Isfahan University of Medical Sciences

Science Communicator Platform

Stay connected! Follow us on X network (Twitter):
Share By
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 Publisher Pubmed



Fullman N1 ; Yearwood J1 ; Abay SM9 ; Abbafati C10 ; Abdallah F11 ; Abdela J13 ; Abdelalim A11 ; Abebe Z18 ; Abebo TA19 ; Aboyans V21 ; Abraha HN26 ; Abreu DMX27 ; Aburaddad LJ28 ; Adane AA18, 32 Show All Authors
Authors
  1. Fullman N1
  2. Yearwood J1
  3. Abay SM9
  4. Abbafati C10
  5. Abdallah F11
  6. Abdela J13
  7. Abdelalim A11
  8. Abebe Z18
  9. Abebo TA19
  10. Aboyans V21
  11. Abraha HN26
  12. Abreu DMX27
  13. Aburaddad LJ28
  14. Adane AA18, 32
  15. Adedoyin RA34
  16. Adetokunboh O35, 36
  17. Adhikari TB37
  18. Afarideh M42
  19. Afshin A1
  20. Agarwal G53
  21. Agius D54, 55
  22. Agrawal A56, 57
  23. Agrawal S60
  24. Ahmad Kiadaliri A61
  25. Aichour MTE63
  26. Akibu M64
  27. Akinyemi RO65, 66
  28. Akinyemiju TF67
  29. Akseer N69, 70
  30. Al Lami FH72
  31. Alahdab F73, 74
  32. Alaly Z75
  33. Alam K76
  34. Alam T1
  35. Alasfoor D78
  36. Albittar MI79
  37. Alene KA16, 80
  38. Aleyadhy A82, 83
  39. Ali SD84, 85, 86
  40. Alijanzadeh M87
  41. Aljunid SM88, 89
  42. Alkerwi A90
  43. Alla F91
  44. Allebeck P94
  45. Allen C1
  46. Alomari MA97
  47. Alraddadi R98
  48. Alsharif U99
  49. Altirkawi KA82
  50. Alvisguzman N100
  51. Amare AT102, 103
  52. Amenu K7
  53. Ammar W104
  54. Amoako YA105
  55. Anber N107
  56. Andrei CL108
  57. Androudi S109
  58. Antonio CAT111
  59. Araujo VEM27, 112
  60. Aremu O113
  61. Arnlov J93, 114
  62. Artaman A115
  63. Aryal KK116, 117
  64. Asayesh H118
  65. Asfaw ET22
  66. Asgedom SW26
  67. Asghar RJ119
  68. Ashebir MM24
  69. Asseffa NA120
  70. Atey TM26
  71. Atre SR121, 124
  72. Atteraya MS125
  73. Avilaburgos L126
  74. Avokpaho EFGA127, 128
  75. Awasthi A129
  76. Ayala Quintanilla BP131, 133
  77. Ayalew AA134
  78. Ayele HT135, 136
  79. Ayer R137
  80. Ayuk TB138, 139
  81. Azzopardi P140, 141, 142, 147
  82. Azzopardimuscat N54, 148
  83. Babalola TK149
  84. Badali H151, 152
  85. Badawi A71, 153
  86. Banach M154
  87. Banerjee A156
  88. Banstola A158
  89. Barber RM1
  90. Barboza MA159, 160
  91. Barkercollo SL161
  92. Barnighausen T163, 164, 165
  93. Barquera S126
  94. Barrero LH167
  95. Bassat Q168, 169
  96. Basu S170
  97. Baune BT102
  98. Bazarganhejazi S171, 172
  99. Bedi N173
  100. Beghi E174
  101. Behzadifar M175, 181
  102. Behzadifar M175, 181
  103. Bekele BB15, 184
  104. Belachew AB24
  105. Belay SA185
  106. Belay YA134
  107. Bell ML186
  108. Bello AK187
  109. Bennett DA192
  110. Bennett JR1
  111. Bensenor IM196
  112. Berhe DF23, 198
  113. Bernabe E201
  114. Bernstein RS202, 204
  115. Beuran M108, 205
  116. Bhalla A207
  117. Bhatt P208
  118. Bhaumik S60
  119. Bhutta ZA69, 209
  120. Biadgo B18
  121. Bijani A213
  122. Bikbov B174
  123. Birungi C157
  124. Biryukov S1
  125. Bizuneh H215, 216
  126. Bolliger IW1
  127. Bolt K1
  128. Bouorm IR104
  129. Bozorgmehr K217
  130. Brady OJ219
  131. Brazinova A220
  132. Breitborde NJK221
  133. Brenner H222
  134. Britton G223
  135. Brugha TS224
  136. Butt ZA225
  137. Cahuanahurtado L126
  138. Camposnonato IR126, 163
  139. Campuzano JC126
  140. Car J226, 231
  141. Car M231, 232
  142. Cardenas R233
  143. Carrero JJ92
  144. Carvalho F235
  145. Castanedaorjuela CA239, 240
  146. Castillo Rivas J160, 241
  147. Catalalopez F242, 243
  148. Cercy K1
  149. Chalek J1
  150. Chang HY244, 245
  151. Chang JC246
  152. Chattopadhyay A247
  153. Chaturvedi P248
  154. Chiang PPC249
  155. Chisumpa VH250, 251
  156. Choi JYJ253, 254
  157. Christensen H255
  158. Christopher DJ256
  159. Chung SC156
  160. Ciobanu LG102
  161. Cirillo M257
  162. Colombara D1
  163. Conti S259
  164. Cooper C191, 260
  165. Cornaby L1
  166. Cortesi PA258
  167. Cortinovis M174
  168. Costa Pereira A261
  169. Cousin E262
  170. Criqui MH263
  171. Cromwell EA1
  172. Crowe CS6
  173. Crump JA264
  174. Daba AK20
  175. Dachew BA17, 32
  176. Dadi AF18, 265
  177. Dandona L1, 60
  178. Dandona R1, 60
  179. Dargan PI266
  180. Daryani A269
  181. Daryani M270
  182. Das J210
  183. Das SK271
  184. Das Neves J236, 238
  185. Davis Weaver N1
  186. Davletov K272
  187. De Courten B273, 274
  188. De Leo D275
  189. De Neve JW276
  190. Dellavalle RP277
  191. Demoz G9, 279
  192. Deribe K8, 280
  193. Des Jarlais DC281, 282
  194. Dey S59
  195. Dharmaratne SD283
  196. Dhimal M284
  197. Djalalinia S285
  198. Doku DT287, 288
  199. Dolan K289
  200. Dorsey ER290
  201. Dos Santos KPB291
  202. Doyle KE81, 292
  203. Driscoll TR293
  204. Dubey M247
  205. Dubljanin E296
  206. Duncan BB298, 299
  207. Echko M1
  208. Edessa D14
  209. Edvardsson D132, 300
  210. Ehrlich JR301
  211. Eldrenkamp E1
  212. Elkhatib Z94, 302
  213. Endres M99
  214. Endries AY305
  215. Eshrati B286, 306
  216. Eskandarieh S307
  217. Esteghamati A42
  218. Fakhar M268
  219. Farag T1
  220. Faramarzi M214
  221. Faraon EJA110, 308
  222. Faro A309
  223. Farzadfar F49
  224. Fatusi A33
  225. Fazeli MS310
  226. Feigin VL311
  227. Feigl AB163
  228. Fentahun N312
  229. Fereshtehnejad SM93
  230. Fernandes E234
  231. Fernandes JC314
  232. Fijabi DO315
  233. Filip I316
  234. Fischer F317
  235. Fitzmaurice C1, 2, 318
  236. Flaxman AD1
  237. Flor LS319, 320
  238. Foigt N321
  239. Foreman KJ1, 231
  240. Frostad JJ1
  241. Furst T228, 322, 324
  242. Futran ND6
  243. Gakidou E1
  244. Gallus S174
  245. Gambashidze K325
  246. Gamkrelidze A325
  247. Ganji M42
  248. Gebre AK26
  249. Gebrehiwot TT313
  250. Gebremedhin AT313, 326
  251. Gelaw YA17, 31
  252. Geleijnse JM327
  253. Geremew D18
  254. Gething PW190
  255. Ghadimi R211, 328
  256. Ghasemi Falavarjani K183
  257. Ghasemikasman M214
  258. Gill PS698
  259. Giref AZ9
  260. Giroud M329
  261. Gishu MD14, 330
  262. Giussani G174
  263. Godwin WW1
  264. Goli S331
  265. Gomezdantes H126
  266. Gona PN332
  267. Goodridge A333
  268. Gopalani SV334
  269. Goryakin Y335
  270. Goulart AC194
  271. Grada A336
  272. Griswold M1
  273. Grosso G337, 338
  274. Gugnani HC339
  275. Guo Y32
  276. Gupta R340
  277. Gupta R340
  278. Gupta T342, 343
  279. Gupta T342, 343
  280. Gupta V345
  281. Haagsma JA347
  282. Hachinski V349
  283. Hafezinejad N42
  284. Hailu GB26, 350
  285. Hamadeh RR351
  286. Hamidi S352
  287. Hankey GJ353, 355, 356
  288. Harb HL104
  289. Harewood HC357
  290. Harikrishnan S358
  291. Haro JM360
  292. Hassen HY184
  293. Havmoeller R95
  294. Hawley C1
  295. Hay SI1, 188
  296. He J1
