Healthcare Access and Quality Index 2019: Overview
“Some of the limitations of the HAQ [Healthcare Access and Quality] Index have been highlighted in the previous analyses.12,13,21 First, we were not able to further disaggregate characteristics of healthcare access or quality, including separating quality from other features of health care,76,77 determining the ability of any particular client or group to seek and obtain care, or estimating the role of acceptability or cultural barriers.78 Second, the Nolte and McKee list has not been updated, resulting in the omission of some causes of death that could be amenable to timely and appropriate health care. Future analyses should consider expanding this list of causes. Third, our analysis is subject to limitations in the GBD [Global Burden of Disease] cause of death estimation, such as death misclassifications and lack of complete vital registration records differing by country. Fourth, using MIRs [Mortality-to-Incidence Ratios] for cancers and other causes instead of RSDRs [Risk-Standardized Death Rates] provided an improved indicator of country-level differences in access to effective care, but broader MIR use is limited by the sparsity of data and methodological demands. Fifth, we only consider amenable mortality up to the age of 74 years because we chose to be consistent with past versions of the HAQ Index and with Nolte and McKee’s views that mortality might not be amenable with quality healthcare access after age 75 years. Future analyses should interrogate this view and consider whether extending the age range beyond age 74 years would be more consistent with life expectancy. Sixth, grouping populations by the OECD definition of working-age connects our analysis with a more high-income country perspective; alternative age groupings could be useful and pertinent depending on the country context. Seventh, we recognise that the direct and indirect determinants of health are broad and varied. Multiple factors outside of the immediate health sector, including policies, social determinants, and other drivers, could affect access to quality health care— eg, access contingent upon employment or age. Eighth, we acknowledge that uncertainty can differ depending on the age group, since different data quality, population size, and cause variation exist across age. This could affect both the bounds set when scaling MIRs and RSDRs to 0–100 as well as in the analysis of coefficient of variation over time; however, we believe the effect to be minimal.”
Source: GBD 2019 Healthcare Access and Quality Collaborators (2022). Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. The Lancet. Global health, 10(12), e1715–e1743. https://doi.org/10.1016/S2214-109X(22)00429-6
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Page last updated March 24, 2025 by Doug McVay, Editor.