expectations, political pressure on public authorities to restructure traditional governance models and, in some countries, increasing competition from the private sector

Hospital governance has received particular attention, reflecting the growing number of political, financial and technical, as well as social and professional, factors that affect decision-making in the hospital sector. Reforms have introduced different models of hospital governance in different European countries.

This policy brief provides an overview of 10 case studies from Western Europe on macro-level arrangements in hospital governance – the structural, organizational and operational architecture of the health system. The aim is to compare the experience of decentralized hospital governance to inform policy-making as there have been concerns about the tradeoffs involved.

The concept of hospital governance represents a relatively new approach to hospital-related policy and health policy analysis. Its emergence since the early 2000s reflects the growing number of political, financial and technical, as well as social and professional, factors that affect hospital sector decision-making. Reforms have introduced different models of hospital governance in different European countries.

Hospital governance conceptually encompasses three increasingly blurred levels of hospital-related decision-making, in the context of each health system. The main "entry point" for this policy brief is the macro-level, mostly government-based, aspect of governance rather than the day-to-day operational management of the micro-level or institutional decision-making at the meso-level. One of the key processes has been an increasing decentralization of the macro-governance of public hospitals, and the role of the private sector has also increased in many countries.

Read more: What is the experience of decentralized hospital governance in Europe?

Taking the patients' perspective and putting their needs at the center sets the stage for a shift in health care delivery and even a redefinition of what falls under the purview of health care. Physicians and other clinicians will have to embrace new ways of working together, integrating the role of technology and teamwork in delivering multidisciplinary, data-informed care. Technology partners play a key role in supporting and innovating to improve access to effective, affordable care. Working cooperatively with patients on their needs, preferences and goals will result in a health care system that can deliver affordable care and optimal outcomes for patients' evolving needs.

The American Hospital Association invited hospital administrators and health care leaders to this event sponsored by Siemens Healthineers to learn innovative strategies and technologies that put patients at the center, break down barriers and bring care closer to home.

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