Half a billion surgical cases: Aligning surgical delivery with best-performing health systems

Shrime, Mark G.; Daniels, Kimberly; Meara, John G.

doi:10.1016/j.surg.2015.03.025

Cited by 11 publications

(9 citation statements)

References 14 publications

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“…There have been a few studies that assessed these indicators since 2015, when the Lancet commission report was released. An attempt has been made to define global estimates on surgeons, anaesthesiologists and obstetricians 14 15 ; surgical volumes 4 16 ; financial burden on surgery 17 ; and perioperative mortality. 18 19 While there are major gaps in surgical access across sub-Saharan Africa (SSA), understanding these gaps would support global and country-level decision-makers to plan and programme for improvements.…”

Section: Introductionmentioning

confidence: 99%

Geospatial mapping of access to timely essential surgery in sub-Saharan Africa

et al. 2018

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IntroductionDespite an estimated one-third of the global burden of disease being surgical, only limited estimates of accessibility to surgical treatment in sub-Saharan Africa exist and these remain spatially undefined. Geographical metrics of access to major hospitals were estimated based on travel time. Estimates were then used to assess need for surgery at country level.MethodsMajor district and regional hospitals were assumed to have capability to perform bellwether procedures. Geographical locations of hospitals in relation to the population in the 47 sub-Saharan countries were combined with spatial ancillary data on roads, elevation, land use or land cover to estimate travel-time metrics of 30 min, 1 hour and 2 hours. Hospital catchment was defined as population residing in areas less than 2 hours of travel time to the next major hospital. Travel-time metrics were combined with fine-scale population maps to define burden of surgery at hospital catchment level.ResultsOverall, the majority of the population (92.5%) in sub-Saharan Africa reside in areas within 2 hours of a major hospital catchment defined based on spatially defined travel times. The burden of surgery in all-age population was 257.8 million to 294.7 million people and was highest in high-population density countries and lowest in sparsely populated or smaller countries. The estimated burden in children <15 years was 115.3 million to 131.8 million and had similar spatial distribution to the all-age pattern.ConclusionThe study provides an assessment of accessibility and burden of surgical disease in sub-Saharan Africa. Yet given the optimistic assumption of adequare surgical capability of major hospitals, the true burden of surgical disease is expected to be much greater. In-depth health facility assessments are needed to define infrastructure, personnel and medicine supply for delivering timely and safe affordable surgery to further inform the analysis.

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Section: Introductionmentioning

confidence: 99%

Geospatial mapping of access to timely essential surgery in sub-Saharan Africa

et al. 2018

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“…All health systems do not provide these essential interventions to their population [ 19 , 24 ]. Recent surveys and expert opinions suggest that up to 30% of the global burden of disease requires a minimum number of surgical procedures for adequate management [ 19 , 37 ]. Data from the Global Burden of Disease (GBD) study from the Institute of Health Metrics and Evaluation estimated that more than 321 million surgical procedures would have been needed to address surgically-amenable diseases in the 6.9 billion World population in 2010 [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

A multidimensional framework for rating health system performance and sustainability: A nine plus one ranking system

Müller

Oakley²,

Saad

et al. 2021

J Glob Health

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Background Health Care provision in terms of prevention, detection and treatment is primarily dependent on the quality of the hosting Health System. In its health report 2000, the WHO's attempt to assess and rank health systems’ quality Worldwide was heavily criticized. We propose a novel framework for health system performance and ranking using three indicators for three domains; general health system performance, clinical outcome of treatment applied to the main causes of death and health system sustainability domains. Methods Each domain was rated as “A – high”, “B – intermediate” or “C – poor” according to the aggregate score values of its three indicators. Hence the highest rank a health system can achieve is “AAA” and the lowest is “CCC”. If there is a need to define a “numerical rank” to further differentiate health systems with similar rating from one another, the total health expenditure per capita per year was used as an additional “number 10” indicator to achieve that level of differentiation. The framework was applied to Health Systems serving most of the World population including China, India, Brazil, USA, Russia, Germany, Japan, UK, France, Singapore and Switzerland. Data pertinent to each indicator was captured from published reports in peer-reviewed journals and/or from official websites. A Delphi survey was conducted for data not available online. Results Among the 11 health systems tested, no one scored AAA, Switzerland, France, Germany and Japan scored AAB, Singapore scored ABB, UK scored BBB, USA, Russia and China scored BBC, Brazil scored BCC while India scored CCC. Total health expenditure per capita per year lead to ranking Switzerland first followed by France, Germany, and Japan. Conclusion This novel ranking system is a practical and an applicable tool that test health system performance and sustainability. It can be utilized to guide all organizations, people and actions whose primary intent is to promote, restore or maintain health to achieve their targets. An International Health System Ranking database that will be hosted by the Institute of Global, Health, Faculty of Medicine, University of Geneva, Switzerland.

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“…A large portion of healthcare expenditures is related to surgical care. Globally, it has been estimated that between 11% and 30% of the global burden of disease could benefit from surgical management 2,3 . In 2005, the United States spent an estimated US$572 billion on surgical care, accounting for 29% of their total health care expenditures 4 .…”

Section: Introductionmentioning

confidence: 99%

“…In 2005, the United States spent an estimated US$572 billion on surgical care, accounting for 29% of their total health care expenditures 4 . However, there has been much variability in surgical volume across countries 2 . With estimations of the rising need of surgical procedures globally 2 , a better understanding of opportunities to optimize surgical spending is needed to help control healthcare expenditures.…”

Section: Introductionmentioning

confidence: 99%

Global hospital and operative costs associated with various ventral cavity procedures: a comprehensive literature review and analysis across regions

Chen

Clymer

Ferko³

2019

Journal of Medical Economics

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Objectives: The aim of this literature review was to provide a comprehensive report on hospital costs, and cost components, for a range of ventral cavity surgical procedures across three regions of focus:(1) Americas, (2) Europe, Middle East and Africa (EMEA), and (3) Asia-Pacific. Methods: A structured search was performed and utilized a combination of controlled vocabulary (e.g., "Hepatectomy", "Colectomy", "Costs and Cost Analysis") and keywords (e.g. "liver resection", "bowel removal", "economics"). Studies were considered eligible for inclusion if they reported hospitalrelated costs associated with the procedures of interest. Cost outcomes included operating room (OR) time costs, total OR costs, ward stay costs, total admission costs, OR cost per minute and ward cost per day. All costs were converted to 2018 USD. Results: Total admission costs were observed to be highest in the Americas, with an average cost of $15,791. The average OR time cost per minute was found to vary by region: $24.83 (Americas), $14.29 (Asia-Pacific), and $13.90 (EMEA). A cost-breakdown demonstrated that OR costs typically comprised close to 50%, or more, of hospital admission costs. This review also demonstrates that decreasing OR time by 30 min provides cost savings approximately equivalent to a 1-day reduction in ward time. Conclusion:This literature review provided a comprehensive assessment of hospital costs across various surgical procedures, approaches, and geographical regions. Our findings indicate that novel processes and healthcare technologies that aim to reduce resources such as operating time and hospital stay, can potentially provide resource savings for hospital payers.

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Half a billion surgical cases: Aligning surgical delivery with best-performing health systems

Cited by 11 publications

References 14 publications

Geospatial mapping of access to timely essential surgery in sub-Saharan Africa

Geospatial mapping of access to timely essential surgery in sub-Saharan Africa

A multidimensional framework for rating health system performance and sustainability: A nine plus one ranking system

Global hospital and operative costs associated with various ventral cavity procedures: a comprehensive literature review and analysis across regions

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