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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, Nancy; Yearwood, Jamal; Abay, Solomon M; Abbafati, Cristiana; Abd-Allah, Foad; Abdela, Jemal; Abdelalim, Ahmed; Abebe, Zegeye; Abebo, Teshome Abuka; Aboyans, Victor; Abraha, Haftom Niguse; Abreu, Daisy M X; Abu-Raddad, Laith J; Adane, Akilew Awoke; Adedoyin, Rufus Adesoji; Adetokunboh, Olatunji; Adhikari, Tara Ballav; Afarideh, Mohsen; Afshin, Ashkan; Agarwal, Gina; Agius, Dominic; Agrawal, Anurag; Agrawal, Sutapa; Ahmad Kiadaliri, Aliasghar; Aichour, Miloud Taki Eddine; Akibu, Mohammed; Akinyemi, Rufus Olusola; Akinyemiju, Tomi F; Akseer, Nadia; Al Lami, Faris Hasan; Alahdab, Fares; Al-Aly, Ziyad; Alam, Khurshid; Alam, Tahiya; Alasfoor, Deena; Albittar, Mohammed I; Alene, Kefyalew Addis; Al-Eyadhy, Ayman; Ali, Syed Danish; Alijanzadeh, Mehran; Aljunid, Syed M; Alkerwi, Ala'a; Alla, François; Allebeck, Peter; Allen, Christine; Alomari, Mahmoud A; Al-Raddadi, Rajaa; Alsharif, Ubai; Altirkawi, Khalid A; Alvis-Guzman, Nelson; Amare, Azmeraw T; Amenu, Kebede; Ammar, Walid; Amoako, Yaw Ampem; Anber, Nahla; Andrei, Catalina Liliana; Androudi, Sofia; Antonio, Carl Abelardo T; Araújo, Valdelaine E M; Aremu, Olatunde; Ärnlöv, Johan; Artaman, Al; Aryal, Krishna Kumar; Asayesh, Hamid; Asfaw, Ephrem Tsegay; Asgedom, Solomon Weldegebreal; Asghar, Rana Jawad; Ashebir, Mengistu Mitiku; Asseffa, Netsanet Abera; Atey, Tesfay Mehari; Atre, Sachin R; Atteraya, Madhu S; Avila-Burgos, Leticia; Avokpaho, Euripide Frinel G Arthur; Awasthi, Ashish; Ayala Quintanilla, Beatriz Paulina; Ayalew, Animut Alebel; Ayele, Henok Tadesse; Ayer, Rakesh; Ayuk, Tambe Betrand; Azzopardi, Peter; Azzopardi-Muscat, Natasha; Babalola, Tesleem Kayode; Badali, Hamid; Badawi, Alaa; Banach, Maciej; Banerjee, Amitava; Banstola, Amrit; Barber, Ryan M; Barboza, Miguel A; Barker-Collo, Suzanne L; Bärnighausen, Till; Barquera, Simon; Barrero, Lope H; Bassat, Quique; Basu, Sanjay; Baune, Bernhard T; Bazargan-Hejazi, Shahrzad; Bedi, Neeraj; Beghi, Ettore; Behzadifar, Masoud; Behzadifar, Meysam; Bekele, Bayu Begashaw; Belachew, Abate Bekele; Belay, Saba Abraham; Belay, Yihalem Abebe; Bell, Michelle L; Bello, Aminu K; Bennett, Derrick A; Bennett, James R; Bensenor, Isabela M; Berhe, Derbew Fikadu; Bernabé, Eduardo; Bernstein, Robert Steven; Beuran, Mircea; Bhalla, Ashish; Bhatt, Paurvi; Bhaumik, Soumyadeep; Bhutta, Zulfiqar A; Biadgo, Belete; Bijani, Ali; Bikbov, Boris; Birungi, Charles; Biryukov, Stan; Bizuneh, Hailemichael; Bolliger, Ian W; Bolt, Kaylin; Bou-Orm, Ibrahim R; Bozorgmehr, Kayvan; Brady, Oliver Jerome; Brazinova, Alexandra; Breitborde, Nicholas J K; Brenner, Hermann; Britton, Gabrielle; Brugha, Traolach S; Butt, Zahid A; Cahuana-Hurtado, Lucero; Campos-Nonato, Ismael Ricardo; Campuzano, Julio Cesar; Car, Josip; Car, Mate; Cárdenas, Rosario; Carrero, Juan Jesus; Carvalho, Felix; Castañeda-Orjuela, Carlos A; Castillo Rivas, Jacqueline; Catalá-López, Ferrán; Cercy, Kelly; Chalek, Julian; Chang, Hsing-Yi; Chang, Jung-Chen; Chattopadhyay, Aparajita; Chaturvedi, Pankaj; Chiang, Peggy Pei-Chia; Chisumpa, Vesper Hichilombwe; Choi, Jee-Young J; Christensen, Hanne; Christopher, Devasahayam Jesudas; Chung, Sheng-Chia; Ciobanu, Liliana G; Cirillo, Massimo; Colombara, Danny; Conti, Sara; Cooper, Cyrus; Cornaby, Leslie; Cortesi, Paolo Angelo; Cortinovis, Monica; Costa