Researchers assessed personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016 using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016). Past success and current challenges in improving personal health-care access and quality worldwide were assessed in a more detailed manner via GBD 2016. Many low-socio-demographic Index (SDI) and middle-SDI countries demonstrated substantial gains since 2000, however, considerable challenges were also encountered unless heightened policy action and investments focused on advancing access to and quality of health-care across key health services, especially non-communicable diseases. Several low-middle to high-middle SDI countries showed stagnating or minimal improvements experienced reflecting the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. The pursuit of universal health coverage hinges upon improving both access and quality worldwide alongside initiatives to strengthen public health programmes, and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations.

Methods

• Researchers used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time via drawing from established methods and updated estimates from GBD 2016,.
• They risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure to better identify the potential effects of personal health-care access and quality from underlying risk factor patterns.
• Mortality-to-incidence ratios for cancers were used to provide a stronger signal of the effects of personal health care and access on cancer survival that was supported by the expansion of cancer registry data in GBD 2016.
• Each cause was transformed to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); these thresholds were set at the country level, and were then applied to subnational locations.
• To construct the HAQ Index, a principal components analysis was applied using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time.
• Comparison was performed of HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development.
• Relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita were examined as derived from the broader GBD study and other data sources.

Results

• Researchers noted that HAQ Index performance in 2016 spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, to values as low as 18·6 (13·1–24·4) in the Central African Republic, 19·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau.
• Between 1990 and 2016, variation in the pace of progress achieved was observed; between 2000 and 2016, markedly faster improvements occurred in many countries in sub-Saharan Africa and southeast Asia; whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000.
• In personal health-care access and quality, striking subnational disparities were noted; China and India showed particularly large gaps between locations with the highest and lowest scores in 2016.
• Performance ranged from 91·5 (89·1–93·6) in Beijing to 48·0 (43·4–53·2) in Tibet (a 43·5-point difference) in China; while India displayed a 30·8-point disparity, from 64·8 (59·6–68·8) in Goa to 34·0 (30·3–38·1) in Assam.
• The smallest range in subnational HAQ performance was recorded in Japan in 2016 (a 4·8-point difference).
• However, differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England.
• From 1990 to 2016, Mexico showed somewhat narrowing of state-level gaps in the HAQ Index (from a 20·9-point to 17·0-point difference), whereas Brazil demonstrated slightly increased disparities across states during this time (a 17·2-point to 20·4-point difference).
• Strong associations to overall development were indicated by the performance on the HAQ Index, with high and high-middle SDI countries generally showing higher scores and faster gains for non-communicable diseases.
• From 2000 to 2016, substantial gains in some key health service areas were reported in countries across the development spectrum, most notably vaccine-preventable diseases.
• Findings demonstrated a positive association of national performance on the HAQ Index with higher levels of total health spending per capita, as well as health systems inputs; however, these relationships were quite heterogeneous, especially among low-to-middle SDI countries.