Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016
Published in: | The Lancet |
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Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Other Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Format: | Article in Journal/Newspaper |
Language: | English |
Published: |
2018
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Subjects: | |
Online Access: | http://hdl.handle.net/11588/729713 https://doi.org/10.1016/S0140-6736(18)30994-2 https://www.ncbi.nlm.nih.gov/pubmed/?term=GBD%202016%20Healthcare%20Access%20and%20Quality%20Collaborators%5BCorporate%20Author%5D |
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ftunivnapoliiris:oai:www.iris.unina.it:11588/729713 |
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Open Polar |
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IRIS Università degli Studi di Napoli Federico II |
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English |
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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 Injuries 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 as well as subnational locations in seven countries from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016 we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns we risk-standardised cause-specific deaths due to non-cancers by location-year 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 we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100 with 0 as the first percentile (worst) observed between 1990 and 2016 and 100 as the 99th percentile (best) we set these thresholds at the country level and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values 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) a summary measure of overall development. As derived from the broader GBD study and other data sources we examined relationships between national HAQ Index scores and potential correlates of performance such as total health spending per capita. Findings In 2016 HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands to values as low as 18·6 (13·1–24·4) in the Central African Republic 19·0 (14·3–23·7) in Somalia and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China 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) while India saw a 30·8-point disparity 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) whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference) whereas in Brazil 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 with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016 most notably vaccine-preventable diseases. Overall national performance on the HAQ Index was positively associated with higher levels of total health spending per capita as well as health systems inputs but these relationships were quite heterogeneous 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 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 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 the pursuit of universal health coverage hinges upon improving both access and quality worldwide and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations. |
spellingShingle |
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 Injuries 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 as well as subnational locations in seven countries from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016 we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns we risk-standardised cause-specific deaths due to non-cancers by location-year 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 we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100 with 0 as the first percentile (worst) observed between 1990 and 2016 and 100 as the 99th percentile (best) we set these thresholds at the country level and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values 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) a summary measure of overall development. As derived from the broader GBD study and other data sources we examined relationships between national HAQ Index scores and potential correlates of performance such as total health spending per capita. Findings In 2016 HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands to values as low as 18·6 (13·1–24·4) in the Central African Republic 19·0 (14·3–23·7) in Somalia and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China 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) while India saw a 30·8-point disparity 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) whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference) whereas in Brazil 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 with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016 most notably vaccine-preventable diseases. Overall national performance on the HAQ Index was positively associated with higher levels of total health spending per capita as well as health systems inputs but these relationships were quite heterogeneous 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 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 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 the pursuit of universal health coverage hinges upon improving both access and quality worldwide and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations. Fullman N Yearwood J Abay SM Abbafati C Abd-Allah F Abdela J Abdelalim A Abebe Z Abebo TA Aboyans V Abraha HN Abreu DMX Abu-Raddad LJ Adane AA Adedoyin RA Adetokunboh O Adhikari TB Afarideh M Afshin A Agarwal G Agius D Agrawal A Agrawal S Ahmad Kiadaliri A Aichour MTE Akibu M Akinyemi RO Akinyemiju TF Akseer N Al Lami FH Alahdab F Al-Aly Z Alam K Alam T Alasfoor D Albittar MI Alene KA Al-Eyadhy A Ali SD Alijanzadeh M Aljunid SM Alkerwi A Alla F Allebeck P Allen C Alomari MA Al-Raddadi R Alsharif U Altirkawi KA Alvis-Guzman N Amare AT Amenu K Ammar W Amoako YA Anber N Andrei CL Androudi S Antonio CAT Araújo VEM Aremu O Ärnlöv J Artaman A Aryal KK Asayesh H Asfaw ET Asgedom SW Asghar RJ Ashebir MM Asseffa NA Atey TM Atre SR Atteraya MS Avila-Burgos L Avokpaho EFGA Awasthi A Ayala Quintanilla BP Ayalew AA Ayele HT Ayer R Ayuk TB Azzopardi P Azzopardi-Muscat N Babalola