“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

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Page last updated Nov. 9, 2022 by Doug McVay, Editor.