Global Health Service Monitor 2020

Key findings:

• Coronavirus is considered by the public across 27 countries to be the greatest health problem this year – by a large margin. Today, almost twice as many people say COVID-19 is a pressing health concern facing their country than cancer, which came top in our 2018 survey.
• Mental health is considered an important health issue, ranking third overall. More people aged under 35 report this as a big problem. Scores are also higher among women than men.
• The public’s assessment of their country’s health service is generally more positive than it was two years ago and there is greater reported trust that patients will receive the best treatment.
• Access to treatment/waiting times is considered the biggest challenge to healthcare systems, followed by understaffing. Cost is also a key issue in many countries.
• One in three expect healthcare in their country to improve in the future. Twice as many think it will get better than get worse, but countries with more established health systems tend to be more pessimistic.

Biggest health problems

The top health concern globally today is of course Coronavirus. It is top in 26 of 27 countries with 72% overall selecting this as the health problem facing people in their country today. Almost twice as many select COVID-19 than cancer (37%) – the second most pressing health concern this year.

Mental health and stress come next as the most important health problems selected by the public, with Sweden, Chile and Australia most concerned about mental health. South Korea, Japan and Sweden are most likely to single out stress.

Obesity falls from 2nd place in our ranking of health problems to 5th in this year’s survey.

The severity of heart disease as a health problem is not reflected in its 7th place ranking here. Our “Perils of Death” study at the start of 2020 found that it accounts for almost one-third of global deaths, something that is underestimated by the global public. Cancer is also a greater cause of death than people generally estimate.

For more on global Coronavirus concern, see our latest What Worries the World survey.

How do we rate our country’s health services?

Despite the Coronavirus pandemic putting huge strain on healthcare systems of countries around the world, we find more people worldwide giving positive ratings of the health services they have access to than two years ago. This year, 50% rate it ‘good’ (+5 points vs. 2018) and 18% ‘poor’ (-5 points vs. 2018).

• Healthcare services are rated most highly by the public in Australia (81%), the Netherlands (76%) and Great Britain (74%).
• The three countries where people are most likely to rate their healthcare as ‘poor’ are Poland (53%), Hungary (42%) and Peru (40%).
• We see the greatest increases in quality ratings for healthcare in Saudi Arabia (+19), China (+14), Brazil and Sweden (both +13).

Overall, people also express a stronger sense of trust today that they will receive the best treatment from their country’s healthcare services. This has increased by 9 points since the last survey, from 41% to 50%. However, 24% globally disagree with this statement (down 4 points, from 28% in 2018).

• Trust is highest in Malaysia (75%), Australia (74%) and China (74%).
• And lowest in Hungary (16%), Russia (16%), Poland (18%).
• We see the greatest increases in trust in healthcare in China (+28 points on the 2018 study), Saudi Arabia (+21) and South Korea (+18).

Challenges to healthcare systems

The biggest perceived challenges in healthcare systems relate to access to treatment, long waiting times and the system being overstretched/understaffed. Cost is also a consideration in many countries.

Biggest challenges are:

1. Access to treatment/long waiting times 40%
2. Not enough staff 36%
3. Cost of accessing treatment 32%

Across all countries, 55% say their healthcare system is overstretched. This is a problem regardless of how highly countries rate their healthcare system. There is highest agreement in Great Britain, Hungary, Sweden, Spain and Peru. In addition, 62% say that waiting times to see a doctor are too long.

When it comes to perceived health inequalities, 59% globally say that many people cannot afford good healthcare in their country. This rises to over 8 in 10 agreeing in seven countries (South Africa, Peru, Chile, Hungary, Brazil, Poland and Argentina). People are also divided on whether health services provide the same standard of care to everyone: 37% agree while 38% disagree, with some geographical differences.

Vaccines

We find almost two-thirds (64%) across 27 countries think that vaccinations against infectious diseases should be compulsory, while 15% disagree. Agreement is highest in Malaysia, Argentina and Saudi Arabia whereas those in Russia, the US, France and Poland are less convinced.

Public intent to vaccinate against COVID-19, if a vaccination were available, is at 73% across 15 countries. Read more from our October 2020 survey.

Looking to the future

One in three expect healthcare to improve in the future: twice as many think it will improve than those who think it will get worse (32% vs. 16%). But there are large geographical differences with those in Latin America especially confident it will improve. Great Britain and France are the countries where there are the highest proportions saying that it will get worse (both 33%).

We have mapped the countries based on how they rate their healthcare system and whether they expect it to improve in the future, giving us four broad categories:

Our 2020 global health services study reveals the public view of health services and concerns at an exceptional time in global public health. Although certain findings speak to the immediate context of the coronavirus pandemic, it also highlights some wider and longer-term challenges to the national health services in many countries around the world.