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dc.contributor.authorFullman, Nancy
dc.contributor.authorYearwood, Jamal
dc.contributor.authorAbay, Solomon M.
dc.contributor.authorAbbafati, Cristiana
dc.contributor.authorAbd-Allah, Foad
dc.contributor.authorAbdela, Jemal
dc.contributor.authorAbdelalim, Ahmed
dc.contributor.authorAbebe, Zegeye
dc.contributor.authorAbebo, Teshome Abuka
dc.contributor.authorAboyans, Victor
dc.contributor.authorAbraha, Haftom Niguse
dc.contributor.authorAbreu, Daisy M. X.
dc.contributor.authorAbu-Raddad, Laith J.
dc.contributor.authorAdane, Akilew Awoke
dc.contributor.authorAdedoyin, Rufus Adesoji
dc.contributor.authorAdetokunboh, Olatunji
dc.contributor.authorAdhikari, Tara Ballav
dc.contributor.authorAfarideh, Mohsen
dc.contributor.authorAfshin, Ashkan
dc.contributor.authorAgarwal, Gina
dc.contributor.authorAgius, Dominic
dc.contributor.authorAgrawal, Anurag
dc.contributor.authorAgrawal, Sutapa
dc.contributor.authorKiadaliri, Aliasghar Ahmad
dc.contributor.authorAichour, Miloud Taki Eddine
dc.contributor.authorAkibu, Mohammed
dc.contributor.authorAkinyemi, Rufus Olusola
dc.contributor.authorAkinyemiju, Tomi F.
dc.contributor.authorAkseer, Nadia
dc.contributor.authorAl Lami, Faris Hasan
dc.contributor.authorAlahdab, Fares
dc.contributor.authorAl-Aly, Ziyad
dc.contributor.authorAlam, Khurshid
dc.contributor.authorAlam, Tahiya
dc.contributor.authorAlasfoor, Deena
dc.contributor.authorAlbittar, Mohammed I.
dc.contributor.authorAlene, Kefyalew Addis
dc.contributor.authorAl-Eyadhy, Ayman
dc.contributor.authorAli, Syed Danish
dc.contributor.authorAlijanzadeh, Mehran
dc.contributor.authorAljunid, Syed M.
dc.contributor.authorAlkerwi, Ala'a
dc.contributor.authorAlla, Francois
dc.contributor.authorAllebeck, Peter
dc.contributor.authorAllen, Christine
dc.contributor.authorAlomari, Mahmoud A.
dc.contributor.authorAl-Raddadi, Rajaa
dc.contributor.authorAlsharif, Ubai
dc.contributor.authorAltirkawi, Khalid A.
dc.contributor.authorAlvis-Guzman, Nelson
dc.contributor.authorAmare, Azmeraw T.
dc.contributor.authorAmenu, Kebede
dc.contributor.authorAmmar, Walid
dc.contributor.authorAmoako, Yaw Ampem
dc.contributor.authorAnber, Nahla
dc.contributor.authorAndrei, Catalina Liliana
dc.contributor.authorAndroudi, Sofia
dc.contributor.authorAntonio, Carl Abelardo T.
dc.contributor.authorAraujo, Valdelaine E. M.
dc.contributor.authorAremu, Olatunde
dc.contributor.authorArnlöv, Johan
dc.contributor.authorArtaman, Al
dc.contributor.authorAryal, Krishna Kumar
dc.contributor.authorAsayesh, Hamid
dc.contributor.authorAsfaw, Ephrem Tsegay
dc.contributor.authorAsgedom, Solomon Weldegebreal
dc.contributor.authorAsghar, Rana Jawad
dc.contributor.authorAshebir, Mengistu Mitiku
dc.contributor.authorAsseffa, Netsanet Abera
dc.contributor.authorAtey, Tesfay Mehari
dc.contributor.authorAtre, Sachin R.
dc.contributor.authorAtteraya, Madhu S.
dc.contributor.authorAvila-Burgos, Leticia
dc.contributor.authorAvokpaho, Euripide Frinel G. Arthur
dc.contributor.authorAwasthi, Ashish
dc.contributor.authorQuintanilla, Beatriz Paulina Ayala
dc.contributor.authorAyalew, Animut Alebel
dc.contributor.authorAyele, Henok Tadesse
dc.contributor.authorAyer, Rakesh
dc.contributor.authorAyuk, Tambe Betrand
dc.contributor.authorAzzopardi, Peter
dc.contributor.authorAzzopardi-Muscat, Natasha
dc.contributor.authorBabalola, Tesleem Kayode
dc.contributor.authorBadali, Hamid
dc.contributor.authorBadawi, Alaa
dc.contributor.authorBanach, Maciej
dc.contributor.authorBanerjee, Amitava
dc.contributor.authorBanstola, Amrit
dc.contributor.authorBarber, Ryan M.
