Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015
National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income coun...
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| Vydáno v: | The Lancet (British edition) Ročník 390; číslo 10091; s. 231 - 266 |
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| Médium: | Journal Article |
| Jazyk: | angličtina |
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England
Elsevier Ltd
2017
Elsevier Limited Elsevier |
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| ISSN: | 0140-6736, 1474-547X, 1474-547X |
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| Abstract | National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015.
We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time.
Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0–42·8) in 1990 to 53·7 (52·2–55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015.
This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world.
Bill & Melinda Gates Foundation. |
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| AbstractList | BACKGROUND: National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. METHODS: We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. FINDINGS: Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. INTERPRETATION: This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. FUNDING: Bill & Melinda Gates Foundation. Summary Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions ( r =0·83), and human resources for health per 1000 ( r =0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0–42·8) in 1990 to 53·7 (52·2–55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Funding Bill & Melinda Gates Foundation. Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r= 0.88), an index of 11 universal health coverage interventions (r= 0.83), and human resources for health per 1000 (r= 0.77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28.6 to 94.6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40.7 (95% uncertainty interval, 39.0-42.8) in 1990 to 53.7 (52.2-55.4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21.2 in 1990 to 20.1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73.8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-systemcharacteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r= 0.88), an index of 11 universal health coverage interventions (r= 0.83), and human resources for health per 1000 (r= 0.77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28.6 to 94.6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40.7 (95% uncertainty interval, 39.0-42.8) in 1990 to 53.7 (52.2-55.4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21.2 in 1990 to 20.1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73.8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-systemcharacteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright (C) The Author(s). Published by Elsevier Ltd. Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright © The Author(s). Published by Elsevier Ltd. National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0–42·8) in 1990 to 53·7 (52·2–55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Bill & Melinda Gates Foundation. National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Funding Bill & Melinda Gates Foundation. National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015.BACKGROUNDNational levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015.We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time.METHODSWe mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time.Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015.FINDINGSBetween 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015.This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world.INTERPRETATIONThis novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world.Bill & Melinda Gates Foundation.FUNDINGBill & Melinda Gates Foundation. BACKGROUND: National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. METHODS: We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. FINDINGS: Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. INTERPRETATION: This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. FUNDING: Bill & Melinda Gates Foundation. |
| Author | Roth, Gregory A Lorch, Scott A Foigt, Nataliya Rai, Rajesh Kumar Wiysonge, Charles Shey Mezgebe, Haftay Berhane Yan, Lijing L Ningrum, Dina Nur Anggraini Sykes, Bryan L Mohammed, Shafiu Nachega, Jean B Larsson, Anders Naghavi, Mohsen Sinshaw, Aklilu Endalamaw Kumsa, Fekede Asefa Lozano, Rafael Mazidi, Mohsen Mantovani, Lorenzo G Lal, Dharmesh Kumar Lind, Margaret Shakh-Nazarova, Marina Abdulle, Abdishakur M Coggeshall, Megan S Ogbo, Felix Akpojene Butt, Zahid A Tesema, Azeb Gebresilassie Chibalabala, Mirriam Talongwa, Roberto Tchio Htet, Aung Soe Santos, Itamar S Smith, Alison Agarwal, Sunilkumar Rawaf, Salman Shaikh, Masood Ali Serdar, Berrin Shiri, Rahman Cortinovis, Monica Gebre, Teshome Singh, Virendra Kan, Haidong Troeger, Christopher Bernal, Oscar Alberto Ribeiro, Antonio L Brainin, Michael Neupane, Sudan Prasad Lotufo, Paulo A Hoek, Hans W Mohammad, Karzan Abdulmuhsin Alam, Sayed Saidul Molokhia, Mariam Workie, Shimelash Bitew Bikbov, Boris Kesavachandran, Chandrasekharan Nair Khalil, Ibrahim Tekelab, Tesfalidet Logroscino, Giancarl |
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| Copyright | 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved. Copyright Elsevier Limited Jul 15, 2017 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license 2017 |
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| CorporateAuthor | GBD 2015 Healthcare Access and Quality Collaborators GBD 2015 Healthcare Access and Quality Collaborators. Electronic address: cjlm@uw.edu Department of Clinical Sciences, Lund Faculty of Medicine Institutionen för kliniska vetenskaper, Lund Lunds universitet Section III Medicinska fakulteten Lund University Sektion III Orthopaedics (Lund) Ortopedi, Lund |
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| Keywords | Development Goals Life Expectancy Avoidable Mortality United-States Systematic Analysis European Countries Death Trends Medical-Care Comparative Risk-Assessment maternal disease risk assessment health insurance ischemic heart disease congenital heart malformation hematologic disease infant pertussis tetanus health care delivery adverse drug reaction demography femoral hernia testis cancer health care access non melanoma skin cancer cerebrovascular disease tuberculosis rectum cancer Healthcare Quality and Access Index standards educational status peptic ulcer rheumatic heart disease global disease burden adult Peru Universal Coverage Article appendicitis cause of death chronic kidney failure Middle East accidental injury procedures middle income country cardiovascular disease socioeconomics Turkey (republic) aged gallbladder disease Hodgkin disease malignant neoplasm South Asia lower respiratory tract infection mortality West African low income country health status indicator assessment of humans epilepsy insurance leukemia endocrine disease skin carcinoma major clinical study Humans fertility statistics and numerical data gastrointestinal disease South Korea Health Services