TK Badali H Badawi A Banach M Banerjee A Banstola A Barber RM Barboza MA Barker-Collo SL Bärnighausen T Barquera S Barrero LH Bassat Q Basu S Baune BT Bazargan-Hejazi S Bedi N Beghi E Behzadifar M Bekele BB Belachew AB Belay SA Belay YA Bell ML Bello AK Bennett DA Bennett JR Bensenor IM Berhe DF Bernabé E Bernstein RS Beuran M Bhalla A Bhatt P Bhaumik S Bhutta ZA Biadgo B Bijani A Bikbov B Birungi C Biryukov S Bizuneh H Bolliger IW Bolt K Bou-Orm IR Bozorgmehr K Brady OJ Brazinova A Breitborde NJK Brenner H Britton G Brugha TS Butt ZA Cahuana-Hurtado L Campos-Nonato IR Campuzano JC Car J Car M Cárdenas R Carrero JJ Carvalho F Castañeda-Orjuela CA Castillo Rivas J Catalá-López F Cercy K Chalek J Chang HY Chang JC Chattopadhyay A Chaturvedi P Chiang PP Chisumpa VH Choi JJ Christensen H Christopher DJ Chung SC Ciobanu LG Cirillo M Colombara D Conti S Cooper C Cornaby L Cortesi PA Cortinovis M Costa Pereira A Cousin E Criqui MH Cromwell EA Crowe CS Crump JA Daba AK Dachew BA Dadi AF Dandona L Dandona R Dargan PI Daryani A Daryani M Das J Das SK das Neves J Davis Weaver N Davletov K de Courten B De Leo D De Neve JW Dellavalle RP Demoz G Deribe K Des Jarlais DC Dey S Dharmaratne SD Dhimal M Djalalinia S Doku DT Dolan K Dorsey ER Dos Santos KPB Doyle KE Driscoll TR Dubey M Dubljanin E Duncan BB Echko M Edessa D Edvardsson D Ehrlich JR Eldrenkamp E El-Khatib ZZ Endres M Endries AY Eshrati B Eskandarieh S Esteghamati A Fakhar M Farag T Faramarzi M Faraon EJA Faro A Farzadfar F Fatusi A Fazeli MS Feigin VL Feigl AB Fentahun N Fereshtehnejad SM Fernandes E Fernandes JC Fijabi DO Filip I Fischer F Fitzmaurice C Flaxman AD Flor LS Foigt N Foreman KJ Frostad JJ Fürst T Futran ND Gakidou E Gallus S Gambashidze K Gamkrelidze A Ganji M Gebre AK Gebrehiwot TT Gebremedhin AT Gelaw YA Geleijnse JM Geremew D Gething PW Ghadimi R Ghasemi Falavarjani K Ghasemi-Kasman M Gill PS Giref AZ Giroud M Gishu MD Giussani G Godwin WW Goli S Gomez-Dantes H Gona PN Goodridge A Gopalani SV Goryakin Y Goulart AC Grada A Griswold M Grosso G Gugnani HC Guo Y Gupta R Gupta T Gupta V Haagsma JA Hachinski V Hafezi-Nejad N Hailu GB Hamadeh RR Hamidi S Hankey GJ Harb HL Harewood HC Harikrishnan S Haro JM Hassen HY Havmoeller R Hawley C Hay SI He J Hearps SJC Hegazy MI Heibati B Heidari M Hendrie D Henry NJ Herrera Ballesteros VH Herteliu C Hibstu DT Hiluf MK Hoek HW Homaie Rad E Horita N Hosgood HD Hosseini M Hosseini SR Hostiuc M Hostiuc S Hoy DG Hsairi M Htet AS Hu G Huang JJ Iburg KM Idris F Igumbor EU Ikeda C Ileanu BV Ilesanmi OS Innos K Irvani SSN Irvine CMS Islami F Jacobs TA Jacobsen KH Jahanmehr N Jain R Jain SK Jakovljevic MB Jalu MT Jamal AA Javanbakht M Jayatilleke AU Jeemon P Jha RP Jha V Jóúwiak J John O Johnson SC Jonas JB Joshua V Jürisson M Kabir Z Kadel R Kahsay A Kalani R Kar C Karanikolos M Karch A Karema CK Karimi SM Kasaeian A Kassa DH Kassa GM Kassa TD Kassebaum NJ Katikireddi SV Kaul A Kawakami N Kazanjan K Kebede S Keiyoro PN Kemp GR Kengne AP Kereselidze M Ketema EB Khader YS Khafaie MA Khajavi A Khalil IA Khan EA Khan G Khan MN Khan MA Khanal MN Khang YH Khater MM Khoja ATA Khosravi A Khubchandani J Kibret GD Kiirithio DN Kim D Kim YJ Kimokoti RW Kinfu Y Kinra S Kisa A Kissoon N Kochhar S Kokubo Y Kopec JA Kosen S Koul PA Koyanagi A Kravchenko M Krishan K Krohn KJ Kuate Defo B Kumar GA Kumar P Kutz M Kuzin I Kyu HH Lad DP Lafranconi A Lal DK Lalloo R Lam H Lan Q Lang JJ Lansingh VC Lansky S Larsson A Latifi A Lazarus JV Leasher JL Lee PH Legesse Y Leigh J Leshargie CT Leta S Leung J Leung R Levi M Li Y Liang J Liben ML Lim LL Lim SS Lind M Linn S Listl S Liu P Liu S Lodha R Lopez AD Lorch SA Lorkowski S Lotufo PA Lucas TCD Lunevicius R Lurton G Lyons RA Maalouf F Macarayan ERK Mackay MT Maddison ER Madotto F Magdy Abd El Razek H Magdy Abd El Razek M Majdan M Majdzadeh R Majeed A Malekzadeh R Malhotra R Malta DC Mamun AA Manhertz T Manguerra H Mansournia MA Mantovani LG Manyazewal T Mapoma CC Margono C Martinez-Raga J Martins SCO Martins-Melo FR Martopullo I März W Massenburg BB Mathur MR Maulik PK Mazidi M McAlinden C McGrath JJ McKee M Mehata S Mehrotra R Mehta KM Mehta V Meier T Mejia-Rodriguez F Meles KG Melku M Memiah P Memish ZA Mendoza W Mengiste DA Mengistu DT Menota BG Mensah GA Meretoja A Meretoja TJ Mezgebe HB Miazgowski T Micha R Milam R Millear A Miller TR Mini GK Minnig S Mirica A Mirrakhimov EM Misganaw A Mitchell PB Mlashu FW Moazen B Mohammad KA Mohammadibakhsh R Mohammed E Mohammed MA Mohammed S Mokdad AH Mola GL Molokhia M Momeniha F Monasta L Montañez Hernandez JC Moosazadeh M Moradi-Lakeh M Moraga P Morawska L Moreno Velasquez I Mori R Morrison SD Moses M Mousavi SM Mueller UO Murhekar M Murthy GVS Murthy S Musa J Musa KI Mustafa G Muthupandian S Nagata C Nagel G Naghavi M Naheed A Naik GA Naik N Najafi F Naldi L Nangia V Nansseu JRN Narayan KV Nascimento BR Negoi I Negoi RI Newton CR Ngunjiri JW Nguyen G Nguyen L Nguyen TH Nichols E Ningrum DNA Nolte E Nong VM Norheim OF Norrving B Noubiap JJN Nyandwi A Obermeyer CM Ofori-Asenso R Ogbo FA Oh IH Oladimeji O Olagunju AT Olagunju TO Olivares PR Oliveira PPV Olsen HE Olusanya BO Olusanya JO Ong K Opio JN Oren E Ortega-Altamirano DV Ortiz A Ozdemir R Pa M Pain AW Palone MRT Pana A Panda-Jonas S Pandian JD Park EK Parsian H Patel T Pati S Patil ST Patle A Patton GC Paturi VR Paudel D Pedroso MM Pedroza SP Pereira DM Perico N Peterson H Petzold M Peykari N Phillips MR Piel FB Pigott DM Pillay JD Piradov MA Polinder S Pond CD Postma MJ Pourmalek F Prakash S Prakash V Prasad N Prasad NM Purcell C Qorbani M Quintana HK Radfar A Rafay A Rafiei A Rahimi K Rahimi-Movaghar A Rahimi-Movaghar V Rahman M Rahman MA Rahman SU Rai RK Raju SB Ram U Rana SM Rankin Z Rasella D Rawaf DL Rawaf S Ray SE Razo-García CA Reddy P Reiner RC Reis C Reitsma MB Remuzzi G Renzaho AMN Resnikoff S Rezaei S Rezai MS Ribeiro AL Rios Blancas MJ Rivera JA Roever L Ronfani L Roshandel G Rostami A Roth GA Rothenbacher D Roy A Roy N Ruhago GM Sabde YD Sachdev PS Sadat N Safdarian M Safiri S Sagar R Sahebkar A Sahraian MA Sajadi HS Salama J Salamati P Saldanha RF Salimzadeh H Salomon JA Samy AM Sanabria JR Sancheti PK Sanchez-Niño MD Santomauro D Santos IS Santric Milicevic MM Sarker AR Sarrafzadegan