Pereira, Alexandre; Cousin, Ewerton; Criqui, Michael H; Cromwell, Elizabeth A; Crowe, Christopher Stephen; Crump, John A; Daba, Alemneh Kabeta; Dachew, Berihun Assefa; Dadi, Abel Fekadu; Dandona, Lalit; Dandona, Rakhi; Dargan, Paul I; Daryani, Ahmad; Daryani, Maryam; Das, Jai; Das, Siddharth Kumar; das Neves, José; Davis Weaver, Nicole; Davletov, Kairat; de Courten, Barbora; De Leo, Diego; De Neve, Jan-Walter; Dellavalle, Robert P; Demoz, Gebre; Deribe, Kebede; Des Jarlais, Don C; Dey, Subhojit; Dharmaratne, Samath D; Dhimal, Meghnath; Djalalinia, Shirin; Doku, David Teye; Dolan, Kate; Dorsey, E Ray; dos Santos, Kadine Priscila Bender; Doyle, Kerrie E; Driscoll, Tim R; Dubey, Manisha; Dubljanin, Eleonora; Duncan, Bruce Bartholow; Echko, Michelle; Edessa, Dumessa; Edvardsson, David; Ehrlich, Joshua R; Eldrenkamp, Erika; El-Khatib, Ziad Ziad; Endres, Matthias; Endries, Aman Yesuf; Eshrati, Babak; Eskandarieh, Sharareh; Esteghamati, Alireza; Fakhar, Mahdi; Farag, Tamer; Faramarzi, Mahbobeh; Faraon, Emerito Jose Aquino; Faro, André; Farzadfar, Farshad; Fatusi, Adesegun; Fazeli, Mir Sohail; Feigin, Valery L; Feigl, Andrea B; Fentahun, Netsanet; Fereshtehnejad, Seyed-Mohammad; Fernandes, Eduarda; Fernandes, João C; Fijabi, Daniel Obadare; Filip, Irina; Fischer, Florian; Fitzmaurice, Christina; Flaxman, Abraham D; Flor, Luisa Sorio; Foigt, Nataliya; Foreman, Kyle J; Frostad, Joseph J; Fürst, Thomas; Futran, Neal D; Gakidou, Emmanuela; Gallus, Silvano; Gambashidze, Ketevan; Gamkrelidze, Amiran; Ganji, Morsaleh; Gebre, Abadi Kahsu; Gebrehiwot, Tsegaye Tewelde; Gebremedhin, Amanuel Tesfay; Gelaw, Yalemzewod Assefa; Geleijnse, Johanna M; Geremew, Demeke; Gething, Peter W; Ghadimi, Reza; Ghasemi Falavarjani, Khalil; Ghasemi-Kasman, Maryam; Gill, Paramjit Singh; Giref, Ababi Zergaw; Giroud, Maurice; Gishu, Melkamu Dedefo; Giussani, Giorgia; Godwin, William W; Goli, Srinivas; Gomez-Dantes, Hector; Gona, Philimon N; Goodridge, Amador; Gopalani, Sameer Vali; Goryakin, Yevgeniy; Goulart, Alessandra Carvalho; Grada, Ayman; Griswold, Max; Grosso, Giuseppe; Gugnani, Harish Chander; Guo, Yuming; Gupta, Rahul; Gupta, Rajeev; Gupta, Tanush; Gupta, Tarun; Gupta, Vipin; Haagsma, Juanita A; Hachinski, Vladimir; Hafezi-Nejad, Nima; Hailu, Gessessew Bugssa; Hamadeh, Randah Ribhi; Hamidi, Samer; Hankey, Graeme J; Harb, Hilda L; Harewood, Heather C; Harikrishnan, Sivadasanpillai; Haro, Josep Maria; Hassen, Hamid Yimam; Havmoeller, Rasmus; Hawley, Caitlin; Hay, Simon I; He, Jiawei; Hearps, Stephen J C; Hegazy, Mohamed I; Heibati, Behzad; Heidari, Mohsen; Hendrie, Delia; Henry, Nathaniel J; Herrera Ballesteros, Victor Hugo; Herteliu, Claudiu; Hibstu, Desalegn Tsegaw; Hiluf, Molla Kahssay; Hoek, Hans W; Homaie Rad, Enayatollah; Horita, Nobuyuki; Hosgood, H Dean; Hosseini, Mostafa; Hosseini, Seyed Reza; Hostiuc, Mihaela; Hostiuc, Sorin; Hoy, Damian G; Hsairi, Mohamed; Htet, Aung Soe; Hu, Guoqing; Huang, John J; Iburg, Kim Moesgaard; Idris, Fachmi; Igumbor, Ehimario Uche; Ikeda, Chad; Ileanu, Bogdan Vasile; Ilesanmi, Olayinka S; Innos, Kaire; Irvani, Seyed Sina Naghibi; Irvine, Caleb M S; Islami, Farhad; Jacobs, Troy A; Jacobsen, Kathryn H; Jahanmehr, Nader; Jain, Rajesh; Jain, Sudhir Kumar; Jakovljevic, Mihajlo B; Jalu, Moti Tolera; Jamal, Amr A; Javanbakht, Mehdi; Jayatilleke, Achala Upendra; Jeemon, Panniyammakal; Jha, Ravi