Háskólinn í ReykjavíkReykjavik UniversityBarber, Ryan MFullman, NancySorensen, Reed J DBollyky, ThomasMcKee, MartinNolte, EllenAbajobir, Amanuel AlemuAbate, Kalkidan HassenAbbafati, CristianaAbbas, Kaja MAbd-Allah, FoadAbdulle, Abdishakur MAbdurahman, Ahmed AbdulahiAbera, Semaw FeredeAbraham, BijuAbreha, Girmatsion FissehaAdane, KelemeworkAdelekan, Ademola LukmanAdetifa, Ifedayo Morayo OAfshin, AshkanAgarwal, ArnavAgarwal, Sanjay KumarAgarwal, SunilkumarAgrawal, AnuragKiadaliri, Aliasghar AhmadAhmadi, AlirezaAhmed, Kedir YimamAhmed, Muktar BeshirAkinyemi, Rufus OlusolaAkinyemiju, Tomi FAkseer, NadiaAl-Aly, ZiyadAlam, KhurshidAlam, NooreAlam, Sayed SaidulAlemu, Zewdie AderawAlene, Kefyalew AddisAlexander, LilyAli, RaghibAli, Syed DanishAlizadeh-Navaei, RezaAlkerwi, Ala'aAlla, FrançoisAllebeck, PeterAllen, ChristineAl-Raddadi, RajaaAlsharif, UbaiAltirkawi, Khalid AMartin, Elena AlvarezAlvis-Guzman, NelsonAmare, Azmeraw TAmini, ErfanAmmar, WalidAmo-Adjei, JoshuAmoako, Yaw AmpemAnderson, Benjamin OAndroudi, SofiaAnsari, HosseinAnsha, Mustafa GeletoAntonio, Carl Abelardo TÄrnlöv, JohanArtaman, AlAsayesh, HamidAssadi, RezaAstatkie, AyalewAtey, Tesfay MehariAtique, SulemanAtnafu, Niguse TadeleAtre, Sachin RAvila-Burgos, LeticiaAvokpaho, Euripide Frinel G ArthurQuintanilla, Beatriz Paulina AyalaAwasthi, AshishAyele, Nebiyu NegussuAzzopardi, PeterSaleem, Huda Omer BaBärnighausen, TillBacha, UmarBadawi, AlaaBanerjee, AmitavaBarac, AleksandraBarboza, Miguel ABarker-Collo, Suzanne LBarrero, Lope HBasu, SanjayBaune, Bernhard TBaye, KaleabBayou, Yibeltal TebekawBazargan-Hejazi, ShahrzadBedi, NeerajBeghi, EttoreBéjot, YannickBello, Aminu KBennett, Derrick ABensenor, Isabela MBerhane, AdugnawBernabé, EduardoBernal, Oscar AlbertoBeyene, Addisu ShunuBeyene, Tariku JibatBhutta, Zulfiqar ABiadgilign, SibhatuBikbov, BorisBirlik, Sait MentesBirungi, CharlesBiryukov, StanBisanzio, DonalBizuayehu, Habtamu MellieBose, DipanBrainin, MichaelBrauer, MichaelBrazinova, AlexandraBreitborde, Nicholas J KBrenner, HermannButt, Zahid ACárdenas, RosarioCahuana-Hurtado, LuceroCampos-Nonato, Ismael RicardoCar, JosipCarrero, Juan JesusCasey, DanielCaso, ValeriaCastañeda-Orjuela, Carlos ARivas, Jacqueline CastilloCatalá-López, FerránCecilio, PedroCercy, KellyCharlson, Fiona JChen, Alan ZChew, AdrienneChibalabala, MirriamChibueze, Chioma EzinneChisumpa, Vesper HichilombweChitheer, Abdulaal AChowdhury, RajivChristensen, HanneChristopher, Devasahayam JesudasCiobanu, Liliana GCirillo, MassimoCoggeshall, Megan SCooper, Leslie TrumbullCortinovis, MonicaCrump, John ADalal, KoustuvDanawi, HadiDandona, LalitDandona, RakhiDargan, Paul Idas Neves, JoseDavey, GailDavitoiu, Dragos VDavletov, KairatDe Leo, DiegoDel Gobbo, Liana Cdel Pozo-Cruz, BorjaDellavalle, Robert PDeribe, KebedeDeribew, AmareDes Jarlais, Don