dc.contributor.authorBarboza, Miguel A.
dc.contributor.authorBarker-Collo, Suzanne L.
dc.contributor.authorBärnighausen, Till
dc.contributor.authorBarquera, Simon
dc.contributor.authorBarrero, Lope H.
dc.contributor.authorBassat, Quique
dc.contributor.authorBasu, Sanjay
dc.contributor.authorBaune, Bernhard T.
dc.contributor.authorBazargan-Hejazi, Shahrzad
dc.contributor.authorBedi, Neeraj
dc.contributor.authorBeghi, Ettore
dc.contributor.authorBehzadifar, Masoud
dc.contributor.authorBehzadifar, Meysam
dc.contributor.authorHtet, Aung Soe
dc.contributor.authorKisa, Adnan
dc.contributor.authorNorheim, Ole Frithjof
dc.contributor.authorSavic, Miloje
dc.contributor.authorSkirbekk, Vegard Fykse
dc.contributor.authorVollset, Stein Emil
dc.contributor.authorWeiderpass, Elisabete
dc.contributor.authorWinkler, Andrea Sylvia
dc.date.accessioned2022-04-28T10:59:19Z
dc.date.available2022-04-28T10:59:19Z
dc.date.issued2018-06-01
dc.description.abstractBackground 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.<p> <p>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.<p> <p>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.<p> <p>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 middleSDI 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.en_US
dc.identifier.citationFullman N, Yearwood, Abay, Abbafati C, Abd-Allah F, Abdela, Abdelalim, Abebe, Abebo TA, Aboyans V, Abraha HN, Abreu, Abu-Raddad LJ, Adane, Adedoyin RA, Adetokunboh O, Adhikari, Afarideh M, Afshin A, Agarwal, Agius, Agrawal A, Agrawal S, Kiadaliri AA, Aichour MTE, Akibu, 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, Aljunid, Alkerwi A, Alla F, Allebeck P, Allen C, Alomari MA, Al-Raddadi R, Alsharif U, Altirkawi KA, Alvis-Guzman N, Amare AT, Amenu, Ammar W, Amoako YA, Anber N, Andrei, Androudi, Antonio CAT, Araujo, Aremu, Arnlöv J, Artaman A, Aryal KK, Asayesh H, Asfaw, Asgedom, Asghar, Ashebir, Asseffa, Atey TM, Atre, Atteraya, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Quintanilla BPA, Ayalew, Ayele, Ayer, Ayuk, Azzopardi P, Azzopardi-Muscat, Babalola, Badali, Badawi A, Banach M, Banerjee A, Banstola, Barber RM, Barboza, Barker-Collo SL, Bärnighausen T, Barquera S, Barrero LH, Bassat Q, Basu S, Baune BT, Bazargan-Hejazi S, Bedi N, Beghi E, Behzadifar, Behzadifar, Htet AS, Kisa A, Norheim OF, Savic M, Skirbekk V, Vollset SE, Weiderpass E, Winkler AS. 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. The Lancet. 2018;391(10136):2236-2271en_US
dc.identifier.cristinIDFRIDAID 1600371
dc.identifier.doi10.1016/S0140-6736(18)30994-2
dc.identifier.issn0140-6736
dc.identifier.issn1474-547X
dc.identifier.urihttps://hdl.handle.net/10037/24927
dc.language.isoengen_US
dc.publisherElsevieren_US
dc.relation.journalThe Lancet
dc.relation.projectIDinfo:eu-repo/grantAgreement/EC/H2020/703226/EU/Chronic kidney disease and acute kidney injury – evaluation of EU and global epidemiology/CKD AKI/en_US
dc.relation.urihttps://reader.elsevier.com/reader/sd/4869B9F2AF630E48730B853CF5149F872C749C884672EA4B1E2C2DD1162DA003CBC64815D31130DA7FA7ED90130F827C
dc.rights.accessRightsopenAccessen_US
dc.rights.holderCopyright 2018 The Author(s)en_US
dc.titleMeasuring 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 2016en_US
dc.type.versionpublishedVersionen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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