Prakash; Jha, Vivekanand; Jóúwiak, Jacek; John, Oommen; Johnson, Sarah Charlotte; Jonas, Jost B; Joshua, Vasna; Jürisson, Mikk; Kabir, Zubair; Kadel, Rajendra; Kahsay, Amaha; Kalani, Rizwan; Kar, Chittaranjan; Karanikolos, Marina; Karch, André; Karema, Corine Kakizi; Karimi, Seyed M; Kasaeian, Amir; Kassa, Dessalegn Haile; Kassa, Getachew Mullu; Kassa, Tesfaye Dessale; Kassebaum, Nicholas J; Katikireddi, Srinivasa Vittal; Kaul, Anil; Kawakami, Norito; Kazanjan, Konstantin; Kebede, Seifu; Keiyoro, Peter Njenga; Kemp, Grant Rodgers; Kengne, Andre Pascal; Kereselidze, Maia; Ketema, Ezra Belay; Khader, Yousef Saleh; Khafaie, Morteza Abdullatif; Khajavi, Alireza; Khalil, Ibrahim A; Khan, Ejaz Ahmad; Khan, Gulfaraz; Khan, Md Nuruzzaman; Khan, Muhammad Ali; Khanal, Mukti Nath; Khang, Young-Ho; Khater, Mona M; Khoja, Abdullah Tawfih Abdullah; Khosravi, Ardeshir; Khubchandani, Jagdish; Kibret, Getiye Dejenu; Kiirithio, Daniel Ngari; Kim, Daniel; Kim, Yun Jin; Kimokoti, Ruth W; Kinfu, Yohannes; Kinra, Sanjay; Kisa, Adnan; Kissoon, Niranjan; Kochhar, Sonali; Kokubo, Yoshihiro; Kopec, Jacek A; Kosen, Soewarta; Koul, Parvaiz A; Koyanagi, Ai; Kravchenko, Michael; Krishan, Kewal; Krohn, Kristopher J; Kuate Defo, Barthelemy; Kumar, G Anil; Kumar, Pushpendra; Kutz, Michael; Kuzin, Igor; Kyu, Hmwe H; Lad, Deepesh Pravinkumar; Lafranconi, Alessandra; Lal, Dharmesh Kumar; Lalloo, Ratilal; Lam, Hilton; Lan, Qing; Lang, Justin J; Lansingh, Van C; Lansky, Sonia; Larsson, Anders; Latifi, Arman; Lazarus, Jeffrey Victor; Leasher, Janet L; Lee, Paul H; Legesse, Yirga; Leigh, James; Leshargie, Cheru Tesema; Leta, Samson; Leung, Janni; Leung, Ricky; Levi, Miriam; Li, Yongmei; Liang, Juan; Liben, Misgan Legesse; Lim, Lee-Ling; Lim, Stephen S; Lind, Margaret; Linn, Shai; Listl, Stefan; Liu, Patrick; Liu, Shiwei; Lodha, Rakesh; Lopez, Alan D; Lorch, Scott A; Lorkowski, Stefan; Lotufo, Paulo A; Lucas, Timothy C D; Lunevicius, Raimundas; Lurton, Grégoire; Lyons, Ronan A; Maalouf, Fadi; Macarayan, Erlyn Rachelle King; Mackay, Mark T; Maddison, Emilie R; Madotto, Fabiana; Magdy Abd El Razek, Hassan; Magdy Abd El Razek, Mohammed; Majdan, Marek; Majdzadeh, Reza; Majeed, Azeem; Malekzadeh, Reza; Malhotra, Rajesh; Malta, Deborah Carvalho; Mamun, Abdullah A; Manhertz, Trey; Manguerra, Helena; Mansournia, Mohammad Ali; Mantovani, Lorenzo G; Manyazewal, Tsegahun; Mapoma, Chabila C; Margono, Christopher; Martinez-Raga, Jose; Martins, Sheila Cristina Ouriques; Martins-Melo, Francisco Rogerlândio; Martopullo, Ira; März, Winfried; Massenburg, Benjamin Ballard; Mathur, Manu Raj; Maulik, Pallab K; Mazidi, Mohsen; McAlinden, Colm; McGrath, John J; McKee, Martin; Mehata, Suresh; Mehrotra, Ravi; Mehta, Kala M; Mehta, Varshil; Meier, Toni; Mejia-Rodriguez, Fabiola; Meles, Kidanu Gebremariam; Melku, Mulugeta; Memiah, Peter; Memish, Ziad A; Mendoza, Walter; Mengiste, Degu Abate; Mengistu, Desalegn Tadese; Menota, Bereket Gebremichael; Mensah, George A; Meretoja, Atte; Meretoja, Tuomo J; Mezgebe, Haftay Berhane; Miazgowski, Tomasz; Micha, Renata; Milam, Robert; Millear, Anoushka; Miller, Ted R; Mini, GK; Minnig, Shawn; Mirica, Andreea; Mirrakhimov, Erkin M; Misganaw, Awoke; Mitchell, Philip B; Mlashu, Fitsum Weldegebreal; Moazen, Babak; Mohammad, Karzan Abdulmuhsin; Mohammadibakhsh, Roghayeh; Mohammed, Ebrahim; Mohammed, Mohammed A; Mohammed, Shafiu; Mokdad, Ali H; Mola, Glen