Journal article
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
The Lancet (British edition), Vol.390(10091), pp.231-266
2017
DOI: 10.1016/S0140-6736(17)30818-8
PMCID: PMC5528124
PMID: 28528753
Abstract
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.
Details
- Title: Subtitle
- 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
- Creators
- Ryan M. Barber - University of WashingtonNancy Fullman - University of WashingtonReed J. D. Sorensen - University of WashingtonThomas Bollyky - Council Foreign Relat, Washington, DC USAMartin McKee - London Sch Hyg & Trop Med, London, EnglandEllen Nolte - London Sch Hyg & Trop Med, European Observ Hlth Syst & Policies, London, EnglandAmanuel Alemu Abajobir - The University of QueenslandKalkidan Hassen Abate - Jimma UniversityCristiana Abbafati - Univ Roma La Sapienza, Rome, ItalyKaja M. Abbas - Virginia TechFoad Abd-Allah - Cairo UniversityAbdishakur M. Abdulle - New York University Abu DhabiAhmed Abdulahi Abdurahman - University of TehranSemaw Ferede Abera - Mekelle UniversityBiju Abraham - NMSM Govt Coll Kalpetta, Kalpetta, Kerala, IndiaGirmatsion Fisseha Abreha - Mekelle UniversityKelemework Adane - Mekelle UniversityAdemola Lukman Adelekan - Publ Hlth Promot Alliance, Osogbo, NigeriaIfedayo Morayo O. Adetifa - London Sch Hyg & Trop Med, London, EnglandAshkan Afshin - University of WashingtonArnav Agarwal - University of TorontoSanjay Kumar Agarwal - All India Inst Med Sci, New Delhi, IndiaSunilkumar Agarwal - Natl Inst Occupat Hlth ICMR, Ahmadabad, Gujarat, IndiaAnurag AgrawalAliasghar Ahmad Kiadaliri - Lund UniversityAlireza Ahmadi - Kermanshah Univ Med Sci, Kermanshah, IranKedir Yimam Ahmed - Debre Markos UniversityMuktar Beshir Ahmed - Jimma UniversityRufus Olusola Akinyemi - University of IbadanTomi F. Akinyemiju - University of AlabamaNadia Akseer - University of TorontoZiyad Al-Aly - Washington Univ, St Louis, MO USAKhurshid Alam - The University of MelbourneNoore Alam - Dept Hlth, Brisbane, Qld, AustraliaSayed Saidul Alam - Int Ctr Diarrhoeal Dis Res ICDDR, Dhaka, BangladeshZewdie Aderaw Alemu - Debre Markos UniversityKefyalew Addis Alene - University of GondarLily Alexander - University of WashingtonRaghib Ali - University of OxfordSyed Danish Ali - University of LondonReza Alizadeh-Navaei - Mazandaran Univ Med Sci, Gastrointestinal Canc Res Ctr, Sari, IranAla'a Alkerwi - Luxembourg Inst Hlth, Strassen, LuxembourgFrancois Alla - Univ Lorraine, Sch Publ Hlth, Nancy, FrancePeter Allebeck - Karolinska InstitutetChristine Allen - University of WashingtonRajaa Al-Raddadi - Minist Hlth, Jeddah, Saudi ArabiaUbai Alsharif - Charité - Universitätsmedizin BerlinKhalid A. Altirkawi - King Saud UniversityElena Alvarez Martin - Spanish Observ Drugs, Govt Delegat Natl Plan Drugs, Minist Hlth Social Policy & Equal, Madrid, SpainNelson Alvis-Guzman - University of CartagenaAzmeraw T. Amare - The University of AdelaideErfan Amini - University of TehranWalid Ammar - Minist Publ Hlth, Beirut, LebanonJoshu Amo-Adjei - African Populat & Hlth Res Ctr, Nairobi, KenyaYaw Ampem Amoako - Komfo Anokye Teaching Hosp, Dept Med, Kumasi, GhanaBenjamin O. Anderson - University of WashingtonSofia Androudi - University of ThessalyHossein Ansari - Zahedan Univ Med Sci, Hlth Promot Res Ctr, Dept Epidemiol & Biostat, Zahedan, IranMustafa Geleto Ansha - West Hararghe Zonal Hlth Dept, Chiro, EthiopiaCarl Abelardo T. Antonio - Univ Philippines, Coll Publ Hlth, Dept Hlth Policy & Adm, Manila, PhilippinesJohan Aernloev - Karolinska InstitutetAl Artaman - University of ManitobaHamid Asayesh - Qom Univ Med Sci, Sch Paramed, Dept Emergency Med, Qom, IranReza Assadi - Mashhad Univ Med Sci, Mashhad, IranAyalew Astatkie - Hawassa UniversityTesfay Mehari Atey - Mekelle UniversitySuleman Atique - Taipei Med Univ, Coll Med Sci & Technol, Grad Inst Biomed Informat, Taipei, TaiwanNiguse Tadele Atnafu - Tepi Univ, Mizan Teferi, EthiopiaSachin R. Atre - Johns Hopkins UniversityLeticia Avila-Burgos - Natl Inst Publ Hlth, Cuernavaca, Morelos, MexicoEuripide Frinel G. Arthur Avokpaho - Inst Rech Clin Benin IRCB, Cotonou, BeninBeatriz Paulina Ayala Quintanilla - La Trobe UniversityAshish Awasthi - Sanjay Gandhi Postgrad Inst Med Sci, Lucknow, Uttar Pradesh, IndiaNebiyu Negussu Ayele - Minist Hlth, Addis Ababa, EthiopiaPeter Azzopardi - The University of MelbourneHuda Omer Ba Saleem - ADEN University PanamáTill Baernighausen - Harvard UniversityUmar Bacha - Univ Management & Technol, Sch Hlth Sci, Lahore, PakistanAlaa Badawi - University of TorontoAmitava Banerjee - Farr InstituteAleksandra Barac - University of BelgradeMiguel A. Barboza - CCSS, Hosp Dr Rafael Calderon Guardia, San Jose, Costa RicaSuzanne L. Barker-Collo - University of AucklandLope H. Barrero - Pontificia Univ Javeriana, Sch Engn, Dept Ind Engn, Bogota, ColombiaSanjay Basu - Stanford UniversityBernhard T. Baune - The University of AdelaideKaleab Baye - Univ Addis Ababa, Addis Ababa, EthiopiaYibeltal Tebekaw Bayou - Jhpiego Ethiopia, Addis Ababa, EthiopiaShahrzad Bazargan-Hejazi - Drew UniversityNeeraj Bedi - Coll Publ Hlth & Trop Med, Jazan, Saudi ArabiaEttore Beghi - IRCCS, Ist Ric Farmacol Mario Negri, Milan, ItalyYannick Bejot - Univ Burgundy, Univ Hosp & Med Sch Dijon, Dijon, FranceAminu K. Bello - University of AlbertaDerrick A. Bennett - University of OxfordIsabela M. Bensenor - Univ Sao Paulo, Sao Paulo, BrazilAdugnaw Berhane - Debre Berhan UniversityEduardo Bernabe - Kings Coll London, London, EnglandOscar Alberto Bernal - University of the AndesAddisu Shunu Beyene - Haramaya UniversityTariku Jibat Beyene - Univ Addis Ababa, Addis Ababa, EthiopiaGBD 2015 Healthcare Access and Quality CollaboratorsDavid C Schwebel (Contributor) - Research Administration
- Resource Type
- Journal article
- Publication Details
- The Lancet (British edition), Vol.390(10091), pp.231-266
- DOI
- 10.1016/S0140-6736(17)30818-8
- PMID
- 28528753
- PMCID
- PMC5528124
- NLM abbreviation
- Lancet
- ISSN
- 0140-6736
- eISSN
- 1474-547X
- Publisher
- Elsevier
- Number of pages
- 36
- Grant note
- MR/L003120/1; MC_PC_13043 / MRC; UK Research & Innovation (UKRI); Medical Research Council UK (MRC) ZIACP010121 / National Cancer Institute; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Cancer Institute (NCI) Bill AMP; Melinda Gates Foundation; CGIAR MC_PC_13043; MR/L003120/1 / Medical Research Council; UK Research & Innovation (UKRI); Medical Research Council UK (MRC) RG/08/014/24067 / British Heart Foundation SCAF/15/02 / Chief Scientist Office; Chief Scientist Office - Scotland NF-SI-0512-10165 / National Institute for Health Research; National Institutes of Health Research (NIHR)
- Language
- English
- Date published
- 2017
- Academic Unit
- Research Administration
- Record Identifier
- 9984949197802771
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