N Sartorius B Satpathy M Savic M Sawhney M Saxena S Saylan MI Schaeffner E Schmidhuber J Schmidt MI Schneider IJC Schumacher AE Schutte AE Schwebel DC Schwendicke F Sekerija M Sepanlou SG Servan-Mori EE Shafieesabet A Shaikh MA Shakh-Nazarova M Shams-Beyranvand M Sharafi H Sharif-Alhoseini M Shariful Islam SM Sharma M Sharma R She J Sheikh A Shfare MT Shi P Shields C Shigematsu M Shinohara Y Shiri R Shirkoohi R Shiue I Shrime MG Shukla SR Siabani S Sigfusdottir ID Silberberg DH Silva DAS Silva JP Silveira DGA Singh JA Singh L Singh NP Singh V Sinha DN Sinke AH Sisay M Skirbekk V Sliwa K Smith A Soares Filho AM Sobaih BHA Somai M Soneji S Soofi M Sorensen RJD Soriano JB Soyiri IN Sposato LA Sreeramareddy CT Srinivasan V Stanaway JD Stathopoulou V Steel N Stein DJ Stokes MA Sturua L Sufiyan MB Suliankatchi RA Sunguya BF Sur PJ Sykes BL Sylaja PN Tabarés-Seisdedos R Tadakamadla SK Tadesse AH Taffere GR Tandon N Tariku AT Taveira N Tehrani-Banihashemi A Temam Shifa G Temsah MH Terkawi AS Tesema AG Tesfaye DJ Tessema B Thakur JS Thomas N Thompson MJ Tillmann T To QG Tobe-Gai R Tonelli M Topor-Madry R Topouzis F Torre A Tortajada M Tran BX Tran KB Tripathi A Tripathy SP Troeger C Truelsen T Tsoi D Tudor Car L Tuem KB Tyrovolas S Uchendu US Ukwaja KN Ullah I Updike R Uthman OA Uzochukwu BSC Valdez PR van Boven JFM Varughese S Vasankari T Violante FS Vladimirov SK Vlassov VV Vollset SE Vos T Wagnew F Waheed Y Wallin MT Walson JL Wang Y Wang YP Wassie MM Weaver MR Weiderpass E Weintraub RG Weiss J Weldegwergs KG Werdecker A West TE Westerman R White RG Whiteford HA Widecka J Winkler AS Wiysonge CS Wolfe CD Wondimkun YA Workicho A Wyper GMA Xavier D Xu G Yan LL Yano Y Yaseri M Yimer NB Yin P Yip P Yirsaw BD Yonemoto N Yonga G Yoon SJ Yotebieng M Younis MZ Yu C Zadnik V Zaidi Z Zaki MES Zaman SB Zamani M Zenebe ZM Zhou M Zhu J Zimsen SRM Zipkin B Zodpey S Zuhlke LJ Murray CJL Lozano R. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016 |
topic_facet |
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 Injuries 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 as well as subnational locations in seven countries from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016 we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns we risk-standardised cause-specific deaths due to non-cancers by location-year 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 we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100 with 0 as the first percentile (worst) observed between 1990 and 2016 and 100 as the 99th percentile (best) we set these thresholds at the country level and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values 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) a summary measure of overall development. As derived from the broader GBD study and other data sources we examined relationships between national HAQ Index scores and potential correlates of performance such as total health spending per capita. Findings In 2016 HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands to values as low as 18·6 (13·1–24·4) in the Central African Republic 19·0 (14·3–23·7) in Somalia and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China 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) while India saw a 30·8-point disparity 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) whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference) whereas in Brazil 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 with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016 most notably vaccine-preventable diseases. Overall national performance on the HAQ Index was positively associated with higher levels of total health spending per capita as well as health systems inputs but these relationships were quite heterogeneous 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 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 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 the pursuit of universal health coverage hinges upon improving both access and quality worldwide and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations. |
author2 |
Fullman, N Yearwood, J Abay, Sm Abbafati, C Abd-Allah, F Abdela, J Abdelalim, A Abebe, Z Abebo, Ta Aboyans, V Abraha, Hn Abreu, Dmx Abu-Raddad, Lj Adane, Aa Adedoyin, Ra Adetokunboh, O Adhikari, Tb Afarideh, M Afshin, A Agarwal, G Agius, D Agrawal, A Agrawal, S Ahmad Kiadaliri, A Aichour, Mte Akibu, M Akinyemi, Ro Akinyemiju, Tf Akseer, N Al Lami, Fh Alahdab, F Al-Aly, Z Alam, K Alam, T Alasfoor, D Albittar, Mi Alene, Ka Al-Eyadhy, A Ali, Sd Alijanzadeh, M Aljunid, Sm Alkerwi, A Alla, F Allebeck, P Allen, C Alomari, Ma Al-Raddadi, R Alsharif, U Altirkawi, Ka Alvis-Guzman, N |
format |
Article in Journal/Newspaper |
author |
Fullman N Yearwood J Abay SM Abbafati C Abd-Allah F Abdela J Abdelalim A Abebe Z Abebo TA Aboyans V Abraha HN Abreu DMX Abu-Raddad LJ Adane AA Adedoyin RA Adetokunboh O Adhikari TB Afarideh M Afshin A Agarwal G Agius D Agrawal A Agrawal S Ahmad Kiadaliri A Aichour MTE Akibu M Akinyemi RO Akinyemiju TF Akseer N Al Lami FH Alahdab F Al-Aly Z Alam K Alam T Alasfoor D Albittar MI Alene KA Al-Eyadhy A Ali SD Alijanzadeh M Aljunid SM Alkerwi A Alla F Allebeck P Allen C Alomari MA Al-Raddadi R Alsharif U Altirkawi KA Alvis-Guzman N Amare AT Amenu K Ammar W Amoako YA Anber N Andrei CL Androudi S Antonio CAT Araújo VEM Aremu O Ärnlöv J Artaman A Aryal KK Asayesh H Asfaw ET Asgedom SW Asghar RJ Ashebir MM Asseffa NA Atey TM Atre SR Atteraya MS Avila-Burgos L Avokpaho EFGA Awasthi A Ayala Quintanilla BP Ayalew AA Ayele HT Ayer R Ayuk TB Azzopardi P Azzopardi-Muscat N Babalola TK Badali H Badawi A Banach M Banerjee A Banstola A Barber RM Barboza MA Barker-Collo SL Bärnighausen T Barquera S Barrero LH Bassat Q Basu S Baune BT Bazargan-Hejazi S Bedi N Beghi E Behzadifar M Bekele BB Belachew AB Belay SA Belay YA Bell ML Bello AK Bennett DA Bennett JR Bensenor IM Berhe DF Bernabé E Bernstein RS Beuran M Bhalla A Bhatt P Bhaumik S Bhutta ZA Biadgo B Bijani A Bikbov B Birungi C Biryukov S Bizuneh H Bolliger IW Bolt K Bou-Orm IR Bozorgmehr K Brady OJ Brazinova A Breitborde NJK Brenner H Britton G Brugha TS Butt ZA Cahuana-Hurtado L Campos-Nonato