Liddell; Molokhia, Mariam; Momeniha, Fatemeh; Monasta, Lorenzo; Montañez Hernandez, Julio Cesar; Moosazadeh, Mahmood; Moradi-Lakeh, Maziar; Moraga, Paula; Morawska, Lidia; Moreno Velasquez, Ilais; Mori, Rintaro; Morrison, Shane D; Moses, Mark; Mousavi, Seyyed Meysam; Mueller, Ulrich O; Murhekar, Manoj; Murthy, Gudlavalleti Venkata Satyanarayana; Murthy, Srinivas; Musa, Jonah; Musa, Kamarul Imran; Mustafa, Ghulam; Muthupandian, Saravanan; Nagata, Chie; Nagel, Gabriele; Naghavi, Mohsen; Naheed, Aliya; Naik, Gurudatta A; Naik, Nitish; Najafi, Farid; Naldi, Luigi; Nangia, Vinay; Nansseu, Jobert Richie Njingang; Narayan, KM Venkat; Nascimento, Bruno Ramos; Negoi, Ionut; Negoi, Ruxandra Irina; Newton, Charles R; Ngunjiri, Josephine Wanjiku; Nguyen, Grant; Nguyen, Long; Nguyen, Trang Huyen; Nichols, Emma; Ningrum, Dina Nur Anggraini; Nolte, Ellen; Nong, Vuong Minh; Norheim, Ole F; Norrving, Bo; Noubiap, Jean Jacques N; Nyandwi, Alypio; Obermeyer, Carla Makhlouf; Ofori-Asenso, Richard; Ogbo, Felix Akpojene; Oh, In-Hwan; Oladimeji, Olanrewaju; Olagunju, Andrew Toyin; Olagunju, Tinuke Oluwasefunmi; Olivares, Pedro R; Oliveira, Patricia Pereira Vasconcelos de; Olsen, Helen E; Olusanya, Bolajoko Olubukunola; Olusanya, Jacob Olusegun; Ong, Kanyin; Opio, John Nelson; Oren, Eyal; Ortega-Altamirano, Doris V; Ortiz, Alberto; Ozdemir, Raziye; PA, Mahesh; Pain, Amanda W; Palone, Marcos Roberto Tovani; Pana, Adrian; Panda-Jonas, Songhomitra; Pandian, Jeyaraj D; Park, Eun-Kee; Parsian, Hadi; Patel, Tejas; Pati, Sanghamitra; Patil, Snehal T; Patle, Ajay; Patton, George C; Paturi, Vishnupriya Rao; Paudel, Deepak; Pedroso, Marcel de Moares; Pedroza, Sandra P; Pereira, David M; Perico, Norberto; Peterson, Hannah; Petzold, Max; Peykari, Niloofar; Phillips, Michael Robert; Piel, Frédéric B; Pigott, David M; Pillay, Julian David; Piradov, Michael A; Polinder, Suzanne; Pond, Constance D; Postma, Maarten J; Pourmalek, Farshad; Prakash, Swayam; Prakash, V; Prasad, Narayan; Prasad, Noela Marie; Purcell, Caroline; Qorbani, Mostafa; Quintana, Hedley Knewjen; Radfar, Amir; Rafay, Anwar; Rafiei, Alireza; Rahimi, Kazem; Rahimi-Movaghar, Afarin; Rahimi-Movaghar, Vafa; Rahman, Mahfuzar; Rahman, Muhammad Aziz; Rahman, Sajjad Ur; Rai, Rajesh Kumar; Raju, Sree Bhushan; Ram, Usha; Rana, Saleem M; Rankin, Zane; Rasella, Davide; Rawaf, David Laith; Rawaf, Salman; Ray, Sarah E; Razo-García, Christian Aspacia; Reddy, Priscilla; Reiner, Robert C; Reis, Cesar; Reitsma, Marissa B; Remuzzi, Giuseppe; Renzaho, Andre M N; Resnikoff, Serge; Rezaei, Satar; Rezai, Mohammad Sadegh; Ribeiro, Antonio L; Rios Blancas, Maria Jesus; Rivera, Juan A; Roever, Leonardo; Ronfani, Luca; Roshandel, Gholamreza; Rostami, Ali; Roth, Gregory A; Rothenbacher, Dietrich; Roy, Ambuj; Roy, Nobhojit; Ruhago, George Mugambage; Sabde, Yogesh Damodar; Sachdev, Perminder S; Sadat, Nafis; Safdarian, Mahdi; Safiri, Saeid; Sagar, Rajesh; Sahebkar, Amirhossein; Sahraian, Mohammad Ali; Sajadi, Haniye Sadat; Salama, Joseph; Salamati, Payman; Saldanha, Raphael de Freitas; Salimzadeh, Hamideh; Salomon, Joshua A; Samy, Abdallah M; Sanabria, Juan Ramon; Sancheti, Parag K; Sanchez-Niño, Maria Dolores; Santomauro, Damian; Santos, Itamar S; Santric Milicevic, Milena M; Sarker, Abdur Razzaque; Sarrafzadegan, Nizal; Sartorius, Benn; Satpathy, Maheswar; Savic, Miloje; Sawhney, Monika; Saxena, Sonia; Saylan, Mete