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 be avoided through public health programmes or policies implemented outside the immediate health sector) can offer a more complete set of potential pathways for improving health.^1,16 The Nolte and McKee list of causes amenable to health care^6–9 remains the most widely used framework to quantify national levels of health-care access and quality on the basis of amenable mortality. This is particularly true for Europe,^11,15,17 the Organisation for Economic Co-operation and Development (OECD),¹² and the USA,¹³ but increasingly also for other country-specific analyses (eg, Brazil,¹⁴ China,¹⁸ and Mexico¹⁹). As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015),²⁰ the GBD collaboration applied this framework to develop a novel measure, the Healthcare Access and Quality (HAQ) Index, to track gains and gaps in personal health-care access and quality in 195 countries and territories over time.

“The HAQ Index offered several strengths and insights into personal health-care access and quality across countries, which has prompted calls for further improvements. First, 32 causes considered amenable to health care comprise the HAQ Index, representing a range of health service areas: vaccine-preventable diseases; infectious diseases and maternal and child health; non-communicable diseases, including cancers, cardiovascular diseases, and other non-communicable diseases such as diabetes; and gastrointestinal conditions from which surgery can easily avert death (eg, appendicitis). Other than in high-income countries, past research rarely accounts for this array of services,²¹ even though effective preventive interventions, treatment, and medical technologies exist; instead, these studies often focus on infectious diseases and maternal and child health, and do not shed light on potential challenges across service areas. Second, because GBD quantifies risk exposure and risk-attributable deaths, we could account for local variations in risk exposure and better isolate differences in mortality related to health care. Nonetheless, challenges can still exist in ensuring that these measures provide a strong signal on health-care access and quality. For instance, in the absence of stronger monitoring systems, low rates of cancer mortality could actually represent inadequate detection and treatment of cancer rather than good access to cancer screening and high-quality care.²² Third, although some insights into the relationship between the HAQ Index and sociodemographic development were explored in GBD 2015,²⁰ further examination of how health financing and system measures are related to the HAQ Index has yet to occur. Fourth, considerable debate continues about how well the current cause list represents the range of causes amenable to health care, particularly non-fatal outcomes, as well as the ages at which health care can substantially improve outcomes. Finally, GBD 2015 highlighted sizeable inequalities across countries20 but did not capture subnational differences in personal health-care access and quality, a crucial need in light of the magnitude by which health outcomes can vary within countries.^23–30

“In this study, we provide updated estimates from 1990 to 2016 for the HAQ Index in 195 countries and territories, as well as at global and regional levels. For the first time, we report subnational estimates of the HAQ Index for seven countries, allowing for a more in-depth examination of inequalities in personal health-care access and quality. With the improved estimation of cancers in GBD 2016,^31–33 we use mortality-to-incidence ratios (MIRs) for cancers to better reflect potential differences in cancer diagnostic and treatment capacity across locations. Finally, we do an exploratory analysis of the associations between the HAQ Index and potential correlates of performance.”

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. 391,10136 (2018): 2236-2271. doi:10.1016/S0140-6736(18)30994-2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986687/

Fact Items Related To The Healthcare Access and Quality Index

• Healthcare Access and Quality Index: Methodology
  “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 ...
• 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 ...
• 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. ...
• Healthcare Access and Quality 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: ...
• 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 ...
• 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 ...

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Page last updated May 21, 2020 by Doug McVay, Senior Policy Analyst.