IR Campuzano JC Car J Car M Cárdenas R Carrero JJ Carvalho F Castañeda-Orjuela CA Castillo Rivas J Catalá-López F Cercy K Chalek J Chang HY Chang JC Chattopadhyay A Chaturvedi P Chiang PP Chisumpa VH Choi JJ Christensen H Christopher DJ Chung SC Ciobanu LG Cirillo M Colombara D Conti S Cooper C Cornaby L Cortesi PA Cortinovis M Costa Pereira A Cousin E Criqui MH Cromwell EA Crowe CS Crump JA Daba AK Dachew BA Dadi AF Dandona L Dandona R Dargan PI Daryani A Daryani M Das J Das SK das Neves J Davis Weaver N Davletov K de Courten B De Leo D De Neve JW Dellavalle RP Demoz G Deribe K Des Jarlais DC Dey S Dharmaratne SD Dhimal M Djalalinia S Doku DT Dolan K Dorsey ER Dos Santos KPB Doyle KE Driscoll TR Dubey M Dubljanin E Duncan BB Echko M Edessa D Edvardsson D Ehrlich JR Eldrenkamp E El-Khatib ZZ Endres M Endries AY Eshrati B Eskandarieh S Esteghamati A Fakhar M Farag T Faramarzi M Faraon EJA Faro A Farzadfar F Fatusi A Fazeli MS Feigin VL Feigl AB Fentahun N Fereshtehnejad SM Fernandes E Fernandes JC Fijabi DO Filip I Fischer F Fitzmaurice C Flaxman AD Flor LS Foigt N Foreman KJ Frostad JJ Fürst T Futran ND Gakidou E Gallus S Gambashidze K Gamkrelidze A Ganji M Gebre AK Gebrehiwot TT Gebremedhin AT Gelaw YA Geleijnse JM Geremew D Gething PW Ghadimi R Ghasemi Falavarjani K Ghasemi-Kasman M Gill PS Giref AZ Giroud M Gishu MD Giussani G Godwin WW Goli S Gomez-Dantes H Gona PN Goodridge A Gopalani SV Goryakin Y Goulart AC Grada A Griswold M Grosso G Gugnani HC Guo Y Gupta R Gupta T Gupta V Haagsma JA Hachinski V Hafezi-Nejad N Hailu GB Hamadeh RR Hamidi S Hankey GJ Harb HL Harewood HC Harikrishnan S Haro JM Hassen HY Havmoeller R Hawley C Hay SI He J Hearps SJC Hegazy MI Heibati B Heidari M Hendrie D Henry NJ Herrera Ballesteros VH Herteliu C Hibstu DT Hiluf MK Hoek HW Homaie Rad E Horita N Hosgood HD Hosseini M Hosseini SR Hostiuc M Hostiuc S Hoy DG Hsairi M Htet AS Hu G Huang JJ Iburg KM Idris F Igumbor EU Ikeda C Ileanu BV Ilesanmi OS Innos K Irvani SSN Irvine CMS Islami F Jacobs TA Jacobsen KH Jahanmehr N Jain R Jain SK Jakovljevic MB Jalu MT Jamal AA Javanbakht M Jayatilleke AU Jeemon P Jha RP Jha V Jóúwiak J John O Johnson SC Jonas JB Joshua V Jürisson M Kabir Z Kadel R Kahsay A Kalani R Kar C Karanikolos M Karch A Karema CK Karimi SM Kasaeian A Kassa DH Kassa GM Kassa TD Kassebaum NJ Katikireddi SV Kaul A Kawakami N Kazanjan K Kebede S Keiyoro PN Kemp GR Kengne AP Kereselidze M Ketema EB Khader YS Khafaie MA Khajavi A Khalil IA Khan EA Khan G Khan MN Khan MA Khanal MN Khang YH Khater MM Khoja ATA Khosravi A Khubchandani J Kibret GD Kiirithio DN Kim D Kim YJ Kimokoti RW Kinfu Y Kinra S Kisa A Kissoon N Kochhar S Kokubo Y Kopec JA Kosen S Koul PA Koyanagi A Kravchenko M Krishan K Krohn KJ Kuate Defo B Kumar GA Kumar P Kutz M Kuzin I Kyu HH Lad DP Lafranconi A Lal DK Lalloo R Lam H Lan Q Lang JJ Lansingh VC Lansky S Larsson A Latifi A Lazarus JV Leasher JL Lee PH Legesse Y Leigh J Leshargie CT Leta S Leung J Leung R Levi M Li Y Liang J Liben ML Lim LL Lim SS Lind M Linn S Listl S Liu P Liu S Lodha R Lopez AD Lorch SA Lorkowski S Lotufo PA Lucas TCD Lunevicius R Lurton G Lyons RA Maalouf F Macarayan ERK Mackay MT Maddison ER Madotto F Magdy Abd El Razek H Magdy Abd El Razek M Majdan M Majdzadeh R Majeed A Malekzadeh R Malhotra R Malta DC Mamun AA Manhertz T Manguerra H Mansournia MA Mantovani LG Manyazewal T Mapoma CC Margono C Martinez-Raga J Martins SCO Martins-Melo FR Martopullo I März W Massenburg BB Mathur MR Maulik PK Mazidi M McAlinden C McGrath JJ McKee M Mehata S Mehrotra R Mehta KM Mehta V Meier T Mejia-Rodriguez F Meles KG Melku M Memiah P Memish ZA Mendoza W Mengiste DA Mengistu DT Menota BG Mensah GA Meretoja A Meretoja TJ Mezgebe HB Miazgowski T Micha R Milam R Millear A Miller TR Mini GK Minnig S Mirica A Mirrakhimov EM Misganaw A Mitchell PB Mlashu FW Moazen B Mohammad KA Mohammadibakhsh R Mohammed E Mohammed MA Mohammed S Mokdad AH Mola GL Molokhia M Momeniha F Monasta L Montañez Hernandez JC Moosazadeh M Moradi-Lakeh M Moraga P Morawska L Moreno Velasquez I Mori R Morrison SD Moses M Mousavi SM Mueller UO Murhekar M Murthy GVS Murthy S Musa J Musa KI Mustafa G Muthupandian S Nagata C Nagel G Naghavi M Naheed A Naik GA Naik N Najafi F Naldi L Nangia V Nansseu JRN Narayan KV Nascimento BR Negoi I Negoi RI Newton CR Ngunjiri JW Nguyen G Nguyen L Nguyen TH Nichols E Ningrum DNA Nolte E Nong VM Norheim OF Norrving B Noubiap JJN Nyandwi A Obermeyer CM Ofori-Asenso R Ogbo FA Oh IH Oladimeji O Olagunju AT Olagunju TO Olivares PR Oliveira PPV Olsen HE Olusanya BO Olusanya JO Ong K Opio JN Oren E Ortega-Altamirano DV Ortiz A Ozdemir R Pa M Pain AW Palone MRT Pana A Panda-Jonas S Pandian JD Park EK Parsian H Patel T Pati S Patil ST Patle A Patton GC Paturi VR Paudel D Pedroso MM Pedroza SP Pereira DM Perico N Peterson H Petzold M Peykari N Phillips MR Piel FB Pigott DM Pillay JD Piradov MA Polinder S Pond CD Postma MJ Pourmalek F Prakash S Prakash V Prasad N Prasad NM Purcell C Qorbani M Quintana HK Radfar A Rafay A Rafiei A Rahimi K Rahimi-Movaghar A Rahimi-Movaghar V Rahman M Rahman MA Rahman SU Rai RK Raju SB Ram U Rana SM Rankin Z Rasella D Rawaf DL Rawaf S Ray SE Razo-García CA Reddy P Reiner RC Reis C Reitsma MB Remuzzi G Renzaho AMN Resnikoff S Rezaei S Rezai MS Ribeiro AL Rios Blancas MJ Rivera JA Roever L Ronfani L Roshandel G Rostami A Roth GA Rothenbacher D Roy A Roy N Ruhago GM Sabde YD Sachdev PS Sadat N Safdarian M Safiri S Sagar R Sahebkar A Sahraian MA Sajadi HS Salama J Salamati P Saldanha RF Salimzadeh H Salomon JA Samy AM Sanabria JR Sancheti PK Sanchez-Niño MD Santomauro D Santos IS Santric Milicevic MM Sarker AR Sarrafzadegan N Sartorius B Satpathy M Savic M Sawhney M Saxena S Saylan MI Schaeffner E Schmidhuber J Schmidt MI Schneider IJC Schumacher AE Schutte AE Schwebel DC Schwendicke F Sekerija M Sepanlou SG Servan-Mori EE Shafieesabet A Shaikh MA Shakh-Nazarova M Shams-Beyranvand M Sharafi H Sharif-Alhoseini M Shariful Islam SM Sharma M Sharma R She J Sheikh A Shfare MT Shi P Shields C Shigematsu M Shinohara Y Shiri R Shirkoohi R Shiue I Shrime MG Shukla SR Siabani S Sigfusdottir ID Silberberg DH Silva DAS Silva JP Silveira DGA Singh JA Singh L Singh NP Singh V Sinha DN Sinke