I; Schaeffner, Elke; Schmidhuber, Josef; Schmidt, Maria Inês; Schneider, Ione J C; Schumacher, Austin E; Schutte, Aletta E; Schwebel, David C; Schwendicke, Falk; Sekerija, Mario; Sepanlou, Sadaf G; Servan-Mori, Edson E; Shafieesabet, Azadeh; Shaikh, Masood Ali; Shakh-Nazarova, Marina; Shams-Beyranvand, Mehran; Sharafi, Heidar; Sharif-Alhoseini, Mahdi; Shariful Islam, Sheikh Mohammed; Sharma, Meenakshi; Sharma, Rajesh; She, Jun; Sheikh, Aziz; Shfare, Mebrahtu Teweldemedhin; Shi, Peilin; Shields, Chloe; Shigematsu, Mika; Shinohara, Yukito; Shiri, Rahman; Shirkoohi, Reza; Shiue, Ivy; Shrime, Mark G; Shukla, Sharvari Rahul; Siabani, Soraya; Sigfusdottir, Inga Dora; Silberberg, Donald H; Silva, Diego Augusto Santos; Silva, João Pedro; Silveira, Dayane Gabriele Alves; Singh, Jasvinder A; Singh, Lavanya; Singh, Narinder Pal; Singh, Virendra; Sinha, Dhirendra Narain; Sinke, Abiy Hiruye; Sisay, Mekonnen; Skirbekk, Vegard; Sliwa, Karen; Smith, Alison; Soares Filho, Adauto Martins; Sobaih, Badr H A; Somai, Melek; Soneji, Samir; Soofi, Moslem; Sorensen, Reed J D; Soriano, Joan B; Soyiri, Ireneous N; Sposato, Luciano A; Sreeramareddy, Chandrashekhar T; Srinivasan, Vinay; Stanaway, Jeffrey D; Stathopoulou, Vasiliki; Steel, Nicholas; Stein, Dan J; Stokes, Mark Andrew; Sturua, Lela; Sufiyan, Muawiyyah Babale; Suliankatchi, Rizwan Abdulkader; Sunguya, Bruno F; Sur, Patrick J; Sykes, Bryan L; Sylaja, PN; Tabarés-Seisdedos, Rafael; Tadakamadla, Santosh Kumar; Tadesse, Andualem Henok; Taffere, Getachew Redae; Tandon, Nikhil; Tariku, Amare Tariku; Taveira, Nuno; Tehrani-Banihashemi, Arash; Temam Shifa, Girma; Temsah, Mohamad-Hani; Terkawi, Abdullah Sulieman; Tesema, Azeb Gebresilassie; Tesfaye, Dawit Jember; Tessema, Belay; Thakur, JS; Thomas, Nihal; Thompson, Matthew J; Tillmann, Taavi; To, Quyen G; Tobe-Gai, Ruoyan; Tonelli, Marcello; Topor-Madry, Roman; Topouzis, Fotis; Torre, Anna; Tortajada, Miguel; Tran, Bach Xuan; Tran, Khanh Bao; Tripathi, Avnish; Tripathy, Srikanth Prasad; Troeger, Christopher; Truelsen, Thomas; Tsoi, Derrick; Tudor Car, Lorainne; Tuem, Kald Beshir; Tyrovolas, Stefanos; Uchendu, Uche S; Ukwaja, Kingsley N; Ullah, Irfan; Updike, Rachel; Uthman, Olalekan A; Uzochukwu, Benjamin S Chudi; Valdez, Pascual Rubén; van Boven, Job F M; Varughese, Santosh; Vasankari, Tommi; Violante, Francesco S; Vladimirov, Sergey K; Vlassov, Vasiliy Victorovich; Vollset, Stein Emil; Vos, Theo; Wagnew, Fasil; Waheed, Yasir; Wallin, Mitchell T; Walson, Judd L; Wang, Yafeng; Wang, Yuan-Pang; Wassie, Molla Mesele; Weaver, Marcia R; Weiderpass, Elisabete; Weintraub, Robert G; Weiss, Jordan; Weldegwergs, Kidu Gidey; Werdecker, Andrea; West, T Eoin; Westerman, Ronny; White, Richard G; Whiteford, Harvey A; Widecka, Justyna; Winkler, Andrea Sylvia; Wiysonge, Charles Shey; Wolfe, Charles DA; Wondimkun, Yohanes Ayele; Workicho, Abdulhalik; Wyper, Grant M A; Xavier, Denis; Xu, Gelin; Yan, Lijing L; Yano, Yuichiro; Yaseri, Mehdi; Yimer, Nigus Bililign; Yin, Peng; Yip, Paul; Yirsaw, Biruck Desalegn; Yonemoto, Naohiro; Yonga, Gerald; Yoon, Seok-Jun; Yotebieng, Marcel; Younis, Mustafa Z; Yu, Chuanhua; Zadnik, Vesna; Zaidi, Zoubida; Zaki, Maysaa El Sayed; Zaman, Sojib Bin; Zamani, Mohammad; Zenebe, Zerihun Menlkalew; Zhou, Maigeng; Zhu, Jun; Zimsen, Stephanie R M; Zipkin, Ben; Zodpey, Sanjay; Zuhlke, Liesl Joanna; Murray, Christopher J L; Lozano, Rafael

