Healthcare Access and Quality Index 2019: Overview
“The 2019 HAQ [Healthcare Access and Quality] Index supersedes and improves upon previous versions of the HAQ Index.23,24 First, the 2019 HAQ Index draws mortality, incidence, and risk factor estimates from GBD [Global Burden of Disease] 2019 to generate MIRs [Mortality-to-Incidence Ratios] and RSDRs [Risk-Standardized Death Rates], which represent mortality amenable to healthcare access and quality. GBD 2019 improved upon previous GBD iterations by adding a substantial amount of new data, using more standardised cross-walking methods, improving redistribution algorithms, processing clinical informatics data to reflect differential access to health-care facilities across locations, and adding new systematic reviews for risk–outcome pairs, among other improvements.5,50 Further information on data additions and cause-specific modelling updates (eg, cancers, tuberculosis) can be found in the appendix (pp 59–169) and the GBD 2019 capstone series. Second, in addition to an overall HAQ Index, we estimated the index for three select age groups: young, working age, and post-working age. Third, we expanded the list of causes for which we used MIRs rather than RSDRs, thereby better representing causes for which health-care quality and access do not affect incidence or for which detection and diagnosis is poor in some settings. Finally, we used the arithmetic mean of scaled causes of amenable mortality rather than using principal component analysis weights, improving interpretability but preserving nearly all the cross-country variation of previous versions of the HAQ Index (appendix pp 15–30). The HAQ Index is also one of the most commonly used covariates in the GBD study.”
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
“As in previous HAQ [Healthcare Access and Quality] Index studies, we standardised death rates to account for environmental and behavioural risk factors to isolate differences in health-care access and quality from differences due to background risk exposure. We risk-standardised death rates by removing the joint effects of location-specific behavioural and environmental risk factors and replacing them with the global background risk for all locations.52 In other words, we eliminated differences across locations due to underlying health risk not related to the health system by setting risks in all locations to the same, global level of risk exposure. Additional information on risk-standardisation is available in the appendix (pp 16–17). Risk-standardisation was used for 20 of the 32 causes of amenable mortality in the analysis (appendix p 20). Five of the 20 causes (tetanus, appendicitis, congenital heart anomalies, adverse effects of medical treatment, and inguinal, femoral, and abdominal hernia) had no attributable risks to standardise and the observed death rate was used.
“For other causes, we used MIRs [Mortality-to-Incidence Ratios], which provide an approximation of the impact of health-care access and quality on averting death once a disease is developed. We considered MIRs (1) for chronic conditions where incidence of disease is not amenable to health-care access and quality, and (2) when low mortality rates are an indication of inadequate detection, such as for cancer.53 We determined which metric to use on the basis of the convergent validity of amenable mortality with a general summary of health, healthy life expectancy (HALE).54 The rationale is that the form of the death metric most correlated with health-care access and quality will be more correlated with HALE. We selected MIRs when the Pearson correlation was higher for MIR and HALE than RSDRs [Risk-Standardized Death Rates] and HALE (appendix pp 31–32).Using the amenable age range for a given cause, GBD [Global Burden of Disease] population estimates were used to age-standardise the MIRs and RSDRs.2 Different age structures in the age group analysis were accounted for by rescaling age weights to sum to 1 within each age group.”
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, 2023 by Doug McVay, Editor.