AH Sisay M Skirbekk V Sliwa K Smith A Soares Filho AM Sobaih BHA Somai M Soneji S Soofi M Sorensen RJD Soriano JB Soyiri IN Sposato LA Sreeramareddy CT Srinivasan V Stanaway JD Stathopoulou V Steel N Stein DJ Stokes MA Sturua L Sufiyan MB Suliankatchi RA Sunguya BF Sur PJ Sykes BL Sylaja PN Tabarés-Seisdedos R Tadakamadla SK Tadesse AH Taffere GR Tandon N Tariku AT Taveira N Tehrani-Banihashemi A Temam Shifa G Temsah MH Terkawi AS Tesema AG Tesfaye DJ Tessema B Thakur JS Thomas N Thompson MJ Tillmann T To QG Tobe-Gai R Tonelli M Topor-Madry R Topouzis F Torre A Tortajada M Tran BX Tran KB Tripathi A Tripathy SP Troeger C Truelsen T Tsoi D Tudor Car L Tuem KB Tyrovolas S Uchendu US Ukwaja KN Ullah I Updike R Uthman OA Uzochukwu BSC Valdez PR van Boven JFM Varughese S Vasankari T Violante FS Vladimirov SK Vlassov VV Vollset SE Vos T Wagnew F Waheed Y Wallin MT Walson JL Wang Y Wang YP Wassie MM Weaver MR Weiderpass E Weintraub RG Weiss J Weldegwergs KG Werdecker A West TE Westerman R White RG Whiteford HA Widecka J Winkler AS Wiysonge CS Wolfe CD Wondimkun YA Workicho A Wyper GMA Xavier D Xu G Yan LL Yano Y Yaseri M Yimer NB Yin P Yip P Yirsaw BD Yonemoto N Yonga G Yoon SJ Yotebieng M Younis MZ Yu C Zadnik V Zaidi Z Zaki MES Zaman SB Zamani M Zenebe ZM Zhou M Zhu J Zimsen SRM Zipkin B Zodpey S Zuhlke LJ Murray CJL Lozano R. |
author_facet |
Fullman N Yearwood J Abay SM Abbafati C Abd-Allah F Abdela J Abdelalim A Abebe Z Abebo TA Aboyans V Abraha HN Abreu DMX Abu-Raddad LJ Adane AA Adedoyin RA Adetokunboh O Adhikari TB Afarideh M Afshin A Agarwal G Agius D Agrawal A Agrawal S Ahmad Kiadaliri A Aichour MTE Akibu M Akinyemi RO Akinyemiju TF Akseer N Al Lami FH Alahdab F Al-Aly Z Alam K Alam T Alasfoor D Albittar MI Alene KA Al-Eyadhy A Ali SD Alijanzadeh M Aljunid SM Alkerwi A Alla F Allebeck P Allen C Alomari MA Al-Raddadi R Alsharif U Altirkawi KA Alvis-Guzman N Amare AT Amenu K Ammar W Amoako YA Anber N Andrei CL Androudi S Antonio CAT Araújo VEM Aremu O Ärnlöv J Artaman A Aryal KK Asayesh H Asfaw ET Asgedom SW Asghar RJ Ashebir MM Asseffa NA Atey TM Atre SR Atteraya MS Avila-Burgos L Avokpaho EFGA Awasthi A Ayala Quintanilla BP Ayalew AA Ayele HT Ayer R Ayuk TB Azzopardi P Azzopardi-Muscat N Babalola TK Badali H Badawi A Banach M Banerjee A Banstola A Barber RM Barboza MA Barker-Collo SL Bärnighausen T Barquera S Barrero LH Bassat Q Basu S Baune BT Bazargan-Hejazi S Bedi N Beghi E Behzadifar M Bekele BB Belachew AB Belay SA Belay YA Bell ML Bello AK Bennett DA Bennett JR Bensenor IM Berhe DF Bernabé E Bernstein RS Beuran M Bhalla A Bhatt P Bhaumik S Bhutta ZA Biadgo B Bijani A Bikbov B Birungi C Biryukov S Bizuneh H Bolliger IW Bolt K Bou-Orm IR Bozorgmehr K Brady OJ Brazinova A Breitborde NJK Brenner H Britton G Brugha TS Butt ZA Cahuana-Hurtado L Campos-Nonato IR Campuzano JC Car J Car M Cárdenas R Carrero JJ Carvalho F Castañeda-Orjuela CA Castillo Rivas J Catalá-López F Cercy K Chalek J Chang HY Chang JC Chattopadhyay A Chaturvedi P Chiang PP Chisumpa VH Choi JJ Christensen H Christopher DJ Chung SC Ciobanu LG Cirillo M Colombara D Conti S Cooper C Cornaby L Cortesi PA Cortinovis M Costa Pereira A Cousin E Criqui MH Cromwell EA Crowe CS Crump JA Daba AK Dachew BA Dadi AF Dandona L Dandona R Dargan PI Daryani A Daryani M Das J Das SK das Neves J Davis Weaver N Davletov K de Courten B De Leo D De Neve JW Dellavalle RP Demoz G Deribe K Des Jarlais DC Dey S Dharmaratne SD Dhimal M Djalalinia S Doku DT Dolan K Dorsey ER Dos Santos KPB Doyle KE Driscoll TR Dubey M Dubljanin E Duncan BB Echko M Edessa D Edvardsson D Ehrlich JR Eldrenkamp E El-Khatib ZZ Endres M Endries AY Eshrati B Eskandarieh S Esteghamati A Fakhar M Farag T Faramarzi M Faraon EJA Faro A Farzadfar F Fatusi A Fazeli MS Feigin VL Feigl AB Fentahun N Fereshtehnejad SM Fernandes E Fernandes JC Fijabi DO Filip I Fischer F Fitzmaurice C Flaxman AD Flor LS Foigt N Foreman KJ Frostad JJ Fürst T Futran ND Gakidou E Gallus S Gambashidze K Gamkrelidze A Ganji M Gebre AK Gebrehiwot TT Gebremedhin AT Gelaw YA Geleijnse JM Geremew D Gething PW Ghadimi R Ghasemi Falavarjani K Ghasemi-Kasman M Gill PS Giref AZ Giroud M Gishu MD Giussani G Godwin WW Goli S Gomez-Dantes H Gona PN Goodridge A Gopalani SV Goryakin Y Goulart AC Grada A Griswold M Grosso G Gugnani HC Guo Y Gupta R Gupta T Gupta V Haagsma JA Hachinski V Hafezi-Nejad N Hailu GB Hamadeh RR Hamidi S Hankey GJ Harb HL Harewood HC Harikrishnan S Haro JM Hassen HY Havmoeller R Hawley C Hay SI He J Hearps SJC Hegazy MI Heibati B Heidari M Hendrie D Henry NJ Herrera Ballesteros VH Herteliu C Hibstu DT Hiluf MK Hoek HW Homaie Rad E Horita N Hosgood HD Hosseini M Hosseini SR Hostiuc M Hostiuc S Hoy DG Hsairi M Htet AS Hu G Huang JJ Iburg KM Idris F Igumbor EU Ikeda C Ileanu BV Ilesanmi OS Innos K Irvani SSN Irvine CMS Islami F Jacobs TA Jacobsen KH Jahanmehr N Jain R Jain SK Jakovljevic MB Jalu MT Jamal AA Javanbakht M Jayatilleke AU Jeemon P Jha RP Jha V Jóúwiak J John O Johnson SC Jonas JB Joshua V Jürisson M Kabir Z Kadel R Kahsay A Kalani R Kar C Karanikolos M Karch A Karema CK Karimi SM Kasaeian A Kassa DH Kassa GM Kassa TD Kassebaum NJ Katikireddi SV Kaul A Kawakami N Kazanjan K Kebede S Keiyoro PN Kemp GR Kengne AP Kereselidze M Ketema EB Khader YS Khafaie MA Khajavi A Khalil IA Khan EA Khan G Khan MN Khan MA Khanal MN Khang YH Khater MM Khoja ATA Khosravi A Khubchandani J Kibret GD Kiirithio DN Kim D Kim YJ Kimokoti RW Kinfu Y Kinra S Kisa A Kissoon N Kochhar S Kokubo Y Kopec JA Kosen S Koul PA Koyanagi A Kravchenko M Krishan K Krohn KJ Kuate Defo B Kumar GA Kumar P Kutz M Kuzin I Kyu HH Lad DP Lafranconi A Lal DK Lalloo R Lam H Lan Q Lang JJ Lansingh VC Lansky S Larsson A Latifi A Lazarus JV Leasher JL Lee PH Legesse Y Leigh J Leshargie CT Leta S Leung J Leung R Levi M Li Y Liang J Liben ML Lim LL Lim SS Lind M Linn S Listl S Liu P Liu S Lodha R Lopez AD Lorch SA Lorkowski S Lotufo PA Lucas TCD Lunevicius R Lurton G Lyons RA Maalouf F Macarayan ERK Mackay MT Maddison ER Madotto F Magdy Abd El Razek H Magdy Abd El Razek M Majdan M Majdzadeh R Majeed A Malekzadeh R Malhotra R Malta DC Mamun AA Manhertz T Manguerra H Mansournia MA Mantovani LG Manyazewal T Mapoma CC Margono C Martinez-Raga J Martins SCO