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Title: Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016
Authors: Fullman, Nancy
Yearwood, Jamal
Abay, Solomon M
Abbafati, Cristiana
Abd-Allah, Foad
Abdela, Jemal
Abdelalim, Ahmed
Abebe, Zegeye
Abebo, Teshome Abuka
Aboyans, Victor
Abraha, Haftom Niguse
Behzadifar, Masoud
Behzadifar, Meysam
Bekele, Bayu Begashaw
Belachew, Abate Bekele
Belay, Saba Abraham
Belay, Yihalem Abebe
Bell, Michelle L
Bello, Aminu K
Bennett, Derrick A
Bennett, James R
Abreu, Daisy M X
Bensenor, Isabela M
Berhe, Derbew Fikadu
Bernabé, Eduardo
Bernstein, Robert Steven
Beuran, Mircea
Bhalla, Ashish
Bhatt, Paurvi
Bhaumik, Soumyadeep
Bhutta, Zulfiqar A
Biadgo, Belete
Abu-Raddad, Laith J
Bijani, Ali
Bikbov, Boris
Birungi, Charles
Biryukov, Stan
Bizuneh, Hailemichael
Bolliger, Ian W
Bolt, Kaylin
Bou-Orm, Ibrahim R
Bozorgmehr, Kayvan
Brady, Oliver Jerome
Adane, Akilew Awoke
Brazinova, Alexandra
Breitborde, Nicholas J K
Brenner, Hermann
Britton, Gabrielle
Brugha, Traolach S
Butt, Zahid A
Cahuana-Hurtado, Lucero
Campos-Nonato, Ismael Ricardo
Campuzano, Julio Cesar
Car, Josip
Adedoyin, Rufus Adesoji
Car, Mate
Cárdenas, Rosario
Carrero, Juan Jesus
Carvalho, Felix
Castañeda-Orjuela, Carlos A
Castillo Rivas, Jacqueline
Catalá-López, Ferrán
Cercy, Kelly
Chalek, Julian
Chang, Hsing-Yi
Adetokunboh, Olatunji
Chang, Jung-Chen
Chattopadhyay, Aparajita
Chaturvedi, Pankaj
Chiang, Peggy Pei-Chia
Chisumpa, Vesper Hichilombwe
Choi, Jee-Young J
Christensen, Hanne
Christopher, Devasahayam Jesudas
Chung, Sheng-Chia
Ciobanu, Liliana G
Adhikari, Tara Ballav
Cirillo, Massimo
Colombara, Danny
Conti, Sara
Cooper, Cyrus
Cornaby, Leslie
Cortesi, Paolo Angelo
Cortinovis, Monica
Costa Pereira, Alexandre
Cousin, Ewerton
Criqui, Michael H
Afarideh, Mohsen
Cromwell, Elizabeth A
Crowe, Christopher Stephen
Crump, John A
Daba, Alemneh Kabeta
Dachew, Berihun Assefa
Dadi, Abel Fekadu
Dandona, Lalit
Dandona, Rakhi
Dargan, Paul I
Daryani, Ahmad
Afshin, Ashkan
Daryani, Maryam
Das, Jai
Das, Siddharth Kumar
das Neves, José
Davis Weaver, Nicole
Davletov, Kairat
de Courten, Barbora
De Leo, Diego
De Neve, Jan-Walter
Dellavalle, Robert P
Agarwal, Gina
Demoz, Gebre
Deribe, Kebede
Des Jarlais, Don C
Dey, Subhojit
Dharmaratne, Samath D
Dhimal, Meghnath
Djalalinia, Shirin
Doku, David Teye
Dolan, Kate
Dorsey, E Ray
Agius, Dominic
dos Santos, Kadine Priscila Bender
Doyle, Kerrie E
Driscoll, Tim R
Dubey, Manisha
Dubljanin, Eleonora
Duncan, Bruce Bartholow
Echko, Michelle
Edessa, Dumessa
Edvardsson, David
Ehrlich, Joshua R
Agrawal, Anurag
Eldrenkamp, Erika
El-Khatib, Ziad Ziad
Endres, Matthias
Endries, Aman Yesuf
Eshrati, Babak
Eskandarieh, Sharareh
Esteghamati, Alireza
Fakhar, Mahdi
Farag, Tamer
Faramarzi, Mahbobeh
Agrawal, Sutapa
Faraon, Emerito Jose Aquino
Faro, André
Farzadfar, Farshad
Fatusi, Adesegun