CDey, SubhojitDharmaratne, Samath DDicker, DanielDing, Eric LDokova, KlaraDorsey, E RayDoyle, Kerrie EDubey, ManishaEhrenkranz, RebeccaEllingsen, Christian LyckeElyazar, IqbalEnayati, AhmadaliErmakov, Sergey PetrovichEshrati, BabakEsteghamati, AlirezaEstep, KaraFürst, ThomasFaghmous, Imad D AFanuel, Fanuel Belayneh BekeleFaraon, Emerito Jose AquinoFarid, Talha AFarinha, Carla Sofia e SaFaro, AndreFarvid, Maryam SFarzadfar, FarshadFeigin, Valery LFeigl, Andrea BFereshtehnejad, Seyed-MohammadFernandes, Jefferson GFernandes, João CFeyissa, Tesfaye RegassaFischer, FlorianFitzmaurice, ChristinaFleming, Thomas DFoigt, NataliyaForeman, Kyle JForouzanfar, Mohammad HFranklin, Richard CFrostad, JosephG/hiwot, Tsegaye TeweldeGakidou, EmmanuelaGambashidze, KetevanGamkrelidze, AmiranGao, WayneGarcia-Basteiro, Alberto LGebre, TeshomeGebremedhin, Amanuel TesfayGebremichael, Mengistu WeldayGebru, Alemseged AregayGelaye, Amha AdmasieGeleijnse, Johanna MGenova-Maleras, RicardGibney, Katherine BGiref, Ababi ZergawGishu, Melkamu DedefoGiussani, GiorgiaGodwin, William WGold, AudraGoldberg, Ellen MGona, Philimon NGoodridge, AmadorGopalani, Sameer ValiGoto, AtsushiGraetz, NicholasGreaves, 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RitulKan, HaidongKarch, AndreKarema, Corine KakiziKarimi, Seyed MKasaeian, AmirKassebaum, Nicholas JKastor, AnshulKatikireddi, Srinivasa VittalKazanjan, KonstantinKeiyoro, Peter NjengaKemmer, LauraKemp, Andrew HaddonKengne, Andre PascalKerbo, Amene AbebeKereselidze, MaiaKesavachandran, Chandrasekharan NairKhader, Yousef SalehKhalil, IbrahimKhan, Abdur RahmanKhan, Ejaz AhmadKhan, GulfarazKhang, Young-HoKhoja, Abdullah Tawfih AbdullahKhonelidze, IrmaKhubchandani, JagdishKibret, Getiye DejenuKim, DanielKim, PaulineKim, Yun JinKimokoti, Ruth WKinfu, YohannesKissoon, NiranjanKivipelto, MiiaKokubo, YoshihiroKolk, AnneliKolte, DhavalKopec, Jacek AKosen, SoewartaKoul, Parvaiz AKoyanagi, AiKravchenko, MichaelKrishnaswami, SanjayKrohn, Kristopher JDefo, Barthelemy KuateBicer, Burcu KucukKuipers, Ernst JKulkarni, Veena SKumar, G AnilKumsa, Fekede AsefaKutz, MichaelKyu, Hmwe HLager, Anton Carl JonasLal, AparnaLal, Dharmesh KumarLalloo, RatilalLallukka, TeaLan, QingLangan, Sinead MLansingh, Van CLarson, Heidi JLarsson, AndersLaryea, Dennis OdaiLatif, Asma AbdulLawrynowicz, Alicia Elena BeatrizLeasher, Janet LLeigh, JamesLeinsalu, MallLeshargie, Cheru TesemaLeung, JanniLeung, RickyLevi, MiriamLiang, XiaofengLim, Stephen SLind, MargaretLinn, ShaiLipshultz, Steven ELiu, PatrickLiu, YangLo, Loon-TzianLogroscino, GiancarloLopez, Alan DLorch, Scott ALotufo, Paulo ALozano, RafaelLunevicius, RaimundasLyons, Ronan AMacarayan, Erlyn Rachelle KingMackay, Mark TEl Razek, Hassan Magdy AbdEl Razek, Mohammed Magdy AbdMahdavi, MahdiMajeed, AzeemMalekzadeh, RezaMalta, Deborah CarvalhoMantovani, Lorenzo