  297. Hearps SJC361
  298. Hegazy MI12
  299. Heibati B177
  300. Heidari M362
  301. Hendrie D363
  302. Henry NJ1
  303. Herrera Ballesteros VH364, 365
  304. Herteliu C366
  305. Hibstu DT19
  306. Hiluf MK368
  307. Hoek HW197, 369
  308. Homaie Rad E371
  309. Horita N372
  310. Hosgood HD343
  311. Hosseini M52
  312. Hosseini SR213
  313. Hostiuc M108
  314. Hostiuc S108
  315. Hoy DG373
  316. Hsairi M374
  317. Htet AS77, 117
  318. Hu G375
  319. Huang JJ186
  320. Iburg KM377
  321. Idris F378, 379
  322. Igumbor EU380, 381
  323. Ikeda C1
  324. Ileanu BV367
  325. Ilesanmi OS382
  326. Innos K383
  327. Irvani SSN384, 387
  328. Irvine CMS1
  329. Islami F388
  330. Jacobs TA389
  331. Jacobsen KH390
  332. Jahanmehr N386
  333. Jain R391
  334. Jain SK392
  335. Jakovljevic MM3, 393
  336. Jalu MT14, 215
  337. Jamal AA82
  338. Javanbakht M394
  339. Jayatilleke AU395, 396
  340. Jeemon P58, 397
  341. Jha RP398
  342. Jha V193, 399
  343. Jozwiak J400
  344. John O399
  345. Johnson SC1
  346. Jonas JB401
  347. Joshua V402
  348. Jurisson M404
  349. Kabir Z405
  350. Kadel R406
  351. Kahsay A26
  352. Kalani R6
  353. Kar C407
  354. Karanikolos M218
  355. Karch A408, 409
  356. Karema CK323, 410
  357. Karimi SM411
  358. Kasaeian A43, 44
  359. Kassa DH134
  360. Kassa GM134
  361. Kassa TD26
  362. Kassebaum NJ1, 412
  363. Katikireddi SV413
  364. Kaul A414
  365. Kawakami N415
  366. Kazanjan K325
  367. Kebede S26
  368. Keiyoro PN416, 417
  369. Kemp GR1
  370. Kengne AP419, 422
  371. Kereselidze M325
  372. Ketema EB26
  373. Khader YS96
  374. Khafaie MA423
  375. Khajavi A387
  376. Khalil IA1
  377. Khan EA424
  378. Khan G425
  379. Khan MN68, 426, 427
  380. Khan MA428
  381. Khanal MN429
  382. Khang YH252, 430
  383. Khater MM12
  384. Khoja ATA122, 431, 432
  385. Khosravi A49, 433
  386. Khubchandani J434
  387. Kibret GD134
  388. Kiirithio DN435, 436
  389. Kim D437
  390. Kim YJ438
  391. Kimokoti RW439
  392. Kinfu Y440
  393. Kinra S219
  394. Kisa A441
  395. Kissoon N443
  396. Kochhar S4, 444
  397. Kokubo Y445
  398. Kopec JA443
  399. Kosen S446
  400. Koul PA447
  401. Koyanagi A359
  402. Kravchenko M448
  403. Krishan K449
  404. Krohn KJ1
  405. Kuate Defo B450, 451
  406. Kumar GA60
  407. Kumar P247
  408. Kutz M1
  409. Kuzin I452
  410. Kyu HH1
  411. Lad DP207
  412. Lafranconi A259
  413. Lal DK60
  414. Lalloo R30
  415. Lam H454
  416. Lan Q455
  417. Lang JJ153, 456
  418. Lansingh VC457, 458
  419. Lansky S459, 460
  420. Larsson A461
  421. Latifi A463
  422. Lazarus JV464, 465
  423. Leasher JL467
  424. Lee PH468
  425. Legesse Y26
  426. Leigh J294
  427. Leshargie CT134
  428. Leta S9
  429. Leung J6, 31
  430. Leung R469
  431. Levi M470
  432. Li Y471
  433. Liang J472
  434. Liben ML368
  435. Lim LL473, 474
  436. Lim SS1
  437. Lind M1
  438. Linn S475
  439. Listl S166, 476
  440. Liu PY1
  441. Liu S477
  442. Lodha R478
  443. Lopez AD145
  444. Lorch SA479
  445. Lorkowski S480, 481
  446. Lotufo PA196
  447. Lucas TCD188, 189
  448. Lunevicius R482, 483
  449. Lurton G1
  450. Lyons RA484
  451. Maalouf F486
  452. Macarayan ERK162
  453. Mackay MT146, 487
  454. Maddison ER1
  455. Madotto F259
  456. Magdy Abd El Razek H488
  457. Magdy Abd El Razek M489
  458. Majdan M490
  459. Majdzadeh R46, 491