Accessibility female health care disparity health care quality diarrhea inguinal hernia death certificate adolescent East African uterine cervix cancer child chronic respiratory tract disease income comparative study biliary tract disease Health Status Indicators environmental impact standardization uterus cancer diabetes mellitus geographic mapping Global Burden of Disease neurologic disease urogenital tract disease China health behavior performance measurement system priority journal human diphtheria health care system hospital bed high income country colon cancer abdominal wall hernia breast cancer health care cost newborn risk factor controlled study newborn disease Africa south of the Sahara hypertension measles upper respiratory tract infection Quality of Health Care |
| Language | English |
| License | This is an open access article under the CC BY license. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
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| Snippet | National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the... Summary Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be... Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in... BACKGROUND: National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in... |
| SourceID | swepub pubmedcentral proquest pubmed crossref elsevier |
| SourceType | Open Access Repository Aggregation Database Index Database Enrichment Source Publisher |
| StartPage | 231 |
| SubjectTerms | 1977 1986 1988 Abakaliki Abdallah M.] Ain Shams Univ Abdulhalik] Univ Ghent Abdullah Sulieman] Cleveland Clin Abdullah Sulieman] King Fahad Med City Abdullah Sulieman] Univ Virginia Abiy Hiruye] Ethiopian Med Assoc Abuja Accra ACT Addis Ababa Addis Continental Inst Publ Hlth Adelaide Aklilu Endalamaw] Univ Gondar AL USA Alan J.] Adapt Knowledge Management Albany Alberto] IIS Fdn Jimenez Diaz UAM Albuquerque Alem] Howard Univ Alemayehu B.] Univ Sydney Aletta E.] North West Univ Aletta E.] South African Med Res Council Algeria Algorithms Alicia Elena Beatriz] Inst Nacl Epidemiol Dr Juan H Jara Alireza Allmänmedicin Almada Alton Amini Amir] AT Still Univ Amir] Univ Tehran Med Sci Amira] Najah Univ Anand Anders] Uppsala Univ Andhra Pradesh Andre M. N. N.] Univ Western Sydney Andrea] Fed Inst Populat Res Anselm] Soc Family Hlth Anton Carl Jonas] Stockholm Cty Council Antonio L.] Univ Fed Minas Gerais Anwar Aparna Aparna] Australian Natl Univ AR USA Arash] Iran Univ Med Sci Arba Minch Arctic Univ Norway arlton jrh Asma Abdul] Lahore Coll Women Univ Aswan Aswan Fac Med Athens Atlanta Aurora Australia avoidable mortality Avon AZ USA Baltimore Bangalore Bangladesh Baracaldo Bari Beijing Beirut Belgium Belo Horizonte Ben Benasco] World Hlth Org Ben] FOM Univ Benn] SAMRC Benn] Univ KwaZulu Natal Bereket] Univ KwaZulu Natal Bergamo Berrin] Univ Colorado Bethesda Bhutan Birmingham Bishkek Bogota Bolajoko Olubukunola Bolivia Bologna Boroko Boston Brasilia Brazil Breast Surg Unit Brien Holden Vision Inst Brisbane Bristol british medical journal Bruno Ramos Bruno Ramos] Hosp Univ Ciencias Med Bryan L.] Univ Calif Irvine Bucharest Buenos Aires Burwood CA USA Cairo Calgary Callaghan Cambridge Cameroon Canada Canberra Cape Town Carla Makhlouf] Amer Univ Beirut Carlos] EcoHlth Alliance Carlos] Inst Ecol Bolivia Castillo Champaign Chandigarh Chandrashekhar T.] Int Med Univ Charles D. A.] Guys & St Thomas NHS Fdn Trust Charles D. A.] Kings Coll London Charles R.] KEMRI Wellcome Trust Charles Shey] Cochrane South Africa Charles Shey] Univ Stellenbosch Charlottesville Chennai Cherbourg Chicago Chie] Natl Ctr Child Hlth & Dev Chigozie