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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,...

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

John A Crump

Alemneh Kabeta Daba

Berihun Assefa Dachew

Abel Fekadu Dadi

Lalit Dandona

Rakhi Dandona

Paul I Dargan

Ahmad Daryani

Maryam Daryani

Jai Das

Siddharth Kumar Das

José das Neves

Nicole Davis Weaver

Kairat Davletov

Barbora de Courten

Diego De Leo

Jan-Walter De Neve

Robert P Dellavalle

Gebre Demoz

Kebede Deribe

Don C Des Jarlais

Subhojit Dey

Samath D Dharmaratne

Meghnath Dhimal

Shirin Djalalinia

David Teye Doku

Kate Dolan

E Ray Dorsey

Kadine Priscila Bender dos Santos

Kerrie E Doyle

Tim R Driscoll

Manisha Dubey

Eleonora Dubljanin

Bruce Bartholow Duncan

Michelle Echko

Dumessa Edessa

David Edvardsson

Joshua R Ehrlich

Erika Eldrenkamp

Ziad Ziad El-Khatib

Matthias Endres

Aman Yesuf Endries

Babak Eshrati

Sharareh Eskandarieh

Alireza Esteghamati

Mahdi Fakhar

Tamer Farag

Mahbobeh Faramarzi

Emerito Jose Aquino Faraon

André Faro

Farshad Farzadfar

Adesegun Fatusi

Mir Sohail Fazeli

Valery L Feigin

Andrea B Feigl

Netsanet Fentahun

Seyed-Mohammad Fereshtehnejad

Eduarda Fernandes

João C Fernandes

Daniel Obadare Fijabi

Irina Filip

Florian Fischer

Christina Fitzmaurice

Abraham D Flaxman

Luisa Sorio Flor

Nataliya Foigt

Kyle J Foreman

Joseph J Frostad

Thomas Fürst

Neal D Futran

Emmanuela Gakidou

Silvano Gallus

Ketevan Gambashidze

Amiran Gamkrelidze

Morsaleh Ganji

Abadi Kahsu Gebre

Tsegaye Tewelde Gebrehiwot

Amanuel Tesfay Gebremedhin

Yalemzewod Assefa Gelaw

Johanna M Geleijnse

Demeke Geremew

Peter W Gething

Reza Ghadimi

Khalil Ghasemi Falavarjani

Maryam Ghasemi-Kasman

Paramjit Singh Gill

Ababi Zergaw Giref

Maurice Giroud

Melkamu Dedefo Gishu

Giorgia Giussani

William W Godwin

Srinivas Goli

Hector Gomez-Dantes

Philimon N Gona

Amador Goodridge

Sameer Vali Gopalani

Yevgeniy Goryakin

Alessandra Carvalho Goulart

Ayman Grada

Max Griswold

Giuseppe Grosso

Harish Chander Gugnani

Yuming Guo

Rahul Gupta

Rajeev Gupta

Tanush Gupta

Tarun Gupta

Vipin Gupta

Juanita A Haagsma

Vladimir Hachinski

Nima Hafezi-Nejad

Gessessew Bugssa Hailu

Randah Ribhi Hamadeh

Samer Hamidi

Graeme J Hankey

Hilda L Harb

Heather C Harewood

Sivadasanpillai Harikrishnan

Josep Maria Haro

Hamid Yimam Hassen

Rasmus Havmoeller

Caitlin Hawley

Simon I Hay

Jiawei He

Stephen J C Hearps

Mohamed I Hegazy

Behzad Heibati

Mohsen Heidari

Delia Hendrie

Nathaniel J Henry

Victor Hugo Herrera Ballesteros

Claudiu Herteliu

Desalegn Tsegaw Hibstu

Molla Kahssay Hiluf

Hans W Hoek

Enayatollah Homaie Rad

Nobuyuki Horita

H Dean Hosgood

Mostafa Hosseini

Seyed Reza Hosseini

Mihaela Hostiuc

Sorin Hostiuc

Damian G Hoy

Mohamed Hsairi

Aung Soe Htet

Guoqing Hu

John J Huang

Kim Moesgaard Iburg

Fachmi Idris

Ehimario Uche Igumbor

Chad Ikeda

Bogdan Vasile Ileanu

Olayinka S Ilesanmi

Kaire Innos

Seyed Sina Naghibi Irvani

Caleb M S Irvine

Farhad Islami

Troy A Jacobs

Kathryn H Jacobsen

Nader Jahanmehr

Rajesh Jain

Sudhir Kumar Jain

Mihajlo B Jakovljevic

Moti Tolera Jalu

Amr A Jamal

Mehdi Javanbakht

Achala Upendra Jayatilleke

Panniyammakal Jeemon

Ravi Prakash Jha

Vivekanand Jha

Jacek Jóúwiak

Oommen John

Sarah Charlotte Johnson

Jost B Jonas

Vasna Joshua

Mikk Jürisson

Zubair Kabir

Rajendra Kadel

Amaha Kahsay

Rizwan Kalani

Chittaranjan Kar

Marina Karanikolos

André Karch

Corine Kakizi Karema

Seyed M Karimi

Amir Kasaeian

Dessalegn Haile Kassa

Getachew Mullu Kassa

Tesfaye Dessale Kassa

Nicholas J Kassebaum

Srinivasa Vittal Katikireddi

Anil Kaul

Norito Kawakami

Konstantin Kazanjan

Seifu Kebede

Peter Njenga Keiyoro

Grant Rodgers Kemp

Andre Pascal Kengne

Maia Kereselidze

Ezra Belay Ketema

Yousef Saleh Khader

Morteza Abdullatif Khafaie

Alireza Khajavi

Ibrahim A Khalil

Ejaz Ahmad Khan

Gulfaraz Khan

Md Nuruzzaman Khan

Muhammad Ali Khan

Mukti Nath Khanal

Young-Ho Khang

Mona M Khater