Authors

Nancy Fullman

Jamal Yearwood

Solomon M Abay

Cristiana Abbafati

Foad Abd-Allah

Jemal Abdela

Ahmed Abdelalim

Zegeye Abebe

Teshome Abuka Abebo

Victor Aboyans

Haftom Niguse Abraha

Daisy M X Abreu

Laith J Abu-Raddad

Akilew Awoke Adane

Rufus Adesoji Adedoyin

Olatunji Adetokunboh

Tara Ballav Adhikari

Mohsen Afarideh

Ashkan Afshin

Gina Agarwal

Dominic Agius

Anurag Agrawal

Sutapa Agrawal

Aliasghar Ahmad Kiadaliri

Miloud Taki Eddine Aichour

Mohammed Akibu

Rufus Olusola Akinyemi

Tomi F Akinyemiju

Nadia Akseer

Faris Hasan Al Lami

Fares Alahdab

Ziyad Al-Aly

Khurshid Alam

Tahiya Alam

Deena Alasfoor

Mohammed I Albittar

Kefyalew Addis Alene

Ayman Al-Eyadhy

Syed Danish Ali

Mehran Alijanzadeh

Syed M Aljunid

Ala'a Alkerwi

François Alla

Peter Allebeck

Christine Allen

Mahmoud A Alomari

Rajaa Al-Raddadi

Ubai Alsharif

Khalid A Altirkawi

Nelson Alvis-Guzman

Azmeraw T Amare

Kebede Amenu

Walid Ammar

Yaw Ampem Amoako

Nahla Anber

Catalina Liliana Andrei

Sofia Androudi

Carl Abelardo T Antonio

Valdelaine E M Araújo

Olatunde Aremu

Johan Ärnlöv

Al Artaman

Krishna Kumar Aryal

Hamid Asayesh

Ephrem Tsegay Asfaw

Solomon Weldegebreal Asgedom

Rana Jawad Asghar

Mengistu Mitiku Ashebir

Netsanet Abera Asseffa

Tesfay Mehari Atey

Sachin R Atre

Madhu S Atteraya

Leticia Avila-Burgos

Euripide Frinel G Arthur Avokpaho

Ashish Awasthi

Beatriz Paulina Ayala Quintanilla

Animut Alebel Ayalew

Henok Tadesse Ayele

Rakesh Ayer

Tambe Betrand Ayuk

Peter Azzopardi

Natasha Azzopardi-Muscat

Tesleem Kayode Babalola

Hamid Badali

Alaa Badawi

Maciej Banach

Amitava Banerjee

Amrit Banstola

Ryan M Barber

Miguel A Barboza

Suzanne L Barker-Collo

Till Bärnighausen

Simon Barquera

Lope H Barrero

Quique Bassat

Sanjay Basu

Bernhard T Baune

Shahrzad Bazargan-Hejazi

Neeraj Bedi

Ettore Beghi

Masoud Behzadifar

Meysam Behzadifar

Bayu Begashaw Bekele

Abate Bekele Belachew

Saba Abraham Belay

Yihalem Abebe Belay

Michelle L Bell

Aminu K Bello

Derrick A Bennett

James R Bennett

Isabela M Bensenor

Derbew Fikadu Berhe

Eduardo Bernabé

Robert Steven Bernstein

Mircea Beuran

Ashish Bhalla

Paurvi Bhatt

Soumyadeep Bhaumik

Zulfiqar A Bhutta

Belete Biadgo

Ali Bijani

Boris Bikbov

Charles Birungi

Stan Biryukov

Hailemichael Bizuneh

Ian W Bolliger

Kaylin Bolt

Ibrahim R Bou-Orm

Kayvan Bozorgmehr

Oliver Jerome Brady

Alexandra Brazinova

Nicholas J K Breitborde

Hermann Brenner

Gabrielle Britton

Traolach S Brugha

Zahid A Butt

Lucero Cahuana-Hurtado

Ismael Ricardo Campos-Nonato

Julio Cesar Campuzano

Josip Car

Mate Car

Rosario Cárdenas

Juan Jesus Carrero

Felix Carvalho

Carlos A Castañeda-Orjuela

Jacqueline Castillo Rivas

Ferrán Catalá-López

Kelly Cercy

Julian Chalek

Hsing-Yi Chang

Jung-Chen Chang

Aparajita Chattopadhyay

Pankaj Chaturvedi

Peggy Pei-Chia Chiang

Vesper Hichilombwe Chisumpa

Jee-Young J Choi

Hanne Christensen

Devasahayam Jesudas Christopher

Sheng-Chia Chung

Liliana G Ciobanu

Massimo Cirillo

Danny Colombara

Sara Conti

Cyrus Cooper

Leslie Cornaby

Paolo Angelo Cortesi

Monica Cortinovis

Alexandre Costa Pereira

Ewerton Cousin

Michael H Criqui

Elizabeth A Cromwell

Christopher Stephen Crowe

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Glen Liddell Mola

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Fatemeh Momeniha

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Paula Moraga

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Gudlavalleti Venkata Satyanarayana Murthy

Srinivas Murthy

Jonah Musa

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Ghulam Mustafa

Saravanan Muthupandian

Chie Nagata

Gabriele Nagel

Mohsen Naghavi

Aliya Naheed

Gurudatta A Naik

Nitish Naik

Farid Najafi

Luigi Naldi

Vinay Nangia

Jobert Richie Njingang Nansseu

KM Venkat Narayan

Bruno Ramos Nascimento

Ionut Negoi

Ruxandra Irina Negoi

Charles R Newton

Josephine Wanjiku Ngunjiri

Grant Nguyen

Long Nguyen

Trang Huyen Nguyen

Emma Nichols

Dina Nur Anggraini Ningrum

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Tinuke Oluwasefunmi Olagunju