  460. Majeed A229
  461. Malekzadeh R41
  462. Malhotra R478
  463. Malta DC492
  464. Mamun AA32
  465. Manguerra H1
  466. Manhertz T1
  467. Mansournia MA39
  468. Mantovani LG259
  469. Manyazewal T493
  470. Mapoma CC250
  471. Margono C1
  472. Martinezraga J494, 495
  473. Martins SCO496, 497
  474. Martinsmelo FR498
  475. Martopullo I1
  476. Marz W499, 500
  477. Massenburg BB5, 303
  478. Mathur MR60, 157
  479. Maulik PK501, 502
  480. Mazidi M503
  481. Mcalinden C504, 505
  482. Mcgrath JJ29, 376, 506
  483. Mckee M219
  484. Mehata S507
  485. Mehrotra R508
  486. Mehta KM509
  487. Mehta V510
  488. Meier T511
  489. Mejiarodriguez F126
  490. Meles KG24, 25
  491. Melku M18
  492. Memiah P513
  493. Memish ZA514, 515
  494. Mendoza W516
  495. Mengiste DA14
  496. Mengistu DT22
  497. Menota BG9
  498. Mensah GA453
  499. Meretoja A143, 518
  500. Meretoja TJ517, 520
  501. Mezgebe HB26
  502. Miazgowski T521
  503. Micha R522
  504. Milam R310
  505. Millear A1
  506. Miller TR363, 524
  507. Mini GK525, 526
  508. Minnig S1
  509. Mirica A367
  510. Mirrakhimov EM527, 528
  511. Misganaw A1
  512. Mitchell PB531
  513. Mlashu FW14
  514. Moazen B50, 533
  515. Mohammad KA534, 535
  516. Mohammadibakhsh R536
  517. Mohammed E26
  518. Mohammed MA216, 294
  519. Mohammed S165, 537
  520. Mokdad AH1
  521. Mola GLD538
  522. Molokhia M201
  523. Momeniha F182
  524. Monasta L539
  525. Montanez Hernandez JC126
  526. Moosazadeh M267
  527. Moradilakeh M178, 179, 180
  528. Moraga P540
  529. Morawska L541
  530. Moreno Velasquez I543
  531. Mori R544
  532. Morrison SD6
  533. Moses M1
  534. Mousavi SM40
  535. Mueller UO546
  536. Murhekar M547
  537. Murthy GVS59, 219
  538. Murthy S443
  539. Musa J548, 549
  540. Musa KI550
  541. Mustafa G551, 552
  542. Muthupandian S22
  543. Nagata C544
  544. Nagel G554
  545. Naghavi M1
  546. Naheed A555
  547. Naik GA68
  548. Naik N478
  549. Najafi F557
  550. Naldi L558
  551. Nangia V559
  552. Nansseu JRN560, 561
  553. Narayan KMV203
  554. Nascimento BR562, 563
  555. Negoi I108, 205
  556. Negoi RI108
  557. Newton CR193, 564
  558. Ngunjiri JW565
  559. Nguyen G1
  560. Nguyen L95
  561. Nguyen TH566
  562. Nichols E1
  563. Ningrum DNA567, 568
  564. Nolte E218
  565. Nong VM566
  566. Norheim OF569
  567. Norrving B62
  568. Noubiap JJN422, 570
  569. Nyandwi A571
  570. Obermeyer CM485
  571. Oforiasenso R273
  572. Ogbo FA572
  573. Oh IH574
  574. Oladimeji O575
  575. Olagunju AT101, 150, 576
  576. Olagunju TO53, 349
  577. Olivares PR577
  578. De Oliveira PPV112
  579. Olsen HE1
  580. Olusanya BO578
  581. Olusanya JO578
  582. Ong K1
  583. Opio JN579
  584. Oren E580
  585. Ortegaaltamirano DV126
  586. Ortiz A581
  587. Ozdemir R582
  588. Pa M583
  589. Pain AW1
  590. Palone MRT196
  591. Pana A367
  592. Pandajonas S532
  593. Pandian JD584
  594. Park EK585
  595. Parsian H214
  596. Patel T586
  597. Pati S60
  598. Patil ST587
  599. Patle A588
  600. Patton GC141, 142
  601. Paturi VR589, 590
  602. Paudel D591
  603. De Moares Pedroso M592
  604. Pedroza SP1
  605. Pereira DM593
  606. Perico N174
  607. Peterson H1
  608. Petzold M594, 595
  609. Peykari N286
  610. Phillips MR203, 596
  611. Piel FB227
  612. Pigott DM1
  613. Pillay JD597
  614. Piradov MA448
  615. Polinder S346