Martins-Melo FR Martopullo I März W Massenburg BB Mathur MR Maulik PK Mazidi M McAlinden C McGrath JJ McKee M Mehata S Mehrotra R Mehta KM Mehta V Meier T Mejia-Rodriguez F Meles KG Melku M Memiah P Memish ZA Mendoza W Mengiste DA Mengistu DT Menota BG Mensah GA Meretoja A Meretoja TJ Mezgebe HB Miazgowski T Micha R Milam R Millear A Miller TR Mini GK Minnig S Mirica A Mirrakhimov EM Misganaw A Mitchell PB Mlashu FW Moazen B Mohammad KA Mohammadibakhsh R Mohammed E Mohammed MA Mohammed S Mokdad AH Mola GL Molokhia M Momeniha F Monasta L Montañez Hernandez JC Moosazadeh M Moradi-Lakeh M Moraga P Morawska L Moreno Velasquez I Mori R Morrison SD Moses M Mousavi SM Mueller UO Murhekar M Murthy GVS Murthy S Musa J Musa KI Mustafa G Muthupandian S Nagata C Nagel G Naghavi M Naheed A Naik GA Naik N Najafi F Naldi L Nangia V Nansseu JRN Narayan KV Nascimento BR Negoi I Negoi RI Newton CR Ngunjiri JW Nguyen G Nguyen L Nguyen TH Nichols E Ningrum DNA Nolte E Nong VM Norheim OF Norrving B Noubiap JJN Nyandwi A Obermeyer CM Ofori-Asenso R Ogbo FA Oh IH Oladimeji O Olagunju AT Olagunju TO Olivares PR Oliveira PPV Olsen HE Olusanya BO Olusanya JO Ong K Opio JN Oren E Ortega-Altamirano DV Ortiz A Ozdemir R Pa M Pain AW Palone MRT Pana A Panda-Jonas S Pandian JD Park EK Parsian H Patel T Pati S Patil ST Patle A Patton GC Paturi VR Paudel D Pedroso MM Pedroza SP Pereira DM Perico N Peterson H Petzold M Peykari N Phillips MR Piel FB Pigott DM Pillay JD Piradov MA Polinder S Pond CD Postma MJ Pourmalek F Prakash S Prakash V Prasad N Prasad NM Purcell C Qorbani M Quintana HK Radfar A Rafay A Rafiei A Rahimi K Rahimi-Movaghar A Rahimi-Movaghar V Rahman M Rahman MA Rahman SU Rai RK Raju SB Ram U Rana SM Rankin Z Rasella D Rawaf DL Rawaf S Ray SE Razo-García CA Reddy P Reiner RC Reis C Reitsma MB Remuzzi G Renzaho AMN Resnikoff S Rezaei S Rezai MS Ribeiro AL Rios Blancas MJ Rivera JA Roever L Ronfani L Roshandel G Rostami A Roth GA Rothenbacher D Roy A Roy N Ruhago GM Sabde YD Sachdev PS Sadat N Safdarian M Safiri S Sagar R Sahebkar A Sahraian MA Sajadi HS Salama J Salamati P Saldanha RF Salimzadeh H Salomon JA Samy AM Sanabria JR Sancheti PK Sanchez-Niño MD Santomauro D Santos IS Santric Milicevic MM Sarker AR Sarrafzadegan N Sartorius B Satpathy M Savic M Sawhney M Saxena S Saylan MI Schaeffner E Schmidhuber J Schmidt MI Schneider IJC Schumacher AE Schutte AE Schwebel DC Schwendicke F Sekerija M Sepanlou SG Servan-Mori EE Shafieesabet A Shaikh MA Shakh-Nazarova M Shams-Beyranvand M Sharafi H Sharif-Alhoseini M Shariful Islam SM Sharma M Sharma R She J Sheikh A Shfare MT Shi P Shields C Shigematsu M Shinohara Y Shiri R Shirkoohi R Shiue I Shrime MG Shukla SR Siabani S Sigfusdottir ID Silberberg DH Silva DAS Silva JP Silveira DGA Singh JA Singh L Singh NP Singh V Sinha DN Sinke AH Sisay M Skirbekk V Sliwa K Smith A Soares Filho AM Sobaih BHA Somai M Soneji S Soofi M Sorensen RJD Soriano JB Soyiri IN Sposato LA Sreeramareddy CT Srinivasan V Stanaway JD Stathopoulou V Steel N Stein DJ Stokes MA Sturua L Sufiyan MB Suliankatchi RA Sunguya BF Sur PJ Sykes BL Sylaja PN Tabarés-Seisdedos R Tadakamadla SK Tadesse AH Taffere GR Tandon N Tariku AT Taveira N Tehrani-Banihashemi A Temam Shifa G Temsah MH Terkawi AS Tesema AG Tesfaye DJ Tessema B Thakur JS Thomas N Thompson MJ Tillmann T To QG Tobe-Gai R Tonelli M Topor-Madry R Topouzis F Torre A Tortajada M Tran BX Tran KB Tripathi A Tripathy SP Troeger C Truelsen T Tsoi D Tudor Car L Tuem KB Tyrovolas S Uchendu US Ukwaja KN Ullah I Updike R Uthman OA Uzochukwu BSC Valdez PR van Boven JFM Varughese S Vasankari T Violante FS Vladimirov SK Vlassov VV Vollset SE Vos T Wagnew F Waheed Y Wallin MT Walson JL Wang Y Wang YP Wassie MM Weaver MR Weiderpass E Weintraub RG Weiss J Weldegwergs KG Werdecker A West TE Westerman R White RG Whiteford HA Widecka J Winkler AS Wiysonge CS Wolfe CD Wondimkun YA Workicho A Wyper GMA Xavier D Xu G Yan LL Yano Y Yaseri M Yimer NB Yin P Yip P Yirsaw BD Yonemoto N Yonga G Yoon SJ Yotebieng M Younis MZ Yu C Zadnik V Zaidi Z Zaki MES Zaman SB Zamani M Zenebe ZM Zhou M Zhu J Zimsen SRM Zipkin B Zodpey S Zuhlke LJ Murray CJL Lozano R. |
author_sort |
Fullman N |
title |
Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016 |
title_short |
Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016 |
title_full |
Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016 |
title_fullStr |
Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016 |
title_full_unstemmed |
Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016 |
title_sort |
measuring performance on the healthcare access and quality index for 195 countries and territories and selected subnational locations: a systematic analysis from the global burden of disease study 2016 |
publishDate |
2018 |
url |
http://hdl.handle.net/11588/729713 https://doi.org/10.1016/S0140-6736(18)30994-2 https://www.ncbi.nlm.nih.gov/pubmed/?term=GBD%202016%20Healthcare%20Access%20and%20Quality%20Collaborators%5BCorporate%20Author%5D |
geographic |
Norway |
geographic_facet |
Norway |
genre |
Iceland |
genre_facet |
Iceland |
op_relation |
info:eu-repo/semantics/altIdentifier/wos/WOS:000433904700029 volume:391 issue:10136 firstpage:2236 lastpage:2271 numberofpages:36 journal:THE LANCET http://hdl.handle.net/11588/729713 doi:10.1016/S0140-6736(18)30994-2 info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-85047728707 https://www.ncbi.nlm.nih.gov/pubmed/?term=GBD%202016%20Healthcare%20Access%20and%20Quality%20Collaborators%5BCorporate%20Author%5D |
op_rights |
info:eu-repo/semantics/closedAccess |
op_doi |
https://doi.org/10.1016/S0140-6736(18)30994-2 |
container_title |
The Lancet |
container_volume |
391 |
container_issue |
10136 |
container_start_page |
2236 |
op_container_end_page |
2271 |
_version_ |
1809917421580976128 |