Abdullah Tawfih Abdullah Khoja

Ardeshir Khosravi

Jagdish Khubchandani

Getiye Dejenu Kibret

Daniel Ngari Kiirithio

Daniel Kim

Yun Jin Kim

Ruth W Kimokoti

Yohannes Kinfu

Sanjay Kinra

Adnan Kisa

Niranjan Kissoon

Sonali Kochhar

Yoshihiro Kokubo

Jacek A Kopec

Soewarta Kosen

Parvaiz A Koul

Ai Koyanagi

Michael Kravchenko

Kewal Krishan

Kristopher J Krohn

Barthelemy Kuate Defo

G Anil Kumar

Pushpendra Kumar

Michael Kutz

Igor Kuzin

Hmwe H Kyu

Deepesh Pravinkumar Lad

Alessandra Lafranconi

Dharmesh Kumar Lal

Ratilal Lalloo

Hilton Lam

Qing Lan

Justin J Lang

Van C Lansingh

Sonia Lansky

Anders Larsson

Arman Latifi

Jeffrey Victor Lazarus

Janet L Leasher

Paul H Lee

Yirga Legesse

James Leigh

Cheru Tesema Leshargie

Samson Leta

Janni Leung

Ricky Leung

Miriam Levi

Yongmei Li

Juan Liang

Misgan Legesse Liben

Lee-Ling Lim

Stephen S Lim

Margaret Lind

Shai Linn

Stefan Listl

Patrick Liu

Shiwei Liu

Rakesh Lodha

Alan D Lopez

Scott A Lorch

Stefan Lorkowski

Paulo A Lotufo

Timothy C D Lucas

Raimundas Lunevicius

Grégoire Lurton

Ronan A Lyons

Fadi Maalouf

Erlyn Rachelle King Macarayan

Mark T Mackay

Emilie R Maddison

Fabiana Madotto

Hassan Magdy Abd El Razek

Mohammed Magdy Abd El Razek

Marek Majdan

Reza Majdzadeh

Azeem Majeed

Reza Malekzadeh

Rajesh Malhotra

Deborah Carvalho Malta

Abdullah A Mamun

Trey Manhertz

Helena Manguerra

Mohammad Ali Mansournia

Lorenzo G Mantovani

Tsegahun Manyazewal

Chabila C Mapoma

Christopher Margono

Jose Martinez-Raga

Sheila Cristina Ouriques Martins

Francisco Rogerlândio Martins-Melo

Ira Martopullo

Winfried März

Benjamin Ballard Massenburg

Manu Raj Mathur

Pallab K Maulik

Mohsen Mazidi

Colm McAlinden

John J McGrath

Martin McKee

Suresh Mehata

Ravi Mehrotra

Kala M Mehta

Varshil Mehta

Toni Meier

Fabiola Mejia-Rodriguez

Kidanu Gebremariam Meles

Mulugeta Melku

Peter Memiah

Ziad A Memish

Walter Mendoza

Degu Abate Mengiste

Desalegn Tadese Mengistu

Bereket Gebremichael Menota

George A Mensah

Atte Meretoja

Tuomo J Meretoja

Haftay Berhane Mezgebe

Tomasz Miazgowski

Renata Micha

Robert Milam

Anoushka Millear

Ted R Miller

GK Mini

Shawn Minnig

Andreea Mirica

Erkin M Mirrakhimov

Awoke Misganaw

Philip B Mitchell

Fitsum Weldegebreal Mlashu

Babak Moazen

Karzan Abdulmuhsin Mohammad

Roghayeh Mohammadibakhsh

Ebrahim Mohammed

Mohammed A Mohammed

Shafiu Mohammed

Ali H Mokdad

Glen Liddell Mola

Mariam Molokhia

Fatemeh Momeniha

Lorenzo Monasta

Julio Cesar Montañez Hernandez

Mahmood Moosazadeh

Maziar Moradi-Lakeh

Paula Moraga

Lidia Morawska

Ilais Moreno Velasquez

Rintaro Mori

Shane D Morrison

Mark Moses

Seyyed Meysam Mousavi

Ulrich O Mueller

Manoj Murhekar

Gudlavalleti Venkata Satyanarayana Murthy

Srinivas Murthy

Jonah Musa

Kamarul Imran Musa

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

Ellen Nolte

Vuong Minh Nong

Ole F Norheim

Bo Norrving

Jean Jacques N Noubiap

Alypio Nyandwi

Carla Makhlouf Obermeyer

Richard Ofori-Asenso

Felix Akpojene Ogbo

In-Hwan Oh

Olanrewaju Oladimeji

Andrew Toyin Olagunju

Tinuke Oluwasefunmi Olagunju

Pedro R Olivares

Patricia Pereira Vasconcelos de Oliveira

Helen E Olsen

Bolajoko Olubukunola Olusanya

Jacob Olusegun Olusanya

Kanyin Ong

John Nelson Opio

Eyal Oren

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.

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

Journal Article Type Article
Acceptance Date May 23, 2018
Online Publication Date Jun 1, 2018
Publication Date Jun 2, 2018
Deposit Date May 15, 2019
Publicly Available Date Mar 28, 2024
Journal The Lancet
Print ISSN 0140-6736
Electronic ISSN 1474-547X
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 391
Issue 10136
Pages 2236-2271
DOI https://doi.org/10.1016/S0140-6736%2818%2930994-2
Public URL https://hull-repository.worktribe.com/output/1750569
Publisher URL https://www.sciencedirect.com/science/article/pii/S0140673618309942?via%3Dihub

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