Charles Kenny starts out with the good news:

There’s good news to report on health care in America. Obamacare has increased coverage by 10 million people, spending growth has dramatically declined, and preventable hospital errors such as drug mistakes fell 17 percent from 2010 to 2013, saving 50,000 lives. In the U.S., at least, it appears possible to increase efficiency, cost-effectiveness, and access all at the same time.


The Affordable Care Act (ACA) is far from the universal health care the World Health Organization (WHO) is calling for in every country.  And in the developing world, universal health care appears not to be the panacea that was once hoped for.  Kenny says that while access to health care vastly improves (particularly among the very poor), the quality of health (using indicators such as death rates and reduced sickness) in developing countries may not:

In India, for example, the government has started paying mothers who deliver children in hospitals. As a result, from 2005 to 2011, the number born in a health facility more than doubled in nine Indian states. But the massive increase in institutional births had no impact on infant mortality.


Even with better access to health care, the quality of care (and the quality of its providers) in poorer countries is often inferior to that in wealthier nations.  But Kenny says that’s not the biggest reason why outcomes remain poor:

The lack of a relationship between the availability of health care and life expectancy in developing countries goes beyond weaknesses in hospitals and clinics. It’s also related to the fact that what kills most people in poor countries are conditions that don’t require hospitals to fix. In sub-Saharan Africa, the five leading killers are malaria, HIV, lower respiratory infections, diarrhea, and malnutrition. Further and growing causes of mortality across the developing world include traffic accidents, tobacco usage, and health conditions related to being overweight. Clean water, access to and use of toilets, condoms, soap, vaccinations, and and bed nets, alongside better nutrition, tobacco controls, and road safety measures can prevent the majority of these deaths. Doctors and nurses save thousands of lives a day, but infrastructure and public health interventions—neither requiring highly trained medical staff—save many millions each year. Often, the medical system can do little more than provide palliative care when these other approaches aren’t used or don’t work.


The emphasis above is my own.  The point is that the story of access to healthcare, of positive health outcomes (illnesses treated effectively, lives saved), and economic savings in the system doesn’t begin and end with hospitals and health care providers. Public health policies geared towards prevention are what set the stage for medical systems to succeed.