000135954 001__ 135954 000135954 005__ 20240229105047.0 000135954 0247_ $$2doi$$a10.1016/S0140-6736(18)30994-2 000135954 0247_ $$2pmid$$apmid:29893224 000135954 0247_ $$2pmc$$apmc:PMC5986687 000135954 0247_ $$2ISSN$$a0099-5355 000135954 0247_ $$2ISSN$$a0140-6736 000135954 0247_ $$2ISSN$$a1474-547X 000135954 0247_ $$2altmetric$$aaltmetric:43098079 000135954 037__ $$aDKFZ-2018-00691 000135954 041__ $$aeng 000135954 082__ $$a610 000135954 1001_ $$aGBD 2016 Healthcare Access and Quality Collaborators$$b0$$eCollaboration Author 000135954 245__ $$aMeasuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016. 000135954 260__ $$aLondon [u.a.]$$bElsevier$$c2018 000135954 3367_ $$2DRIVER$$aarticle 000135954 3367_ $$2DataCite$$aOutput Types/Journal article 000135954 3367_ $$0PUB:(DE-HGF)16$$2PUB:(DE-HGF)$$aJournal Article$$bjournal$$mjournal$$s1530524101_2274 000135954 3367_ $$2BibTeX$$aARTICLE 000135954 3367_ $$2ORCID$$aJOURNAL_ARTICLE 000135954 3367_ $$00$$2EndNote$$aJournal Article 000135954 520__ $$aA 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.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.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.GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations.Bill & Melinda Gates Foundation. 000135954 536__ $$0G:(DE-HGF)POF3-313$$a313 - Cancer risk factors and prevention (POF3-313)$$cPOF3-313$$fPOF III$$x0 000135954 588__ $$aDataset connected to CrossRef, PubMed, 000135954 7001_ $$aFullman, Nancy$$b1 000135954 7001_ $$aYearwood, Jamal$$b2 000135954 7001_ $$aAbay, Solomon M$$b3 000135954 7001_ $$aAbbafati, Cristiana$$b4 000135954 7001_ $$aAbd-Allah, Foad$$b5 000135954 7001_ $$aAbdela, Jemal$$b6 000135954 7001_ $$aAbdelalim, Ahmed$$b7 000135954 7001_ $$aAbebe, Zegeye$$b8 000135954 7001_ $$aAbebo, Teshome Abuka$$b9 000135954 7001_ $$aAboyans, Victor$$b10 000135954 7001_ $$aAbraha, Haftom Niguse$$b11 000135954 7001_ $$aAbreu, Daisy M X$$b12 000135954 7001_ 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000135954 7001_ $$aBrady, Oliver Jerome$$b130 000135954 7001_ $$aBrazinova, Alexandra$$b131 000135954 7001_ $$aBreitborde, Nicholas J K$$b132 000135954 7001_ $$0P:(DE-He78)90d5535ff896e70eed81f4a4f6f22ae2$$aBrenner, Hermann$$b133$$udkfz 000135954 7001_ $$aBritton, Gabrielle$$b134 000135954 7001_ $$aBrugha, Traolach S$$b135 000135954 7001_ $$aButt, Zahid A$$b136 000135954 7001_ $$aCahuana-Hurtado, Lucero$$b137 000135954 7001_ $$aCampos-Nonato, Ismael Ricardo$$b138 000135954 7001_ $$aCampuzano, Julio Cesar$$b139 000135954 7001_ $$aCar, Josip$$b140 000135954 7001_ $$aCar, Mate$$b141 000135954 7001_ $$aCárdenas, Rosario$$b142 000135954 7001_ $$aCarrero, Juan Jesus$$b143 000135954 