  616. Pond CD598
  617. Postma MJ198, 199
  618. Pourmalek F443
  619. Prakash S599
  620. Prakash V600
  621. Prasad N601
  622. Prasad NM146, 602
  623. Purcell C1
  624. Qorbani M603
  625. Quintana HK604
  626. Radfar A605
  627. Rafay A606, 607
  628. Rafiei A268
  629. Rahimi K193
  630. Rahimimovaghar A45
  631. Rahimimovaghar V51
  632. Rahman M130, 146
  633. Rahman MA608
  634. Rahman SU609
  635. Rai RK610
  636. Raju SB611
  637. Ram U247
  638. Rana SM606, 607
  639. Rankin Z1
  640. Rasella D612
  641. Rawaf DL230, 613, 614
  642. Rawaf S231
  643. Ray SE1
  644. Razogarcia CA126
  645. Reddy P615
  646. Reiner RC1
  647. Reis C616
  648. Reitsma MB1
  649. Remuzzi G174, 617, 618
  650. Renzaho AMN573
  651. Resnikoff S529, 530
  652. Rezaei S556
  653. Rezai MS270
  654. Ribeiro AL562
  655. Rios Blancas MJ126
  656. Rivera JA126
  657. Roever L619
  658. Ronfani L539
  659. Roshandel G41, 620
  660. Rostami A212
  661. Roth GA1
  662. Rothenbacher D553
  663. Roy A478
  664. Roy N94, 621
  665. Ruhago GM622
  666. Sabde YD623
  667. Sachdev PS531, 624
  668. Sadat N1
  669. Safdarian M51
  670. Safiri S462
  671. Sagar R478
  672. Sahebkar A354, 625
  673. Sahraian MA47
  674. Sajadi HS48
  675. Salama J1
  676. Salamati P51
  677. De Freitas Saldanha R626
  678. Salimzadeh H52
  679. Salomon JA163
  680. Samy AM627
  681. Sanabria JR629, 630
  682. Sancheti PK631
  683. Sancheznino MD632
  684. Santomauro D1, 31, 633
  685. Santos IS195
  686. Santric Milicevic MM295, 297
  687. Sarker AR555
  688. Sarrafzadegan N442, 634
  689. Sartorius B418, 635
  690. Satpathy M636
  691. Savic M638
  692. Sawhney M628
  693. Saxena S231
  694. Saylan MI639
  695. Schaeffner E99
  696. Schmidhuber J640
  697. Schmidt MI298
  698. Schneider IJC641
  699. Schumacher AE1
  700. Schutte AE419, 642
  701. Schwebel DC68
  702. Schwendicke F99
  703. Sekerija M643, 644
  704. Sepanlou SG41
  705. Servanmori EE126
  706. Shafieesabet A645
  707. Shaikh MA79
  708. Shakhnazarova M325
  709. Shamsbeyranvand M42
  710. Sharafi H646
  711. Sharifalhoseini M51
  712. Shariful Islam SM399, 647
  713. Sharma M403
  714. Sharma R649
  715. She J650
  716. Sheikh A304, 654
  717. Shfare MT278
  718. Shi P523
  719. Shields C1
  720. Shigematsu M651
  721. Shinohara Y652
  722. Shiri R519
  723. Shirkoohi R38
  724. Shiue I512, 653
  725. Shrime MG304
  726. Shukla SR655, 656
  727. Siabani S557, 657
  728. Sigfusdottir ID658
  729. Silberberg DH659
  730. Silva DAS641
  731. Silva JP237
  732. Silveira DGA660
  733. Singh JA68
  734. Singh L1
  735. Singh NP661
  736. Singh V662
  737. Sinha DN663, 664
  738. Sinke AH665
  739. Sisay M14
  740. Skirbekk V370, 638
  741. Sliwa K421
  742. Smith A1
  743. Soares Filho AM112
  744. Sobaih BHA82, 666
  745. Somai M667
  746. Soneji S668
  747. Soofi M557
  748. Sorensen RJD1
  749. Soriano JB669, 670
  750. Soyiri IN654
  751. Sposato LA348
  752. Sreeramareddy CT671
  753. Srinivasan V1
  754. Stanaway JD1
  755. Stathopoulou V672
  756. Steel N673, 674
  757. Stein DJ420, 675
  758. Stokes MA648
  759. Sturua L325
  760. Sufiyan MB537
  761. Suliankatchi RA676
  762. Sunguya BF622
  763. Sur PJ1
  764. Sykes BL677
  765. Sylaja PN525
  766. Szoeke CEI144
  767. Tabaresseisdedos R242
  768. Tadakamadla SK275
  769. Tadesse AH678
