Healthcare Access and Quality Index 2019: Overview
“A small number of existing studies have compared countries using amenable mortality across the life course, although these only focus on a subset of countries and territories.15,22,32,40–42 Using amenable mortality, existing evidence suggests European countries improved health-care access and quality most for children and adolescents, with substantially bigger declines in amenable mortality estimated for these age groups as compared with older populations.15 Past studies on amenable mortality by age have engaged the debate about the possibility of convergence in mortality and life expectancy.38,43,44 Convergence in amenable mortality could be an indication of the diffusion of health-care technology (eg, pharmaceuticals and equipment) and know-how from health systems at the frontier of healthcare access and quality to those operating less effectively. Alternatively, wider trends in social and economic development might be more important drivers of improved health-care access and quality through improved ability to pay, investment in health, better education, and other factors.45–47
“This study extends previous research on the HAQ [Healthcare Access and Quality] Index and investigates health-care access and quality over the life course. Our research questions focused on: (1) how much does health-care access and quality differ across age, and (2) to what extent is there convergence or divergence in health-care access and quality over time by age? We address these questions by computing the HAQ Index separately for three select age groups: young (ages 0–14 years), working (ages 15–64 years), and post-working (65–74 years). We grouped populations on the basis of the Organisation for Economic Co-operation and Development (OECD) definition of working age population (15–64 years) and the age limit (75 years) beyond which deaths were not amenable to health care used by Nolte and McKee.25,26,48 With its expanded data inputs and methodological advances, the GBD [Global Burden of Disease] 2019 study enabled the improved estimation of the HAQ Index,5 allowing us to produce the HAQ Index for 204 countries and territories between 1990 and 2019 based on scaled MIRs [Mortality-to-Incidence Ratios] and RSDRs [Risk-Standardized Death Rates] for 32 causes of death that should not occur in the presence of timely, quality health care. We use the updated index to examine convergence stratified for each age group. For each age group, we considered: whether the HAQ Index grew faster in countries with lower 1990 scores; whether variation in the HAQ Index declined; and whether, between 1990 and 2019, average HAQ Index scores grew closer to scores in top-performing countries, as grouped by social and economic development. This manuscript was produced as part of the GBD Collaborator Network and in accordance with the GBD Protocol.49“
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.
