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

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.
Competing Interests: Declaration of interests CA received funding from Merck that was used to conduct the People's Voice Survey in the USA, Mexico, Italy, and the UK. ECB received support for the manuscript from WHO Athens Quality of Care and Patient Safety Office Consultancy Contract. JB and SC received WHO support. EAO received support from the Wellcome Trust Senior Fellowships (number 224272) and the Wellcome Trust Kenya Major Overseas Programme (number 203077), consulting fees for serving on the AstraZeneca Vaccine and Immune Therapies Effectiveness Evidence Scientific Advisory Committee, and support for meetings and travel for TDR Scientific and Technical Advisory Committee meeting attendance supported by WHO. GSF received support for the manuscript provided by the Bill and Melinda Gates Foundation and the Swiss Agency for Development and Cooperation; grants or contracts through the US Centers for Disease Control and Prevention, the Association of State and Territorial Health Officials, and the National Institute of Aging and National Institutes of Health; and support for attending meetings and for travel through Dartmouth College.
(Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)