Fazeli, Mir Sohail
Feigin, Valery L
Feigl, Andrea B
Fentahun, Netsanet
Fereshtehnejad, Seyed-Mohammad
Fernandes, Eduarda
Ahmad Kiadaliri, Aliasghar
Fernandes, João C
Fijabi, Daniel Obadare
Filip, Irina
Fischer, Florian
Fitzmaurice, Christina
Flaxman, Abraham D
Flor, Luisa Sorio
Foigt, Nataliya
Foreman, Kyle J
Frostad, Joseph J
Aichour, Miloud Taki Eddine
Fürst, Thomas
Futran, Neal D
Gakidou, Emmanuela
Gallus, Silvano
Gambashidze, Ketevan
Gamkrelidze, Amiran
Ganji, Morsaleh
Gebre, Abadi Kahsu
Gebrehiwot, Tsegaye Tewelde
Gebremedhin, Amanuel Tesfay
Akibu, Mohammed
Gelaw, Yalemzewod Assefa
Geleijnse, Johanna M
Geremew, Demeke
Gething, Peter W
Ghadimi, Reza
Ghasemi Falavarjani, Khalil
Ghasemi-Kasman, Maryam
Gill, Paramjit Singh
Giref, Ababi Zergaw
Giroud, Maurice
Akinyemi, Rufus Olusola
Gishu, Melkamu Dedefo
Giussani, Giorgia
Godwin, William W
Goli, Srinivas
Gomez-Dantes, Hector
Gona, Philimon N
Goodridge, Amador
Gopalani, Sameer Vali
Goryakin, Yevgeniy
Goulart, Alessandra Carvalho
Akinyemiju, Tomi F
Grada, Ayman
Griswold, Max
Grosso, Giuseppe
Gugnani, Harish Chander
Guo, Yuming
Gupta, Rahul
Gupta, Rajeev
Gupta, Tanush
Gupta, Tarun
Gupta, Vipin
Akseer, Nadia
Haagsma, Juanita A
Hachinski, Vladimir
Hafezi-Nejad, Nima
Hailu, Gessessew Bugssa
Hamadeh, Randah Ribhi
Hamidi, Samer
Hankey, Graeme J
Harb, Hilda L
Harewood, Heather C
Harikrishnan, Sivadasanpillai
Al Lami, Faris Hasan
Haro, Josep Maria
Hassen, Hamid Yimam
Havmoeller, Rasmus
Hawley, Caitlin
Hay, Simon I
He, Jiawei
Hearps, Stephen J C
Hegazy, Mohamed I
Heibati, Behzad
Heidari, Mohsen
Alahdab, Fares
Hendrie, Delia
Henry, Nathaniel J
Herrera Ballesteros, Victor Hugo
Herteliu, Claudiu
Hibstu, Desalegn Tsegaw
Hiluf, Molla Kahssay
Hoek, Hans W
Homaie Rad, Enayatollah
Horita, Nobuyuki
Hosgood, H Dean
Al-Aly, Ziyad
Hosseini, Mostafa
Hosseini, Seyed Reza
Hostiuc, Mihaela
Hostiuc, Sorin
Hoy, Damian G
Hsairi, Mohamed
Htet, Aung Soe
Hu, Guoqing
Huang, John J
Iburg, Kim Moesgaard
Alam, Khurshid
Idris, Fachmi
Igumbor, Ehimario Uche
Ikeda, Chad
Ileanu, Bogdan Vasile
Ilesanmi, Olayinka S
Innos, Kaire
Irvani, Seyed Sina Naghibi
Irvine, Caleb M S
Islami, Farhad
Jacobs, Troy A
Alam, Tahiya
Jacobsen, Kathryn H
Jahanmehr, Nader
Jain, Rajesh
Jain, Sudhir Kumar
Jakovljevic, Mihajlo B
Jalu, Moti Tolera
Jamal, Amr A
Javanbakht, Mehdi
Jayatilleke, Achala Upendra
Jeemon, Panniyammakal
Alasfoor, Deena
Jha, Ravi Prakash
Jha, Vivekanand
Jóúwiak, Jacek
John, Oommen
Johnson, Sarah Charlotte
Jonas, Jost B
Joshua, Vasna
Jürisson, Mikk
Kabir, Zubair
Kadel, Rajendra
Albittar, Mohammed I
Kahsay, Amaha
Kalani, Rizwan
Kar, Chittaranjan
Karanikolos, Marina
Karch, André
Karema, Corine Kakizi
Karimi, Seyed M
Kasaeian, Amir
Kassa, Dessalegn Haile
Kassa, Getachew Mullu
Alene, Kefyalew Addis
Kassa, Tesfaye Dessale
Kassebaum, Nicholas J
Katikireddi, Srinivasa Vittal
Kaul, Anil