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ftunivnapoliiris:oai:www.iris.unina.it:11588/729713 2024-09-09T19:48:01+00:00 Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016 Fullman N Yearwood J Abay SM Abbafati C Abd-Allah F Abdela J Abdelalim A Abebe Z Abebo TA Aboyans V Abraha HN Abreu DMX Abu-Raddad LJ Adane AA Adedoyin RA Adetokunboh O Adhikari TB Afarideh M Afshin A Agarwal G Agius D Agrawal A Agrawal S Ahmad Kiadaliri A Aichour MTE Akibu M Akinyemi RO Akinyemiju TF Akseer N Al Lami FH Alahdab F Al-Aly Z Alam K Alam T Alasfoor D Albittar MI Alene KA Al-Eyadhy A Ali SD Alijanzadeh M Aljunid SM Alkerwi A Alla F Allebeck P Allen C Alomari MA Al-Raddadi R Alsharif U Altirkawi KA Alvis-Guzman N Amare AT Amenu K Ammar W Amoako YA Anber N Andrei CL Androudi S Antonio CAT Araújo VEM Aremu O Ärnlöv J Artaman A Aryal KK Asayesh H Asfaw ET Asgedom SW Asghar RJ Ashebir MM Asseffa NA Atey TM Atre SR Atteraya MS Avila-Burgos L Avokpaho EFGA Awasthi A Ayala Quintanilla BP Ayalew AA Ayele HT Ayer R Ayuk TB Azzopardi P Azzopardi-Muscat N Babalola TK Badali H Badawi A Banach M Banerjee A Banstola A Barber RM Barboza MA Barker-Collo SL Bärnighausen T Barquera S Barrero LH Bassat Q Basu S Baune BT Bazargan-Hejazi S Bedi N Beghi E Behzadifar M Bekele BB Belachew AB Belay SA Belay YA Bell ML Bello AK Bennett DA Bennett JR Bensenor IM Berhe DF Bernabé E Bernstein RS Beuran M Bhalla A Bhatt P Bhaumik S Bhutta ZA Biadgo B Bijani A Bikbov B Birungi C Biryukov S Bizuneh H Bolliger IW Bolt K Bou-Orm IR Bozorgmehr K Brady OJ Brazinova A Breitborde NJK Brenner H Britton G Brugha TS Butt ZA Cahuana-Hurtado L Campos-Nonato IR Campuzano JC Car J Car M Cárdenas R Carrero JJ Carvalho F Castañeda-Orjuela CA Castillo Rivas J Catalá-López F Cercy K Chalek J Chang HY Chang JC Chattopadhyay A Chaturvedi P Chiang PP Chisumpa VH Choi JJ Christensen H Christopher DJ Chung SC Ciobanu LG Cirillo M Colombara D Conti S Cooper C Cornaby L Cortesi PA Cortinovis M Costa Pereira A Cousin E Criqui MH Cromwell EA Crowe CS Crump JA Daba AK Dachew BA Dadi AF Dandona L Dandona R Dargan PI Daryani A Daryani M Das J Das SK das Neves J Davis Weaver N Davletov K de Courten B De Leo D De Neve JW Dellavalle RP Demoz G Deribe K Des Jarlais DC Dey S Dharmaratne SD Dhimal M Djalalinia S Doku DT Dolan K Dorsey ER Dos Santos KPB Doyle KE Driscoll TR Dubey M Dubljanin E Duncan BB Echko M Edessa D Edvardsson D Ehrlich JR Eldrenkamp E El-Khatib ZZ Endres M Endries AY Eshrati B Eskandarieh S Esteghamati A Fakhar M Farag T Faramarzi M Faraon EJA Faro A Farzadfar F Fatusi A Fazeli MS Feigin VL Feigl AB Fentahun N Fereshtehnejad SM Fernandes E Fernandes JC Fijabi DO Filip I Fischer F Fitzmaurice C Flaxman AD Flor LS Foigt N Foreman KJ Frostad JJ Fürst T Futran ND Gakidou E Gallus S Gambashidze K Gamkrelidze A Ganji M Gebre AK Gebrehiwot TT Gebremedhin AT Gelaw YA Geleijnse JM Geremew D Gething PW Ghadimi R Ghasemi Falavarjani K Ghasemi-Kasman M Gill PS Giref AZ Giroud M Gishu MD Giussani G Godwin WW Goli S Gomez-Dantes H Gona PN Goodridge A Gopalani SV Goryakin Y Goulart AC Grada A Griswold M Grosso G Gugnani HC Guo Y Gupta R Gupta T Gupta V Haagsma JA Hachinski V Hafezi-Nejad N Hailu GB Hamadeh RR Hamidi S Hankey GJ Harb HL Harewood HC Harikrishnan S Haro JM Hassen HY Havmoeller R Hawley C Hay SI He J Hearps SJC Hegazy MI Heibati B Heidari M Hendrie D Henry NJ Herrera Ballesteros VH Herteliu C Hibstu DT Hiluf MK Hoek HW Homaie Rad E Horita N Hosgood HD Hosseini M Hosseini SR Hostiuc M Hostiuc S Hoy DG Hsairi M Htet AS Hu G Huang JJ Iburg KM Idris F Igumbor EU Ikeda C Ileanu BV Ilesanmi OS Innos K Irvani SSN Irvine CMS Islami F Jacobs TA Jacobsen KH Jahanmehr N Jain R Jain SK Jakovljevic MB Jalu MT Jamal AA Javanbakht M Jayatilleke AU Jeemon P Jha RP Jha V Jóúwiak J John O Johnson SC Jonas JB Joshua V Jürisson M Kabir Z Kadel R Kahsay A Kalani R Kar C Karanikolos M Karch A Karema CK Karimi SM Kasaeian A Kassa DH Kassa GM Kassa TD Kassebaum NJ Katikireddi SV Kaul A Kawakami N Kazanjan K Kebede S Keiyoro PN Kemp GR Kengne AP Kereselidze M Ketema EB Khader YS Khafaie MA Khajavi A Khalil IA Khan EA Khan G Khan MN Khan MA Khanal MN Khang YH Khater MM Khoja ATA Khosravi A Khubchandani J Kibret GD Kiirithio DN Kim D Kim YJ Kimokoti RW Kinfu Y Kinra S Kisa A Kissoon N Kochhar S Kokubo Y Kopec JA Kosen S Koul PA Koyanagi A Kravchenko M Krishan K Krohn KJ Kuate Defo B Kumar GA Kumar P Kutz M Kuzin I Kyu HH Lad DP Lafranconi A Lal DK Lalloo R Lam H Lan Q Lang JJ Lansingh VC Lansky S Larsson A Latifi A Lazarus JV Leasher JL Lee PH Legesse Y Leigh J Leshargie CT Leta S Leung J Leung R Levi M Li Y Liang J Liben ML Lim LL Lim SS Lind M Linn S Listl S Liu P Liu S Lodha R Lopez AD Lorch SA Lorkowski S Lotufo PA Lucas TCD Lunevicius R Lurton G Lyons RA Maalouf F Macarayan ERK Mackay MT Maddison ER Madotto F Magdy Abd El Razek H Magdy Abd El Razek M Majdan M Majdzadeh R Majeed A Malekzadeh R Malhotra R Malta DC Mamun AA Manhertz T Manguerra H Mansournia MA Mantovani LG Manyazewal T Mapoma CC Margono C Martinez-Raga J Martins SCO Martins-Melo FR Martopullo I März W Massenburg BB Mathur MR Maulik PK Mazidi M McAlinden C McGrath JJ McKee M Mehata S Mehrotra R Mehta KM Mehta V Meier T Mejia-Rodriguez F Meles KG Melku M Memiah P Memish ZA Mendoza W Mengiste DA Mengistu DT Menota BG Mensah GA Meretoja A Meretoja TJ Mezgebe HB Miazgowski T Micha R Milam R Millear A Miller TR Mini GK Minnig S Mirica A Mirrakhimov EM Misganaw A Mitchell PB Mlashu FW Moazen B Mohammad KA Mohammadibakhsh R Mohammed E Mohammed MA Mohammed S Mokdad AH Mola GL Molokhia M Momeniha F Monasta L Montañez Hernandez JC Moosazadeh M Moradi-Lakeh M Moraga P Morawska L Moreno Velasquez I Mori R Morrison SD Moses M Mousavi SM Mueller UO Murhekar M Murthy GVS Murthy S Musa J Musa KI Mustafa G Muthupandian S Nagata C Nagel G Naghavi M Naheed A Naik GA Naik N Najafi F Naldi L Nangia V Nansseu JRN Narayan KV Nascimento BR Negoi I Negoi RI Newton CR Ngunjiri JW Nguyen G Nguyen L Nguyen TH Nichols E Ningrum DNA Nolte E Nong VM Norheim OF Norrving B Noubiap JJN Nyandwi A Obermeyer CM Ofori-Asenso R Ogbo FA Oh IH Oladimeji O Olagunju AT Olagunju TO Olivares PR Oliveira PPV Olsen HE Olusanya BO Olusanya JO Ong K Opio JN Oren E Ortega-Altamirano DV Ortiz A Ozdemir R Pa M Pain AW Palone MRT Pana A Panda-Jonas S Pandian JD Park EK Parsian H Patel T Pati S Patil ST Patle A Patton GC Paturi VR Paudel D Pedroso MM Pedroza SP Pereira DM Perico N Peterson H Petzold M Peykari N Phillips MR Piel FB Pigott DM Pillay JD Piradov MA Polinder S Pond CD Postma MJ Pourmalek F Prakash S Prakash V Prasad N Prasad NM Purcell C Qorbani M Quintana HK