Jesse] Ebonyi State Univ Childrens Hosp Philadelphia Chile Chuanhua] Wuhan Univ Cleveland CO USA Coll Med Coll Optometry Colm] Publ Hlth Wales Colm] Univ Hosp Bristol NHS Fdn Trust Colombia Columbus comparative risk-assessment Competence Ctr Mortality Follow Up German Natl Co Comprehens Biomed Res Ctr Constance D.] Univ Newcastle Copenhagen Coventry Ctr Air Pollut Res Inst Environm Res Ctr Comprehens Canc Ctr Control Chron Condit Ctr Epidemiol & Community Med Ctr Hlth Res Ctr Res Populat & Hlth Ctr Translat Res & Implementat Sci Dar Es Salaam David M.] Univ Porto Dayane Gabriele Alves] Brasilia Univ DC USA death Deborah Carvalho] Univ Fed Minas Gerais Deepak] UK Dept Int Dev Denis] St Johns Med Coll & Res Inst Denmark Dent Inst Dept Anesthesiol Dept Biomed & Clin Sci L Sacco Dept Biostat Dept Clin Neurol Sci Dept Community Med Dept Dermatol Dept Epidemiol & Biostat Dept Internal Med Dept Med Dept Med Sci Dept Neurol Dept Prevent Med Dept Publ Dept Publ Hlth Dept Publ Hlth Sci Dept Res Dept Sociol Dept Vet Affairs Dept Zool Detroit development goals Dhaka Diego Augusto Santos] Univ Fed Santa Catarina Dietrich] Ulm Univ Digest Dis Res Dina Nur Anggraini] Semarang State Univ Discipline Publ Hlth Med Disease Div Populat & Patient Hlth Durban Eduardo A.] Brandeis Univ Edward J.] Univ Ottawa Egypt El Razek Elisabete] Canc Registry Norway Elisabete] Folkhalsan Res Ctr Elisabete] Univ Tromso Elizabeth Palomares] Minist Hlth Elizabeth Palomares] Univ Nacl Autonoma Mexico Endocrinol & Metab Populat Sci Inst Endocrinol & Metab Res Ctr England Epidemiology Erbil Erfan] Univ Tehran Med Sci Erkin M.] Kyrgyz State Med Acad Erkin M.] Natl Ctr Cardiol & Internal Dis Essen Esteghamati Ethiopia Eugene] Univ Yaounde Eugene] Yaounde Cent Hosp European Commiss european countries expectancy Eyal] Univ Arizona Fac Farm Fac Hlth Sci Fac Med Farshad Farzadfar Faulty Pharm Felix Akpojene] Univ Western Sydney Fernando] Biocruces Hlth Res Inst Fernando] Hop Univ Cruces Finland Finnish Inst Occupat Hlth Work Org FL 33314 USA Florence Florianopolis Folkhälsovetenskap France Francesco S.] Univ Bologna Frida Namnyak] Minist Hlth & Social Welf Friedman Sch Nutr Sci & Policy Ft Lauderdale Ft Portal GA 30322 USA Gabriele] Ulm Univ Gastrointestinal & Liver Geelong Gelin] Nanjing Univ General Medicine Genet Epidemiol Grp Geography George A.] NHLBI Germany Ghana Ghent Gholamreza Gholamreza] Golestan Univ Med Sci Giancarlo] Univ Bari Girma Temam] Arba Minch Univ Giuseppe] Papa Giovanni XXIII Giuseppe] Univ Milan Glen Liddell D.] Univ Papua New Guinea Global Burden of Disease Global health Global Hlth Inst Global Hlth Res Ctr Golestan Res Ctr Gastroenterol & Hepatol Gondar Gorgan Gothenburg Grad Sch Grad Sch Publ Hlth Greece Gujarat Gurgaon Guy B.] Univ Sydney Hafezi-Nejad Haifa Haitham] Imperial Coll London Halle Hanover Hassan Magdy Abd] Mansoura Fac Med Hassanvand Health and Welfare Health care Health care policy Health Sciences Health services Health Services Accessibility - standards Health Services Accessibility - statistics & numerical data Health Status Indicators Heidelberg Helsinki Hematol Oncol & Stem Cell Transplantat Res Ctr Hlth Metr Unit Hlth Syst & Policy Res Unit Hong Kong Hong Kong Jockey Club Ctr Suicide Res & Prevent Hosp Clin Hosp Pedro Hispano Humans Huntington Hyderabad Hypertens Africa Res Team HART Hälsa och välfärd Hälsovetenskap Ibadan Iceland ikolainen k IL 60611 USA IL USA In-Hwan] Kyung Hee Univ INCLIVA Hlth Res Inst India Indonesia Inga Dora] Reykjavik Univ Inst Environm Res Inst Epidemiol & Med Biometry Inst Genet & Dev Biol Inst Hlth Care & Social Sci Inst Hlth Policy & Management