Kawakami, Norito
Kazanjan, Konstantin
Kebede, Seifu
Keiyoro, Peter Njenga
Kemp, Grant Rodgers
Kengne, Andre Pascal
Al-Eyadhy, Ayman
Kereselidze, Maia
Ketema, Ezra Belay
Khader, Yousef Saleh
Khafaie, Morteza Abdullatif
Khajavi, Alireza
Khalil, Ibrahim A
Khan, Ejaz Ahmad
Khan, Gulfaraz
Khan, Md Nuruzzaman
Khan, Muhammad Ali
Ali, Syed Danish
Khanal, Mukti Nath
Khang, Young-Ho
Khater, Mona M
Khoja, Abdullah Tawfih Abdullah
Khosravi, Ardeshir
Khubchandani, Jagdish
Kibret, Getiye Dejenu
Kiirithio, Daniel Ngari
Kim, Daniel
Kim, Yun Jin
Alijanzadeh, Mehran
Kimokoti, Ruth W
Kinfu, Yohannes
Kinra, Sanjay
Kisa, Adnan
Kissoon, Niranjan
Kochhar, Sonali
Kokubo, Yoshihiro
Kopec, Jacek A
Kosen, Soewarta
Koul, Parvaiz A
Aljunid, Syed M
Koyanagi, Ai
Kravchenko, Michael
Krishan, Kewal
Krohn, Kristopher J
Kuate Defo, Barthelemy
Kumar, G Anil
Kumar, Pushpendra
Kutz, Michael
Kuzin, Igor
Kyu, Hmwe H
Alkerwi, Ala'a
Lad, Deepesh Pravinkumar
Lafranconi, Alessandra
Lal, Dharmesh Kumar
Lalloo, Ratilal
Lam, Hilton
Lan, Qing
Lang, Justin J
Lansingh, Van C
Lansky, Sonia
Larsson, Anders
Alla, François
Latifi, Arman
Lazarus, Jeffrey Victor
Leasher, Janet L
Lee, Paul H
Legesse, Yirga
Leigh, James
Leshargie, Cheru Tesema
Leta, Samson
Leung, Janni
Leung, Ricky
Allebeck, Peter
Levi, Miriam
Li, Yongmei
Liang, Juan
Liben, Misgan Legesse
Lim, Lee-Ling
Lim, Stephen S
Lind, Margaret
Linn, Shai
Listl, Stefan
Liu, Patrick
Allen, Christine
Liu, Shiwei
Lodha, Rakesh
Lopez, Alan D
Lorch, Scott A
Lorkowski, Stefan
Lotufo, Paulo A
Lucas, Timothy C D
Lunevicius, Raimundas
Lurton, Grégoire
Lyons, Ronan A
Alomari, Mahmoud A
Maalouf, Fadi
Macarayan, Erlyn Rachelle King
Mackay, Mark T
Maddison, Emilie R
Madotto, Fabiana
Magdy Abd El Razek, Hassan
Magdy Abd El Razek, Mohammed
Majdan, Marek
Majdzadeh, Reza
Majeed, Azeem
Al-Raddadi, Rajaa
Malekzadeh, Reza
Malhotra, Rajesh
Malta, Deborah Carvalho
Mamun, Abdullah A
Manhertz, Trey
Manguerra, Helena
Mansournia, Mohammad Ali
Mantovani, Lorenzo G
Manyazewal, Tsegahun
Mapoma, Chabila C
Alsharif, Ubai
Margono, Christopher
Martinez-Raga, Jose
Martins, Sheila Cristina Ouriques
Martins-Melo, Francisco Rogerlândio
Martopullo, Ira
März, Winfried
Massenburg, Benjamin Ballard
Mathur, Manu Raj
Maulik, Pallab K
Mazidi, Mohsen
Altirkawi, Khalid A
McAlinden, Colm
McGrath, John J
McKee, Martin
Mehata, Suresh
Mehrotra, Ravi
Mehta, Kala M
Mehta, Varshil
Meier, Toni
Mejia-Rodriguez, Fabiola
Meles, Kidanu Gebremariam
Alvis-Guzman, Nelson
Melku, Mulugeta
Memiah, Peter
Memish, Ziad A
Mendoza, Walter
Mengiste, Degu Abate
Mengistu, Desalegn Tadese
Menota, Bereket Gebremichael
Mensah, George A
Meretoja, Atte
Meretoja, Tuomo J
Amare, Azmeraw T
Mezgebe, Haftay Berhane
Miazgowski, Tomasz
Micha, Renata
Milam, Robert
Millear, Anoushka
Miller, Ted R
Mini, GK
Minnig, Shawn
Mirica, Andreea
Mirrakhimov, Erkin M