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Jacob Olusegun Olusanya

Kanyin Ong

John Nelson Opio

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Doris V Ortega-Altamirano

Alberto Ortiz

Raziye Ozdemir

Mahesh PA

Amanda W Pain

Marcos Roberto Tovani Palone

Adrian Pana

Songhomitra Panda-Jonas

Jeyaraj D Pandian

Eun-Kee Park

Hadi Parsian

Tejas Patel

Sanghamitra Pati

Snehal T Patil

Ajay Patle

George C Patton

Vishnupriya Rao Paturi

Deepak Paudel

Marcel de Moares Pedroso

Sandra P Pedroza

David M Pereira

Norberto Perico

Hannah Peterson

Max Petzold

Niloofar Peykari

Michael Robert Phillips

Frédéric B Piel

David M Pigott

Julian David Pillay

Michael A Piradov

Suzanne Polinder

Constance D Pond

Maarten J Postma

Farshad Pourmalek

Swayam Prakash

V Prakash

Narayan Prasad

Noela Marie Prasad

Caroline Purcell

Mostafa Qorbani

Hedley Knewjen Quintana

Amir Radfar

Anwar Rafay

Alireza Rafiei

Kazem Rahimi

Afarin Rahimi-Movaghar

Vafa Rahimi-Movaghar

Mahfuzar Rahman

Muhammad Aziz Rahman

Sajjad Ur Rahman

Rajesh Kumar Rai

Sree Bhushan Raju

Usha Ram

Saleem M Rana

Zane Rankin

Davide Rasella

David Laith Rawaf

Salman Rawaf

Sarah E Ray

Christian Aspacia Razo-García

Priscilla Reddy

Robert C Reiner

Cesar Reis

Marissa B Reitsma

Giuseppe Remuzzi

Andre M N Renzaho

Serge Resnikoff

Satar Rezaei

Mohammad Sadegh Rezai

Antonio L Ribeiro

Maria Jesus Rios Blancas

Juan A Rivera

Leonardo Roever

Luca Ronfani

Gholamreza Roshandel

Ali Rostami

Gregory A Roth

Dietrich Rothenbacher

Ambuj Roy

Nobhojit Roy

George Mugambage Ruhago

Yogesh Damodar Sabde

Perminder S Sachdev

Nafis Sadat

Mahdi Safdarian

Saeid Safiri

Rajesh Sagar

Amirhossein Sahebkar

Mohammad Ali Sahraian

Haniye Sadat Sajadi

Joseph Salama

Payman Salamati

Raphael de Freitas Saldanha

Hamideh Salimzadeh

Joshua A Salomon

Abdallah M Samy

Juan Ramon Sanabria

Parag K Sancheti

Maria Dolores Sanchez-Niño

Damian Santomauro

Itamar S Santos

Milena M Santric Milicevic

Abdur Razzaque Sarker

Nizal Sarrafzadegan

Benn Sartorius

Maheswar Satpathy

Miloje Savic

Monika Sawhney

Sonia Saxena

Mete I Saylan

Elke Schaeffner

Josef Schmidhuber

Maria Inês Schmidt

Ione J C Schneider

Austin E Schumacher

Aletta E Schutte

David C Schwebel

Falk Schwendicke

Mario Sekerija

Sadaf G Sepanlou

Edson E Servan-Mori

Azadeh Shafieesabet

Masood Ali Shaikh

Marina Shakh-Nazarova

Mehran Shams-Beyranvand

Heidar Sharafi

Mahdi Sharif-Alhoseini

Sheikh Mohammed Shariful Islam

Meenakshi Sharma

Rajesh Sharma

Jun She

Aziz Sheikh

Mebrahtu Teweldemedhin Shfare

Peilin Shi

Chloe Shields

Mika Shigematsu

Yukito Shinohara

Rahman Shiri

Reza Shirkoohi

Ivy Shiue

Mark G Shrime

Sharvari Rahul Shukla

Soraya Siabani

Inga Dora Sigfusdottir

Donald H Silberberg

Diego Augusto Santos Silva

João Pedro Silva

Dayane Gabriele Alves Silveira

Jasvinder A Singh

Lavanya Singh

Narinder Pal Singh

Virendra Singh

Dhirendra Narain Sinha

Abiy Hiruye Sinke

Mekonnen Sisay

Vegard Skirbekk

Karen Sliwa

Alison Smith

