"Drawing from methods established in GBD 2015,20 our analysis involved four steps: mapping the Nolte and McKee cause list to GBD causes; constructing MIRs for cancers and risk-standardising non-cancer deaths to remove variations in mortality not directly amenable to health care; calculating the HAQ Index on the basis of principal components analysis (PCA), providing an overall score of personal health-care access and quality on a scale of 0–100; and examining associations between national HAQ Index scores and potential correlates of performance."Our study draws from GBD 2016 results,31–33 which entail several improvements since GBD 2015, including 169 new country-years of vital…
Sustainable Development Goals Health Index: Overview
"Evidence before this study"Measuring country progress on the UN’s Sustainable Development Goals (SDGs) has been an important international priority since the SDGs were introduced in 2015. The UN, the Sustainable Development Solutions Network, WHO, and the World Bank also report on the SDGs, but their analyses do not consistently measure indicators for each location and year. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2015 estimated 33 health-related SDG indicators and the overall health-related SDG index from 1990 to 2015 for 188 countries. In GBD 2016, the number of indicators included was expanded to 37, and projections…
McKee on the WHO World Health Report 2000
"The main criticisms were, however, of technical aspects of the methods used to assess performance. By common consent those undertaking this exercise faced a major problem if they were to include all 192 WHO Member States, some of which barely functioned as states and certainly lacked control over all of their territory. Many lacked even the most basic of information. Only a minority had any functioning system of vital registration, so if measures such as health outcomes were to be included they had to be modelled. This would be complicated enough if only the simplest of measures, such as life…
Reinhardt and Cheng on the WHO World Health Report 2000
"First, the WHO research team should have been sure that their estimates are robust. Can they, in good conscience, make that claim? An artificially high ranking, for example, could take the wind out of the sails of desirable health-reform efforts. Similarly, an artificially low ranking could assign a bad grade to past reform efforts that were actually commendable. Rumour in the health services research community has it that France’s no.1 rank was driven in part by a flawed measure of national educational attainment. Under the methodology used by WHO, the more the level of educational attainment or of health spending…
WHO World Health Report 2000: Methodology
"Undoubtedly, many of the concepts and measures used in the report require further refinement and development. To date, our knowledge about health systems has been hampered by the weakness of routine information systems and insufficient attention to research. This report has thus required a major effort to assemble data, collect new information, and carry out the required analysis and synthesis. It has also drawn on the views of a large number of respondents, within and outside WHO, concerning the interpretation of data and the relative importance of different goals. The material in this report cannot provide definitive answers to every…
Healthcare Access and Quality Index: Summary of Results
"Amid gains on personal health-care access and quality, striking disparities remained regarding HAQ Index scores achieved by 2016, and how quickly locations improved over time. In 2016, HAQ Index performance diverged along the development spectrum, ranging from more than 97 in Iceland to less than 20 in the Central African Republic and Somalia. Subnational inequalities were particularly pronounced in China and India, although high-income countries, including England and the USA, also saw considerable local gaps in performance. The global pace of progress accelerated from 2000 to 2016, a trend fuelled by many low-SDI and low-middle-SDI countries in sub-Saharan Africa and…
Healthcare Access and Quality Index: Limitations
"Our analysis is subject to limitations beyond those already described. First, any limitations in GBD 2016 cause-of-death estimation are also applicable to this study.27 For GBD 2016, we aimed to better account for cause-of-death data quality by developing a metric for well-certified deaths and using this measure to inform GBD data standardisation and correction processes. Nonetheless, establishing and maintaining high-quality vital registration systems is essential to improved cause-of-death estimation. For instance, abrupt or prolonged conflict can lead to cause-of-death data gaps or lags in reporting; subsequently, HAQ Index performance might not yet fully capture the ramifications of conflict on health…
HAQ Index: Rankings
Healthcare Access and Quality Index: Performance on the HAQ Index and 32 individual causes, by country or territory, in 2016. Click on thumbnails to view pages as individual image files (jpg format) or click on the link below to view a PDF of the data. 1 2 3 4 5 6 Healthcare Access and Quality Index 2016 from The Lancet (pdf)Download Source: GBD 2016 Healthcare Access and Quality Collaborators. “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.” Lancet (London, England) vol.…
Healthcare Access and Quality Index: Results
"The HAQ Index performance followed distinct geographical patterns in 2016 (figure 1), with most countries in the highest decile clustered in Europe or nearby (ie, Iceland), and almost all countries in the lowest decile located in sub-Saharan Africa. Exceptions to this pattern included Canada, Japan, Australia, and New Zealand in the tenth decile, and Afghanistan in the first decile. More heterogeneity emerged among the next deciles of performance (eg, USA, UK, Malta, Lebanon, Singapore, and South Korea, in the ninth decile; Cuba, Chile, Saudi Arabia, and Russia, in the eighth decile). Most Latin American countries scored between the fourth and…
Healthcare Access and Quality Index: Overview
"Measuring health-care access and quality has become an increasingly important priority alongside its ascent in global health policy. In particular, the use of amenable mortality—deaths from causes that should not occur in the presence of effective medical care—to approximate national levels of personal health-care access and quality has gained greater traction.6–15 Amenable mortality metrics are thought to provide a strong signal of what can or should be addressed by the receipt of effective health care, and thus performance on overall personal health-care access and quality. Combining such measures with those capturing avertable or preventable health outcomes (ie, burden that can…
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