Amenu, Kebede
Misganaw, Awoke
Mitchell, Philip B
Mlashu, Fitsum Weldegebreal
Moazen, Babak
Mohammad, Karzan Abdulmuhsin
Mohammadibakhsh, Roghayeh
Mohammed, Ebrahim
Mohammed, Mohammed A
Mohammed, Shafiu
Mokdad, Ali H
Ammar, Walid
Mola, Glen Liddell
Molokhia, Mariam
Momeniha, Fatemeh
Monasta, Lorenzo
Montañez Hernandez, Julio Cesar
Moosazadeh, Mahmood
Moradi-Lakeh, Maziar
Moraga, Paula
Morawska, Lidia
Moreno Velasquez, Ilais
Amoako, Yaw Ampem
Mori, Rintaro
Morrison, Shane D
Moses, Mark
Mousavi, Seyyed Meysam
Mueller, Ulrich O
Murhekar, Manoj
Murthy, Gudlavalleti Venkata Satyanarayana
Murthy, Srinivas
Musa, Jonah
Musa, Kamarul Imran
Anber, Nahla
Mustafa, Ghulam
Muthupandian, Saravanan
Nagata, Chie
Nagel, Gabriele
Naghavi, Mohsen
Naheed, Aliya
Naik, Gurudatta A
Naik, Nitish
Najafi, Farid
Naldi, Luigi
Andrei, Catalina Liliana
Nangia, Vinay
Nansseu, Jobert Richie Njingang
Narayan, KM Venkat
Nascimento, Bruno Ramos
Negoi, Ionut
Negoi, Ruxandra Irina
Newton, Charles R
Ngunjiri, Josephine Wanjiku
Nguyen, Grant
Nguyen, Long
Androudi, Sofia
Nguyen, Trang Huyen
Nichols, Emma
Ningrum, Dina Nur Anggraini
Nolte, Ellen
Nong, Vuong Minh
Norheim, Ole F
Norrving, Bo
Noubiap, Jean Jacques N
Nyandwi, Alypio
Obermeyer, Carla Makhlouf
Antonio, Carl Abelardo T
Ofori-Asenso, Richard
Ogbo, Felix Akpojene
Oh, In-Hwan
Oladimeji, Olanrewaju
Olagunju, Andrew Toyin
Olagunju, Tinuke Oluwasefunmi
Olivares, Pedro R
Oliveira, Patricia Pereira Vasconcelos de
Olsen, Helen E
Olusanya, Bolajoko Olubukunola
Araújo, Valdelaine E M
Olusanya, Jacob Olusegun
Ong, Kanyin
Opio, John Nelson
Oren, Eyal
Ortega-Altamirano, Doris V
Ortiz, Alberto
Ozdemir, Raziye
PA, Mahesh
Pain, Amanda W
Palone, Marcos Roberto Tovani
Aremu, Olatunde
Pana, Adrian
Panda-Jonas, Songhomitra
Pandian, Jeyaraj D
Park, Eun-Kee
Parsian, Hadi
Patel, Tejas
Pati, Sanghamitra
Patil, Snehal T
Patle, Ajay
Patton, George C
Ärnlöv, Johan  KAKEN_name
Paturi, Vishnupriya Rao
Paudel, Deepak
Pedroso, Marcel de Moares
Pedroza, Sandra P
Pereira, David M
Perico, Norberto
Peterson, Hannah
Petzold, Max
Peykari, Niloofar
Phillips, Michael Robert
Artaman, Al
Piel, Frédéric B
Pigott, David M
Pillay, Julian David
Piradov, Michael A
Polinder, Suzanne
Pond, Constance D
Postma, Maarten J
Pourmalek, Farshad
Prakash, Swayam
Prakash, V
Aryal, Krishna Kumar
Prasad, Narayan
Prasad, Noela Marie
Purcell, Caroline
Qorbani, Mostafa
Quintana, Hedley Knewjen
Radfar, Amir
Rafay, Anwar
Rafiei, Alireza
Rahimi, Kazem
Rahimi-Movaghar, Afarin
Asayesh, Hamid
Rahimi-Movaghar, Vafa
Rahman, Mahfuzar
Rahman, Muhammad Aziz
Rahman, Sajjad Ur
Rai, Rajesh Kumar
Raju, Sree Bhushan
Ram, Usha
Rana, Saleem M
Rankin, Zane
Rasella, Davide
Asfaw, Ephrem Tsegay
Rawaf, David Laith
Rawaf, Salman
Ray, Sarah E
Razo-García, Christian Aspacia
Reddy, Priscilla
Reiner, Robert C
Reis, Cesar
Reitsma, Marissa B
Remuzzi, Giuseppe