  770. Taffere GR24
  771. Tandon N478
  772. Tariku AT18
  773. Taveira N679, 680
  774. Tehranibanihashemi A178, 179
  775. Temam Shifa G9, 305
  776. Temsah MH82
  777. Terkawi AS681, 682, 683
  778. Tesema AG26
  779. Tesfaye DJ19
  780. Tessema B18
  781. Thakur JS206
  782. Thomas N256
  783. Thompson MJ6
  784. Tillmann T155
  785. To QG542
  786. Tobegai R544
  787. Tonelli M684
  788. Topormadry R685, 686
  789. Topouzis F687
  790. Torre A1
  791. Tortajada M494, 688
  792. Tran BX123, 689
  793. Tran KB690
  794. Tripathi A691
  795. Tripathy SP692
  796. Troeger C1
  797. Truelsen T466
  798. Tsoi D1
  799. Tudor Car L226, 231
  800. Tuem KB26
  801. Tyrovolas S693
  802. Uchendu US694
  803. Ukwaja KN695
  804. Ullah I696, 697
  805. Updike R1
  806. Uthman OA698
  807. Uzochukwu BSC699
  808. Valdez PR700, 701
  809. Van Boven JFM199
  810. Varughese S256
  811. Vasankari T702
  812. Venketasubramanian N703
  813. Violante FS704
  814. Vladimirov SK705
  815. Vlassov VV706
  816. Vollset SE1, 637
  817. Vos T1
  818. Wagnew F134
  819. Waheed Y707
  820. Wallin MT708, 709
  821. Walson JL6, 710
  822. Wang Y711
  823. Wang YP712, 713
  824. Wassie MM18, 714
  825. Weaver MR1
  826. Weiderpass E92, 715, 716, 717
  827. Weintraub RG146, 718, 719
  828. Weiss J659
  829. Weldegwergs KG26
  830. Werdecker A545
  831. West TE6
  832. Westerman R546, 720
  833. White RG219
  834. Whiteford HA1, 31, 633
  835. Widecka J721
  836. Winkler AS722, 723
  837. Wiysonge CS35, 36, 724
  838. Wolfe CDA200, 725
  839. Wondimkun YA14
  840. Workicho A313, 726
  841. Wyper GMA727, 728
  842. Xavier D729
  843. Xu G730
  844. Yan LL731
  845. Yano Y732
  846. Yaseri M52, 385
  847. Yimer NB733
  848. Yin P477
  849. Yip P734
  850. Yirsaw BD9, 735
  851. Yonemoto N736
  852. Yonga G737
  853. Yoon SJ738
  854. Yotebieng M221, 739
  855. Younis MZ740
  856. Yu C741
  857. Zadnik V742
  858. Zaidi Z743
  859. El Sayed Zaki M106
  860. Zaman SB555
  861. Zamani M214
  862. Zenebe ZM26
  863. Zhou M1, 477
  864. Zhu J744
  865. Zimsen SRM1
  866. Zipkin B1
  867. Zodpey S60
  868. Zuhlke LJ745
  869. Murray CJL1
  870. Lozano R1

Source: The Lancet Published:2018


Abstract

Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess 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. Methods Drawing from established methods and updated estimates from GBD 2016, we 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. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we 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. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause 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); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance 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. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for 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. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, 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), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas 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. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view - and subsequent provision - of quality health care for all populations. Copyright © 2018 The Author(s). Published by Elsevier Ltd.
Other Related Docs