Nancy Fullman
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
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
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Peter W Gething
Reza Ghadimi
Khalil Ghasemi Falavarjani
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Senior Lecturer in Epidemiology
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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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This work is licensed under a Creative Commons Attribution 4.0 International License.
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