Renzaho, Andre M N
Asgedom, Solomon Weldegebreal
Resnikoff, Serge
Rezaei, Satar
Rezai, Mohammad Sadegh
Ribeiro, Antonio L
Rios Blancas, Maria Jesus
Rivera, Juan A
Roever, Leonardo
Ronfani, Luca
Roshandel, Gholamreza
Rostami, Ali
Asghar, Rana Jawad
Roth, Gregory A
Rothenbacher, Dietrich
Roy, Ambuj
Roy, Nobhojit
Ruhago, George Mugambage
Sabde, Yogesh Damodar
Sachdev, Perminder S
Sadat, Nafis
Safdarian, Mahdi
Safiri, Saeid
Ashebir, Mengistu Mitiku
Sagar, Rajesh
Sahebkar, Amirhossein
Sahraian, Mohammad Ali
Sajadi, Haniye Sadat
Salama, Joseph
Salamati, Payman
Saldanha, Raphael de Freitas
Salimzadeh, Hamideh
Salomon, Joshua A
Samy, Abdallah M
Asseffa, Netsanet Abera
Sanabria, Juan Ramon
Sancheti, Parag K
Sanchez-Niño, Maria Dolores
Santomauro, Damian
Santos, Itamar S
Santric Milicevic, Milena M
Sarker, Abdur Razzaque
Sarrafzadegan, Nizal
Sartorius, Benn
Satpathy, Maheswar
Atey, Tesfay Mehari
Savic, Miloje
Sawhney, Monika
Saxena, Sonia
Saylan, Mete I
Schaeffner, Elke
Schmidhuber, Josef
Schmidt, Maria Inês
Schneider, Ione J C
Schumacher, Austin E
Schutte, Aletta E
Atre, Sachin R
Schwebel, David C
Schwendicke, Falk
Sekerija, Mario
Sepanlou, Sadaf G
Servan-Mori, Edson E
Shafieesabet, Azadeh
Shaikh, Masood Ali
Shakh-Nazarova, Marina
Shams-Beyranvand, Mehran
Sharafi, Heidar
Atteraya, Madhu S
Sharif-Alhoseini, Mahdi
Shariful Islam, Sheikh Mohammed
Sharma, Meenakshi
Sharma, Rajesh
She, Jun
Sheikh, Aziz
Shfare, Mebrahtu Teweldemedhin
Shi, Peilin
Shields, Chloe
Shigematsu, Mika
Avila-Burgos, Leticia
Shinohara, Yukito
Shiri, Rahman
Shirkoohi, Reza
Shiue, Ivy
Shrime, Mark G
Shukla, Sharvari Rahul
Siabani, Soraya
Sigfusdottir, Inga Dora
Silberberg, Donald H
Silva, Diego Augusto Santos
Avokpaho, Euripide Frinel G Arthur
Silva, João Pedro
Silveira, Dayane Gabriele Alves
Singh, Jasvinder A
Singh, Lavanya
Singh, Narinder Pal
Singh, Virendra
Sinha, Dhirendra Narain
Sinke, Abiy Hiruye
Sisay, Mekonnen
Skirbekk, Vegard
Awasthi, Ashish
Sliwa, Karen
Smith, Alison
Soares Filho, Adauto Martins
Sobaih, Badr H A
Somai, Melek
Soneji, Samir
Soofi, Moslem
Sorensen, Reed J D
Soriano, Joan B
Soyiri, Ireneous N
Ayala Quintanilla, Beatriz Paulina
Sposato, Luciano A
Sreeramareddy, Chandrashekhar T
Srinivasan, Vinay
Stanaway, Jeffrey D
Stathopoulou, Vasiliki
Steel, Nicholas
Stein, Dan J
Stokes, Mark Andrew
Sturua, Lela
Sufiyan, Muawiyyah Babale
Ayalew, Animut Alebel
Suliankatchi, Rizwan Abdulkader
Sunguya, Bruno F
Sur, Patrick J
Sykes, Bryan L
Sylaja, PN
Tabarés-Seisdedos, Rafael
Tadakamadla, Santosh Kumar
Tadesse, Andualem Henok
Taffere, Getachew Redae
Tandon, Nikhil
Ayele, Henok Tadesse
Tariku, Amare Tariku
Taveira, Nuno
Tehrani-Banihashemi, Arash
Temam Shifa, Girma
Temsah, Mohamad-Hani
Terkawi, Abdullah Sulieman
Tesema, Azeb Gebresilassie
Tesfaye, Dawit Jember
Tessema, Belay
Thakur, JS
Ayer, Rakesh
Thomas, Nihal