Adauto Martins Soares Filho

Badr H A Sobaih

Melek Somai

Samir Soneji

Moslem Soofi

Reed J D Sorensen

Joan B Soriano

Luciano A Sposato

Chandrashekhar T Sreeramareddy

Vinay Srinivasan

Jeffrey D Stanaway

Vasiliki Stathopoulou

Nicholas Steel

Dan J Stein

Mark Andrew Stokes

Lela Sturua

Muawiyyah Babale Sufiyan

Rizwan Abdulkader Suliankatchi

Bruno F Sunguya

Patrick J Sur

Bryan L Sykes

PN Sylaja

Rafael Tabarés-Seisdedos

Santosh Kumar Tadakamadla

Andualem Henok Tadesse

Getachew Redae Taffere

Nikhil Tandon

Amare Tariku Tariku

Nuno Taveira

Arash Tehrani-Banihashemi

Girma Temam Shifa

Mohamad-Hani Temsah

Abdullah Sulieman Terkawi

Azeb Gebresilassie Tesema

Dawit Jember Tesfaye

Belay Tessema

JS Thakur

Nihal Thomas

Matthew J Thompson

Taavi Tillmann

Quyen G To

Ruoyan Tobe-Gai

Marcello Tonelli

Roman Topor-Madry

Fotis Topouzis

Anna Torre

Miguel Tortajada

Bach Xuan Tran

Khanh Bao Tran

Avnish Tripathi

Srikanth Prasad Tripathy

Christopher Troeger

Thomas Truelsen

Derrick Tsoi

Lorainne Tudor Car

Kald Beshir Tuem

Stefanos Tyrovolas

Uche S Uchendu

Kingsley N Ukwaja

Irfan Ullah

Rachel Updike

Olalekan A Uthman

Benjamin S Chudi Uzochukwu

Pascual Rubén Valdez

Job F M van Boven

Santosh Varughese

Tommi Vasankari

Francesco S Violante

Sergey K Vladimirov

Vasiliy Victorovich Vlassov

Stein Emil Vollset

Theo Vos

Fasil Wagnew

Yasir Waheed

Mitchell T Wallin

Judd L Walson

Yafeng Wang

Yuan-Pang Wang

Molla Mesele Wassie

Marcia R Weaver

Elisabete Weiderpass

Robert G Weintraub

Jordan Weiss

Kidu Gidey Weldegwergs

Andrea Werdecker

T Eoin West

Ronny Westerman

Richard G White

Harvey A Whiteford

Justyna Widecka

Andrea Sylvia Winkler

Charles Shey Wiysonge

Charles DA Wolfe

Yohanes Ayele Wondimkun

Abdulhalik Workicho

Grant M A Wyper

Denis Xavier

Gelin Xu

Lijing L Yan

Yuichiro Yano

Mehdi Yaseri

Nigus Bililign Yimer

Peng Yin

Paul Yip

Biruck Desalegn Yirsaw

Naohiro Yonemoto

Gerald Yonga

Seok-Jun Yoon

Marcel Yotebieng

Mustafa Z Younis

Chuanhua Yu

Vesna Zadnik

Zoubida Zaidi

Maysaa El Sayed Zaki

Sojib Bin Zaman

Mohammad Zamani

Zerihun Menlkalew Zenebe

Maigeng Zhou

Jun Zhu

Stephanie R M Zimsen

Ben Zipkin

Sanjay Zodpey

Liesl Joanna Zuhlke

Christopher J L Murray

Rafael Lozano

Abstract

Copyright © 2018 The Author(s). Published by Elsevier Ltd. 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.

Journal Article Type Article
Publication Date Jun 2, 2018
Journal The Lancet
Print ISSN 0140-6736
Electronic ISSN 1474-547X
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 391
Issue 10136
Pages 2236-2271
Institution Citation Fullman, N., Yearwood, J., Abay, S. M., Abbafati, C., Abd-Allah, F., Abdela, J., …Lozano, R. (2018). 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. Lancet, 391(10136), 2236-2271. https://doi.org/10.1016/S0140-6736%2818%2930994-2
DOI https://doi.org/10.1016/S0140-6736%2818%2930994-2
Publisher URL https://www.sciencedirect.com/science/article/pii/S0140673618309942?via%3Dihub

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