Related Subjects
19·0 (14·3–23·7) in Somalia
Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases
HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland
Injuries
a summary measure of overall development. As derived from the broader GBD study and other data sources
and 100 as the 99th percentile (best)
and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied
and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories
and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values
and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations
as well as health systems inputs
as well as subnational locations in seven countries
but these relationships were quite heterogeneous
countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016
disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development
especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes
followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands
from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016
from 64·8 (59·6–68·8) in Goa to 34·0 (30·3–38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference)
many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services
most notably vaccine-preventable diseases. Overall
national performance on the HAQ Index was positively associated with higher levels of total health spending per capita
particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000
performance ranged from 91·5 (89·1–93·6) in Beijing to 48·0 (43·4–53·2) in Tibet (a 43·5-point difference)
providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI)
replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016
such as total health spending per capita. Findings In 2016
the pursuit of universal health coverage hinges upon improving both access and quality worldwide
to values as low as 18·6 (13·1–24·4) in the Central African Republic
we examined relationships between national HAQ Index scores and potential correlates of performance