Thompson, Matthew J
Tillmann, Taavi
To, Quyen G
Tobe-Gai, Ruoyan
Tonelli, Marcello
Topor-Madry, Roman
Topouzis, Fotis
Torre, Anna
Tortajada, Miguel
Ayuk, Tambe Betrand
Tran, Bach Xuan
Tran, Khanh Bao
Tripathi, Avnish
Tripathy, Srikanth Prasad
Troeger, Christopher
Truelsen, Thomas
Tsoi, Derrick
Tudor Car, Lorainne
Tuem, Kald Beshir
Tyrovolas, Stefanos
Azzopardi, Peter
Uchendu, Uche S
Ukwaja, Kingsley N
Ullah, Irfan
Updike, Rachel
Uthman, Olalekan A
Uzochukwu, Benjamin S Chudi
Valdez, Pascual Rubén
van Boven, Job F M
Varughese, Santosh
Vasankari, Tommi
Azzopardi-Muscat, Natasha
Violante, Francesco S
Vladimirov, Sergey K
Vlassov, Vasiliy Victorovich
Vollset, Stein Emil
Vos, Theo
Wagnew, Fasil
Waheed, Yasir
Wallin, Mitchell T
Walson, Judd L
Wang, Yafeng
Babalola, Tesleem Kayode
Wang, Yuan-Pang
Wassie, Molla Mesele
Weaver, Marcia R
Weiderpass, Elisabete
Weintraub, Robert G
Weiss, Jordan
Weldegwergs, Kidu Gidey
Werdecker, Andrea
West, T Eoin
Westerman, Ronny
Badali, Hamid
White, Richard G
Whiteford, Harvey A
Widecka, Justyna
Winkler, Andrea Sylvia
Wiysonge, Charles Shey
Wolfe, Charles DA
Wondimkun, Yohanes Ayele
Workicho, Abdulhalik
Wyper, Grant M A
Xavier, Denis
Badawi, Alaa
Xu, Gelin
Yan, Lijing L
Yano, Yuichiro
Yaseri, Mehdi
Yimer, Nigus Bililign
Yin, Peng
Yip, Paul
Yirsaw, Biruck Desalegn
Yonemoto, Naohiro
Yonga, Gerald
Banach, Maciej
Yoon, Seok-Jun
Yotebieng, Marcel
Younis, Mustafa Z
Yu, Chuanhua
Zadnik, Vesna
Zaidi, Zoubida
Zaki, Maysaa El Sayed
Zaman, Sojib Bin
Zamani, Mohammad
Zenebe, Zerihun Menlkalew
Banerjee, Amitava
Zhou, Maigeng
Zhu, Jun
Zimsen, Stephanie R M
Zipkin, Ben
Zodpey, Sanjay
Zuhlke, Liesl Joanna
Murray, Christopher J L
Lozano, Rafael
Banstola, Amrit
Barber, Ryan M
Barboza, Miguel A
Barker-Collo, Suzanne L
Bärnighausen, Till
Barquera, Simon
Barrero, Lope H
Bassat, Quique
Basu, Sanjay
Baune, Bernhard T
Bazargan-Hejazi, Shahrzad
Bedi, Neeraj
Beghi, Ettore
Author's alias: 米本, 直裕
Issue Date: Jun-2018
Publisher: Elsevier BV
Journal title: The Lancet
Volume: 391
Issue: 10136
Start page: 2236
End page: 2271
Abstract: Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods: Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings: In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, to values as low as 18·6 (13·1–24·4) in the Central African Republic, 19·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1–93·6) in Beijing to 48·0 (43·4–53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6–68·8) in Goa to 34·0 (30·3–38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation: GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations.
Rights: © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
URI: http://hdl.handle.net/2433/237404
DOI(Published Version): 10.1016/S0140-6736(18)30994-2
PubMed ID: 29893224
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