Inst Invest Hosp Univ Princesa Inst Maternal & Child Hlth Inst Med Sci Inst Populat Based Canc Res Inst Publ Hlth Inst Resilient Regions Int Lab Air Qual & Hlth Internal Medicine international journal of epidemiology Ionut] Carol Davila Univ Med & Pharm Bucharest Iran Iraq Irvine Ispra Israel Istanbul Italy J Edwards Sch Med J. S.] Post Grad Inst Med Educ & Res Jackson Jacob Olusegun] Ctr Healthy Start Initiat Jaipur James James D.] Wayne State Univ Janet L.] Nova Southeastern Univ Japan Jasvinder A.] Birmingham Vet Affairs Med Ctr Jasvinder A.] Univ Alabama Birmingham Jayendra] Minist Hlth Jean B Jean B.] Johns Hopkins Bloomberg Sch Publ Hlth Jean B.] Univ Pittsburgh Jean Jacques N.] Med Diagnost Ctr Jeemon Jiabin] Nationwide Childrens Hosp Jiandong] Queensland Univ Technol Jiandong] Univ Southern Queensland Jiangsu Jinling Hosp Joan B.] Univ Autonoma Madrid Joao] ULS Matosinhos Johannesburg John Nelson] Lira Dist Local Govt Jose] CEU Cardinal Herrera Univ Jose] Hosp Univ Doctor Peset Josephine Wanjiku] Univ Nairobi Joshua] Mt Moon Univ Joshua] Univ Ghent JSS Med Coll JSS Univ Juan Ramon] Case Western Reserve Univ Juan Ramon] Marshall Univ Judd L.] Nat Hist Museum Julian David] Durban Univ Technol Kamarul Imran] Univ Sci Malaysia Karaj Karen M.] Univ Illinois Karnataka Karzan Abdulmuhsin] Univ Salahaddin Kasaeian Kenya Key State Lab Mol Dev Biol Kilifi Kingsley N.] Fed Teaching Hosp kinlay jb Kirksville Konrad] Flinders Univ S Australia Konstantinos] Alexandra Gen Hosp Athens Konstantinos] Ctr Hosp Publ Cotentin Krakow Kuala Lumpur Kubang Kerian Kulkarni Kunshan Kyoto Kyrgyzstan La Paz Lab Farmacognosia Lager Lagos Lahore Lal Lalitpur Lallukka Lan Lansingh Larsson Latif Lawrynowicz Leasher Lebanon Leigh Leinsalu Leung Levi Liang Lidia] Queensland Univ Technol Liesl Joanna] Red Cross War Mem Childrens Hosp life Lijing L.] Duke Kunshan Univ Linn Lipshultz Lira Lira Municipal Council Lisbon Liu Liverpool Lo Logroscino London Loon-Tzian] Alton Mental Hlth Ctr Loon-Tzian] UnionHealth Associates LLC Lorch Lorenzo Lorenzo G.] Univ Milano Bicocca Los Angeles Luca] IRCCS Burlo Garofolo Luciano A.] Western Univ Luigi] Azienda Osped Papa Giovanni XXIII Lunevicius MA 02111 USA MA USA Mackay Madrid Magsaysay Mem Med Ctr Maharashtra Mahboubeh] Univ Tehran Med Sci Mahdavi Mahdi] Erasmus Univ Mahdi] Social Secur Org Res Inst Mahfuzar] BRAC Majdi] YBank Malaysia Malekzadeh Mall] Sodertorn Univ Malta Man Mohan] Janakpuri Superspecialty Hosp Managerial Epidemiol Res Ctr Manorama] Intergrowth 21st Study Res Ctr Mansour] Univ Tehran Med Sci Mansoura Mantovani Manu Raj] Publ Hlth Fdn India Manyazewal Mar Del Plata Maragheh Marcella Marcello] Univ Calgary Marcenes Maria Albertina Santiago] Univ Fed Minas Gerais Maria Dolores] IIS Fdn Jimenez Diaz Marika] Natl Inst Publ Hlth Mark Andrew] Deakin Univ Mark T Mark] Univ Sheffield Marks Martinez-Raga Marzan Massano Mathur Matosinhos Maulik Max] Univ Gothenburg Max] Univ Witwatersrand Mayowa O.] Blossom Specialist Med Ctr Mayowa O.] Dept Med Maysaa El Sayed] Mansoura Univ Maziar] Iran Univ Med Sci Mazidi McAlinden MD 20814 USA MD 20892 USA MD USA Meaney Med Coll Med Sch Medical and Health Sciences medical-care Medicin och hälsovetenskap Mehari Mehdi] Univ Tehran Med Sci Mehndiratta Meier Mekonnen Melbourne Melvin Barrientos] Univ East Ramon Memish Mensah Meretoja Merseyside Mete I.] Bayer Turkey Mexico Mexico City MI 48201 USA MI USA Micha Michael Robert] Emory Univ Michael Robert] Shanghai Jiao Tong Univ Miguel] Hosp Univ Dr Peset Mika] Natl Inst Infect Dis Mika] Sandia Natl Labs Milan milbank memorial fund quarterly-health and society