Radfar A Rafay A Rafiei A Rahimi K Rahimi-Movaghar A Rahimi-Movaghar V Rahman M Rahman MA Rahman SU Rai RK Raju SB Ram U Rana SM Rankin Z Rasella D Rawaf DL Rawaf S Ray SE Razo-García CA Reddy P Reiner RC Reis C Reitsma MB Remuzzi G Renzaho AMN Resnikoff S Rezaei S Rezai MS Ribeiro AL Rios Blancas MJ Rivera JA Roever L Ronfani L Roshandel G Rostami A Roth GA Rothenbacher D Roy A Roy N Ruhago GM Sabde YD Sachdev PS Sadat N Safdarian M Safiri S Sagar R Sahebkar A Sahraian MA Sajadi HS Salama J Salamati P Saldanha RF Salimzadeh H Salomon JA Samy AM Sanabria JR Sancheti PK Sanchez-Niño MD Santomauro D Santos IS Santric Milicevic MM Sarker AR Sarrafzadegan N Sartorius B Satpathy M Savic M Sawhney M Saxena S Saylan MI Schaeffner E Schmidhuber J Schmidt MI Schneider IJC Schumacher AE Schutte AE Schwebel DC Schwendicke F Sekerija M Sepanlou SG Servan-Mori EE Shafieesabet A Shaikh MA Shakh-Nazarova M Shams-Beyranvand M Sharafi H Sharif-Alhoseini M Shariful Islam SM Sharma M Sharma R She J Sheikh A Shfare MT Shi P Shields C Shigematsu M Shinohara Y Shiri R Shirkoohi R Shiue I Shrime MG Shukla SR Siabani S Sigfusdottir ID Silberberg DH Silva DAS Silva JP Silveira DGA Singh JA Singh L Singh NP Singh V Sinha DN Sinke AH Sisay M Skirbekk V Sliwa K Smith A Soares Filho AM Sobaih BHA Somai M Soneji S Soofi M Sorensen RJD Soriano JB Soyiri IN Sposato LA Sreeramareddy CT Srinivasan V Stanaway JD Stathopoulou V Steel N Stein DJ Stokes MA Sturua L Sufiyan MB Suliankatchi RA Sunguya BF Sur PJ Sykes BL Sylaja PN Tabarés-Seisdedos R Tadakamadla SK Tadesse AH Taffere GR Tandon N Tariku AT Taveira N Tehrani-Banihashemi A Temam Shifa G Temsah MH Terkawi AS Tesema AG Tesfaye DJ Tessema B Thakur JS Thomas N Thompson MJ Tillmann T To QG Tobe-Gai R Tonelli M Topor-Madry R Topouzis F Torre A Tortajada M Tran BX Tran KB Tripathi A Tripathy SP Troeger C Truelsen T Tsoi D Tudor Car L Tuem KB Tyrovolas S Uchendu US Ukwaja KN Ullah I Updike R Uthman OA Uzochukwu BSC Valdez PR van Boven JFM Varughese S Vasankari T Violante FS Vladimirov SK Vlassov VV Vollset SE Vos T Wagnew F Waheed Y Wallin MT Walson JL Wang Y Wang YP Wassie MM Weaver MR Weiderpass E Weintraub RG Weiss J Weldegwergs KG Werdecker A West TE Westerman R White RG Whiteford HA Widecka J Winkler AS Wiysonge CS Wolfe CD Wondimkun YA Workicho A Wyper GMA Xavier D Xu G Yan LL Yano Y Yaseri M Yimer NB Yin P Yip P Yirsaw BD Yonemoto N Yonga G Yoon SJ Yotebieng M Younis MZ Yu C Zadnik V Zaidi Z Zaki MES Zaman SB Zamani M Zenebe ZM Zhou M Zhu J Zimsen SRM Zipkin B Zodpey S Zuhlke LJ Murray CJL Lozano R. Fullman, N Yearwood, J Abay, Sm Abbafati, C Abd-Allah, F Abdela, J Abdelalim, A Abebe, Z Abebo, Ta Aboyans, V Abraha, Hn Abreu, Dmx Abu-Raddad, Lj Adane, Aa Adedoyin, Ra Adetokunboh, O Adhikari, Tb Afarideh, M Afshin, A Agarwal, G Agius, D Agrawal, A Agrawal, S Ahmad Kiadaliri, A Aichour, Mte Akibu, M Akinyemi, Ro Akinyemiju, Tf Akseer, N Al Lami, Fh Alahdab, F Al-Aly, Z Alam, K Alam, T Alasfoor, D Albittar, Mi Alene, Ka Al-Eyadhy, A Ali, Sd Alijanzadeh, M Aljunid, Sm Alkerwi, A Alla, F Allebeck, P Allen, C Alomari, Ma Al-Raddadi, R Alsharif, U Altirkawi, Ka Alvis-Guzman, N 2018 http://hdl.handle.net/11588/729713 https://doi.org/10.1016/S0140-6736(18)30994-2 https://www.ncbi.nlm.nih.gov/pubmed/?term=GBD%202016%20Healthcare%20Access%20and%20Quality%20Collaborators%5BCorporate%20Author%5D eng eng info:eu-repo/semantics/altIdentifier/wos/WOS:000433904700029 volume:391 issue:10136 firstpage:2236 lastpage:2271 numberofpages:36 journal:THE LANCET http://hdl.handle.net/11588/729713 doi:10.1016/S0140-6736(18)30994-2 info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-85047728707 https://www.ncbi.nlm.nih.gov/pubmed/?term=GBD%202016%20Healthcare%20Access%20and%20Quality%20Collaborators%5BCorporate%20Author%5D info:eu-repo/semantics/closedAccess 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 Injuries 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 as well as subnational locations in seven countries from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016 we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns we risk-standardised cause-specific deaths due to non-cancers by location-year 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 we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100 with 0 as the first percentile (worst) observed between 1990 and 2016 and 100 as the 99th percentile (best) we set these thresholds at the country level and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values 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) a summary measure of overall development. As derived from the broader GBD study and other data sources we examined relationships between national HAQ Index scores and potential correlates of performance such as total health spending per capita. Findings In 2016 HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands to values as low as 18·6 (13·1–24·4) in the Central African Republic 19·0 (14·3–23·7) in Somalia and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China 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) while India saw a 30·8-point disparity 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) whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference) whereas in Brazil 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 with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016 most notably vaccine-preventable diseases. Overall national performance on the HAQ Index was positively associated with higher levels of total health spending per capita as well as health systems inputs but these relationships were quite heterogeneous 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 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 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 the pursuit of universal health coverage hinges upon improving both access and quality worldwide and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations. info:eu-repo/semantics/article 2018 ftunivnapoliiris https://doi.org/10.1016/S0140-6736(18)30994-2 2024-06-17T15:19:33Z Article in Journal/Newspaper Iceland IRIS Università degli Studi di Napoli Federico II Norway The Lancet 391 10136 2236 2271 |