MHA FPX 5028 Assessment 3 Best Practices Report MHA-FPX 5028 Comparative Models of Global Health Systems Best Practices Report

Prior to 1980, Sickle Cell Disease (SCD) was considered a pediatric disease, with few children surviving their childhoods into adulthood. Approximately 30% of children born in the United States with sickle cell anemia (SCA) in 1970 died before their fifth birthday (Chaturvedi & DeBaun, 2016). Since then, advances in screening, treatment, and vaccination rates have resulted in significant improvements in pediatric survival rates and an increase in the median age at death to 42 for men and 48 for women in the United States (Chaturvedi & DeBaun, 2016). While high-income countries have seen improvements in mortality rates and quality of life indicators, developing nations have struggled to make significant progress in reducing mortality rates among their SCD populations (Thompson et al., 2023).

An area of promise to improve health outcomes and quality of life for SCD patients is the evaluation of care in Caribbean countries, which report higher rates of children born with the sickle cell trait than the United States, yet also have better health outcomes than those in Sub-Saharan Africa (Thompson et al., 2023). In 2020, the Pan American Health Organization (PAHO) launched a cooperative agreement with the Jamaican Ministry of Health to develop a comprehensive, integrated health system delivery network (IHSDN) across 11 primary health centers and three hospitals to manage chronic disease, focusing on electronic health records, workforce development, telehealth, health promotion and prevention activities, and medication management (Pan American Health Organization, n.d.).

This report evaluates the scalability of PAHO’s cooperative agreement with Jamaica to extend best practices from both the United States and Jamaica to low-income or under-resourced countries, particularly in Sub-Saharan Africa. The report reviews best practices and shared key performance indicators, assesses consumer and organizational implications, and examines potential provider management challenges in risk-based contracting versus fee-for-service payment strategies.

Performance Indicators

In 2000, the World Health Organization (WHO) published its first global health ranking report evaluating a variety of key performance indicators among its 191 member countries (Schutte et al., 2018). International health systems are evaluated across several domains, including life expectancy, maternal, infant, and child mortality, communicable and non-communicable disease mortality rates, infrastructure, and vaccination rates (Schutte et al., 2018). Due to challenges in data collection in countries without a robust health technology infrastructure, a common set of globally agreed-upon metrics for sickle cell disease is not available. However, in 2011, the first set of potential SCD quality indicators was published, with 41 identified metrics (Oyeku & Faro, 2017).

These metrics or key performance indicators (KPIs) are distributed across six domains: utilization, care maintenance, screening, acute care treatment, chronic care treatment, and transition from pediatric to adult care (Oyeku & Faro, 2017). Additional global measures include prevalence data and mortality rates across the life cycle (PAHO, 2023). Prevalence data must be matched with balancing measures as the life expectancy of people with SCD shifts and as adolescents move into adulthood and have children of their own, often transmitting the sickle cell trait to subsequent generations (Chaturvedi & DeBaun, 2016). Determining the true mortality rate of SCD is challenging, as co-morbidities and complications associated with SCD may not attribute the cause of death as SCD-associated (Thompson et al., 2023). Cause-specific deaths rank the global mortality rate of SCD at 40, yet, when all-cause death figures are included, the mortality burden for SCD rose to 12 in children aged five and younger (Thompson et al., 2023).

Table 1 indicates potential areas of key performance indicators that can be used by low-, middle-, and high-income countries to measure performance in areas such as accessibility, quality of care, affordability, and care delivery. The Centers for Medicare and Medicaid Services reports a case rate cost of $2.4 billion per year in hospitalizations and emergency department care alone, with estimates of approximately $44,000 per year per beneficiary (Centers for Medicare and Medicaid Services, 2023). According to the Institute for Health Metrics and Evaluation (n.d.), in 2019, Jamaica reported an average of $356 expenditures per person in health care. Additionally, Ramsay et al. (2021) report that for those paying out of pocket, 82% of private pay patients spend approximately $74 per month in US dollars.

Sickle Cell Disease Key Performance Indicators, United States and Jamaica