Millenium Med Coll Mills Min-Jeong] Korea Univ MINSANTE Mirarefin Miriam] Tuscany Reg Ctr Occupat Injuries & Dis Mirrakhimov MO USA Mohammad Mohammad Ali] Univ Tehran Med Sci Mohammad Sadegh] Univ Tehran Med Sci Mohammad Yahya] Minist Hlth Mohammad] New York Med Ctr Mohammed Mohammed Magdy Abd] Aswan Univ Hosp Mohsen] Chinese Acad Sci Mohsen] Univ Saskatchewan Mojde] Hunger Act Los Angeles Mola Monasta Moncada Monika] Marshall Univ Montico Monza Moradi-Lakeh Moraga Morawska Mori Mortality Moscow Mostafa] Alborz Univ Med Sci MS Res Ctr MS USA Muawiyyah Babale] Ahmadu Bello Univ Mueller Muhammad Muhammad] Dev Res & Projects Ctr Munster Musa Musharaf] Inst Conmemorativo Gorgas Estudios Salud Mustafa Z.] Jackson State Univ Mysore Nablus Nachega Nagata Nagel Nagpur Nairobi Naldi Namibia Nangia Nanjing Naohiro] Kyoto Univ Narayanaswamy] Raffles Hosp Nascimento Natl Ctr Epidemiol & Populat Hlth Natl Inst Hlth Natl Sch Publ Hlth Nawal K.] Duke NUS Med Sch Nawal K.] Holmusk Negoi Nepal Netherlands Neurosci Inst New Delhi New York Newcastle Newton Ngalesoni Ngunjiri NH 03755 USA Nicholas] Univ East Anglia Nigeria NIH Nima] Univ Tehran Med Sci Ningrum NM 87185 USA Nolte Nomura Noncommunicable Dis Res Ctr Norfolk Norway Norwich Noubiap NSW Nuno] Inst Super Ciencias Saude Egas Moniz Nuno] Univ Lisbon NY 12222 USA NY USA Obermeyer Ogbo Oh OH 44106 USA OH USA Okoro Oladimeji Olalekan A.] Univ Warwick Olanrewaju] HSRC Olanrewaju] Univ KwaZulu Natal Olivares Olusanya Om Prakash] Banaras Hindu Univ Opio Oporto Oren Ortiz Osborne OSI EE Cruces Oslo Osman Ottawa Outcomes Res Consortium Owolabi p295 p405 p86 PA 19104 USA PA USA Pakhale Pakistan Palestine Pallab K.] George Inst Global Hlth India Panama Panama City Panniyammakal] Publ Hlth Fdn India Parsaeian Patel Paturi Vishnupriya] Diabet Res Ctr Paturi Vishnupriya] Diabet Res Soc Paudel Paul] Univ Hong Kong Paula] Queensland Univ Technol Pedro R.] Univ Autonoma Chile Peilin] Tufts Univ Penrith Peoples Peoples R China Pereira Perelman Sch Med Perez-Padilla Perez-Ruiz Perminder S.] Prince Wales Hosp Perminder S.] Univ New South Wales Personal health Pesudovs Peter A.] Childrens Hosp Philadelphia Peter A.] Univ Penn Petzold Philadelphia Philippines Phillips Pillay Pittsburgh Poland Pond Populat Hlth Strateg Res Ctr Portugal Potchefstroom Prakash Prashant Kumar] Inst Human Dev Prevent Med & Publ Hlth Res Ctr Preventat Med & Publ Hlth Res Ctr Principal components analysis Publ Hlth Med Public health Purwar Qing] NCI Qld Qorbani Quality of care Quality of Health Care - standards Quality of Health Care - statistics & numerical data Queretaro Quezon City Radfar Rafael] CIBERSAM Rafael] Univ Valencia Rafay Raffles Neurosci Ctr Rahimi-Movaghar Rahman Rahman] Univ Helsinki Rai Raimundas] Aintree Univ Hosp Natl Hlth Serv Fdn Trust Raimundas] Univ Liverpool Rajasthan Rajesh Kumar] Soc Hlth & Demog Surveillance Rajesh] Indian Inst Technol Ropar Rana Randwick Rao Rego Remuzzi Renata] Tufts Univ Renzaho Reprod Hlth & ObGyn REQUIMTE LAQV Res & Evaluat Div Res Inst Resnikoff Reykjavik Reza Ribeiro Richard H.] Deakin Univ Ricky] SUNY Albany Rigshosp Rintaro] Natl Ctr Child Hlth & Dev Rio De Janeiro Risk analysis Risk Assessment - methods Risk factors Rita] Joint Res Ctr Riyadh Rizwan Abdulkader] Minist Hlth Robert G.] Royal Childrens Hosp Roberto Tchio] Minist Hlth Rockville Rodrigo] Univ Ciencias Aplicadas & Ambient Rogelio] Natl Inst Resp Dis Roman] Jagiellonian Univ Romania Ronfani Ronny] Fed Inst Populat Res Ronny] German Natl Cohort Consortium Roshandel Rothenbacher Rotterdam Roy Ruoyan] Natl Ctr Child Hlth & Dev Rupnagar Russia S Yorkshire