7001_ $$aCarvalho, Felix$$b144 000135954 7001_ $$aCastañeda-Orjuela, Carlos A$$b145 000135954 7001_ $$aCastillo Rivas, Jacqueline$$b146 000135954 7001_ $$aCatalá-López, Ferrán$$b147 000135954 7001_ $$aCercy, Kelly$$b148 000135954 7001_ $$aChalek, Julian$$b149 000135954 7001_ $$aChang, Hsing-Yi$$b150 000135954 7001_ $$aChang, Jung-Chen$$b151 000135954 7001_ $$aChattopadhyay, Aparajita$$b152 000135954 7001_ $$aChaturvedi, Pankaj$$b153 000135954 7001_ $$aChiang, Peggy Pei-Chia$$b154 000135954 7001_ $$aChisumpa, Vesper Hichilombwe$$b155 000135954 7001_ $$aChoi, Jee-Young J$$b156 000135954 7001_ $$aChristensen, Hanne$$b157 000135954 7001_ $$aChristopher, Devasahayam Jesudas$$b158 000135954 7001_ $$aChung, Sheng-Chia$$b159 000135954 7001_ $$aCiobanu, Liliana G$$b160 000135954 7001_ $$aCirillo, Massimo$$b161 000135954 7001_ $$aColombara, Danny$$b162 000135954 7001_ $$aConti, Sara$$b163 000135954 7001_ $$aCooper, Cyrus$$b164 000135954 7001_ $$aCornaby, Leslie$$b165 000135954 7001_ $$aCortesi, Paolo Angelo$$b166 000135954 7001_ $$aCortinovis, Monica$$b167 000135954 7001_ $$aCosta Pereira, Alexandre$$b168 000135954 7001_ $$aCousin, Ewerton$$b169 000135954 7001_ $$aCriqui, Michael H$$b170 000135954 7001_ $$aCromwell, Elizabeth A$$b171 000135954 7001_ $$aCrowe, Christopher Stephen$$b172 000135954 7001_ $$aCrump, John A$$b173 000135954 7001_ $$aDaba, Alemneh Kabeta$$b174 000135954 7001_ $$aDachew, Berihun Assefa$$b175 000135954 7001_ $$aDadi, Abel Fekadu$$b176 000135954 7001_ $$aDandona, Lalit$$b177 000135954 7001_ $$aDandona, Rakhi$$b178 000135954 7001_ $$aDargan, Paul I$$b179 000135954 7001_ $$aDaryani, Ahmad$$b180 000135954 7001_ $$aDaryani, Maryam$$b181 000135954 7001_ $$aDas, Jai$$b182 000135954 7001_ $$aDas, Siddharth Kumar$$b183 000135954 7001_ $$adas Neves, José$$b184 000135954 7001_ $$aDavis Weaver, Nicole$$b185 000135954 7001_ $$aDavletov, Kairat$$b186 000135954 7001_ $$ade Courten, Barbora$$b187 000135954 7001_ $$aDe Leo, Diego$$b188 000135954 7001_ $$aDe Neve, Jan-Walter$$b189 000135954 7001_ $$aDellavalle, Robert P$$b190 000135954 7001_ $$aDemoz, Gebre$$b191 000135954 7001_ $$aDeribe, Kebede$$b192 000135954 7001_ $$aDes Jarlais, Don C$$b193 000135954 7001_ $$aDey, Subhojit$$b194 000135954 7001_ $$aDharmaratne, Samath D$$b195 000135954 7001_ $$aDhimal, Meghnath$$b196 000135954 7001_ $$aDjalalinia, Shirin$$b197 000135954 7001_ $$aDoku, David Teye$$b198 000135954 7001_ $$aDolan, Kate$$b199 000135954 7001_ $$aDorsey, E Ray$$b200 000135954 7001_ $$aDos Santos, Kadine Priscila Bender$$b201 000135954 7001_ $$aDoyle, Kerrie E$$b202 000135954 7001_ $$aDriscoll, Tim R$$b203 000135954 7001_ $$aDubey, Manisha$$b204 000135954 7001_ $$aDubljanin, Eleonora$$b205 000135954 7001_ $$aDuncan, Bruce Bartholow$$b206 000135954 7001_ $$aEchko, Michelle$$b207 000135954 7001_ $$aEdessa, Dumessa$$b208 000135954 7001_ $$aEdvardsson, David$$b209 000135954 7001_ $$aEhrlich, Joshua R$$b210 000135954 7001_ $$aEldrenkamp, Erika$$b211 000135954 7001_ $$aEl-Khatib, Ziad Ziad$$b212 000135954 7001_ $$aEndres, Matthias$$b213 000135954 7001_ $$aEndries, Aman Yesuf$$b214 000135954 7001_ $$aEshrati, Babak$$b215 000135954 7001_ $$aEskandarieh, Sharareh$$b216 000135954 7001_ $$aEsteghamati, Alireza$$b217 000135954 7001_ $$aFakhar, Mahdi$$b218 000135954 7001_ $$aFarag, Tamer$$b219 000135954 7001_ $$aFaramarzi, Mahbobeh$$b220 000135954 7001_ $$aFaraon, Emerito Jose Aquino$$b221 000135954 7001_ $$aFaro, André$$b222 000135954 7001_ $$aFarzadfar, Farshad$$b223 000135954 7001_ $$aFatusi, Adesegun$$b224 000135954 7001_ $$aFazeli, Mir Sohail$$b225 000135954 7001_ $$aFeigin, Valery L$$b226 000135954 7001_ $$aFeigl, Andrea B$$b227 000135954 7001_ $$aFentahun, Netsanet$$b228 000135954 7001_ $$aFereshtehnejad, Seyed-Mohammad$$b229 000135954 7001_ $$aFernandes, Eduarda$$b230 000135954 7001_ $$aFernandes, João C$$b231 000135954 7001_ $$aFijabi, Daniel Obadare$$b232 000135954 7001_ $$aFilip, Irina$$b233 000135954 7001_ $$aFischer, Florian$$b234 000135954 7001_ $$aFitzmaurice, Christina$$b235 000135954 7001_ $$aFlaxman, Abraham D$$b236 000135954 7001_ $$aFlor, Luisa Sorio$$b237 000135954 7001_ $$aFoigt, Nataliya$$b238 000135954 7001_ $$aForeman, Kyle J$$b239 000135954 7001_ $$aFrostad, Joseph J$$b240 000135954 7001_ $$aFürst, Thomas$$b241 000135954 7001_ $$aFutran, Neal D$$b242 000135954 7001_ $$aGakidou, Emmanuela$$b243 000135954 7001_ $$aGallus, Silvano$$b244 000135954 7001_ $$aGambashidze, Ketevan$$b245 000135954 7001_ $$aGamkrelidze, Amiran$$b246 000135954 7001_ $$aGanji, Morsaleh$$b247 000135954 7001_ $$aGebre, Abadi Kahsu$$b248 000135954 7001_ $$aGebrehiwot, Tsegaye Tewelde$$b249 000135954 7001_ $$aGebremedhin, Amanuel Tesfay$$b250 000135954 7001_ $$aGelaw, Yalemzewod Assefa$$b251 000135954 7001_ $$aGeleijnse, Johanna M$$b252 000135954 7001_ $$aGeremew, Demeke$$b253 000135954 7001_ $$aGething, Peter W$$b254 000135954 7001_ $$aGhadimi, Reza$$b255 000135954 7001_ $$aGhasemi Falavarjani, Khalil$$b256 000135954 7001_ $$aGhasemi-Kasman, Maryam$$b257 000135954 7001_ $$aGill, Paramjit Singh$$b258 000135954 7001_ $$aGiref, Ababi Zergaw$$b259 000135954 7001_ $$aGiroud, Maurice$$b260 000135954 7001_ $$aGishu, Melkamu Dedefo$$b261 000135954 7001_ $$aGiussani, Giorgia$$b262 000135954 7001_ $$aGodwin, William W$$b263 000135954 7001_ $$aGoli, Srinivas$$b264 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