Saale Sabine] Univ Hosp Muenster Sachdev Sackey Sadaf G.] Univ Tehran Med Sci Saeedi Saeid] Maragheh Univ Med Sci Saeid] Tufts Med Ctr Safiri Sahraian Saitama Saleem M.] Contech Int Hlth Consultants Saleem M.] Contech Sch Publ Hlth Saleh Samir] Dartmouth Coll Samy Sanabria Sanchez-Nino Sandra] Deakin Univ Sao Paulo Sara] Univ Tehran Med Sci Sarmiento-Suarez Sartorius Saskatoon Saudi Arabia Sawhney Saylan Sch Hlth & Related Res Sch Hlth & Social Dev Sch Med Sch Med & Hlth Sci Sch Med Sci Sch Nursing & Publ Hlth Sch Optometry & Vis Sci Sch Publ Hlth Sch Publ Hlth & Social Work Sch Social Work Schoettker Schutte Scott A.] Univ Penn Seedat Semarang City Seok-Jun] Korea Univ Seoul Sepanlou Serdar Serge] Univ New South Wales Sergey K.] Fed Res Inst Hlth Org & Informat Setagaya Ku Setif Shafiu] Ahmadu Bello Univ Shaheen Shahraz Shai] Univ Haifa Shamsipour Shanghai Sharma Sheffield Sheikhbahaei Shen Shi Shifa Shigematsu Shimelash Bitew] Wolaita Sodo Univ Shin Shiri Shoman Sigfusdottir Silva Silveira Sina Trauma & Surg Res Ctr Singapore Singh Sinke Sinshaw Smita] Ottawa Hosp Sobngwi Social Work & Social Adm Dept Solna Soneji Soraya Soriano Soumya] Indian Council Med Res Sousa South South Africa South African Med Res Council South Korea Spain Sposato Springfield Sreeramareddy St Louis St Pauls Hosp State Univ Stathopoulou Statistical analysis Steel Steinke Stephen G.] Uniformed Serv Univ Hlth Sci Steven E Steven E.] Childrens Hosp Michigan Stockholm Stockholm Ctr Hlth & Social Change Stokes Strong Stroumpoulis Sufiyan Suliankatchi Sun Suri Sustainable development Swaminathan Swansea Sweden Sydney Sykes systematic analysis Tabares-Seisdedos Tabb Talca Talongwa Tamil Nadu Tampere Tanzania Tarajia Tatiane Cristina Moraes] Fundacao Oswaldo Cruz Tavakkoli Taveira Tea Tehran Tehrani-Banihashemi Tejas] Mt Sinai Hlth Syst Tekelab Terkawi Tesfalidet] Univ Newcastle Thakur Thimphu Thomas] Univ Copenhagen Thomson Tobe-Gai Tokyo Tomas] World Hlth Org Tommi] UKK Inst Hlth Promot Res Tonelli Toni] Martin Luther Univ Halle Wittenberg Topor-Madry Tortajada trends Tromso Truelsen Tsegahun] Ethiopian Publ Hlth Assoc Tucson Tuomo J.] Helsinki Univ Hosp Tuomo J.] Univ Helsinki Turkey Uche S.] Washington DC Uchendu Uganda Ukwaja UKZN Gastrointestinal Canc Res Ctr Ulm Ulrich O Undurraga Uneke united-states Univ Med Ctr Rotterdam Universal Health Insurance - standards Universal Health Insurance - statistics & numerical data Uppsala Urooncol Res Ctr Uthman Uttar Pradesh V.] Charotar Univ Sci & Technol v17 v292 v55 VA USA Vafa] Univ Tehran Med Sci Valencia Valhalla Van C.] Help Me See Inc Van C.] Inst Mexicano Oftalmol Van Dingenen Varanasi Vasankari Vasiliki] Attikon Univ Hosp Vasiliy Victorovich] Natl Res Univ Higher Sch Econ Veena S.] Arkansas State Univ Venketasubramanian Vic Victoria Vinay] Suraj Eye Inst Violante Virendra] Asthma Bhawan Vladimirov Vlassov W Glam W Midlands Wagner] Kings Coll London Wales Waller Walson Waltham Wang Warwick Med Sch Washington Weiderpass Weintraub Werdecker Wesana Westerman Wiesbaden Wilkinson Windhoek Wiysonge Wolaita Sodo Wolfe Woolcock Inst Med Res Workicho Workie Wuhan WV USA Xavier Xiaofeng] Chinese Ctr Dis Control & Prevent Xu Yaghoubi Yakob Yan Yang Yano Yaounde Yaseri Yip Yonemoto Yoon Younis Yu Yuan-Pang] Univ Sao Paulo Yuichiro] Northwestern Univ Zaidi Zaki Zambrana-Torrelio Zapata Zaria Ziad A.] Alfaisal Univ Ziad A.] Saudi Minist Hlth Zoubida] Univ Hosp Zuhlke |
| Title | Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015 |
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| Volume | 390 |
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