GManyazewal, TsegahunMapoma, Chabila CMarcenes, WagnerMarks, Guy BMarquez, NealMartinez-Raga, JoseMarzan, Melvin BarrientosMassano, JoãoMathur, Manu RajMaulik, Pallab KMazidi, MohsenMcAlinden, ColmMcGrath, John JMcNellan, ClaireMeaney, Peter AMehari, AlemMehndiratta, Man MohanMeier, ToniMekonnen, Alemayehu BMeles, Kidanu GebremariamMemish, Ziad AMengesha, Melkamu MeridMengiste, Desalegn 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Helen EOlusanya, Bolajoko OlubukunolaOlusanya, Jacob OlusegunOpio, John NelsonOren, EyalOrtiz, AlbertoOsborne, Richard HOsman, MajdiOwolabi, Mayowa OPA, MaheshPain, Amanda WPakhale, SmitaCastillo, Elizabeth PalomaresPana, AdrianPapachristou, ChristinaParsaeian, MahboubehPatel, TejasPatton, George CPaudel, DeepakPaul, Vinod KPearce, NeilPereira, David MPerez-Padilla, RogelioPerez-Ruiz, FernandoPerico, NorbertoPesudovs, KonradPetzold, MaxPhillips, Michael RobertPigott, David MPillay, Julian DavidPinho, ChristinePolinder, SuzannePond, Constance DPrakash, VPurwar, ManoramaQorbani, MostafaQuistberg, D AlexRadfar, AmirRafay, AnwarRahimi, KazemRahimi-Movaghar, VafaRahman, MahfuzarRahman, Mohammad Hifz UrRai, Rajesh KumarRam, UshaRana, Saleem MRankin, ZaneRao, Paturi VishnupriyaRao, Puja CRawaf, SalmanRego, Maria Albertina SantiagoReitsma, MarissaRemuzzi, GiuseppeRenzaho, Andre M N NResnikoff, SergeRezaei, SatarRezai, Mohammad SadeghRibeiro, Antonio LRoba, Hirbo ShoreRokni, Mohammad BagherRonfani, LucaRoshandel, GholamrezaRoth, Gregory ARothenbacher, DietrichRoy, Nawal KSachdev, Perminder SSackey, Ben BenascoSaeedi, Mohammad YahyaSafiri, SaeidSagar, RajeshSahraian, Mohammad AliSaleh, Muhammad MuhammadSalomon, Joshua ASamy, Abdallah MSanabria, Juan RamonSanchez-Niño, Maria DoloresSandar, LoganSantos, Itamar SSantos, João VascoMilicevic, Milena M SantricSarmiento-Suarez, RodrigoSartorius, BennSatpathy, MaheswarSavic, MilojeSawhney, MonikaSaylan, Mete ISchöttker, BenSchutte, Aletta ESchwebel, David CSeedat, SorayaSeid, Abdulbasit MusaSeifu, Canaan NegashSepanlou, Sadaf GSerdar, BerrinServan-Mori, Edson ESetegn, TesfayeShackelford, Katya AnneShaheen, AmiraShahraz, SaeidShaikh, Masood AliShakh-Nazarova, MarinaShamsipour, MansourIslam, Sheikh Mohammed SharifulSharma, JayendraSharma, RajeshShe, JunSheikhbahaei, SaraShen, JiabinShi, PeilinShigematsu, MikaShin, Min-JeongShiri, RahmanShoman, HaithamShrime, Mark GSibamo, Ephrem Lejore SibamoSigfúsdóttir, Inga DóraSilva, Diego Augusto SantosSilveira, Dayane Gabriele AlvesSindi, ShireenSingh, AbhishekSingh, Jasvinder ASingh, Om PrakashSingh, Prashant KumarSingh, VirendraSinke, Abiy HiruyeSinshaw, Aklilu EndalamawSkirbekk, VegardSliwa, KarenSmith, AlisonSobngwi, EugeneSoneji, SamirSoriano, Joan BSousa, Tatiane Cristina MoraesSposato, Luciano ASreeramareddy, Chandrashekhar TStathopoulou, VasilikiSteel, NicholasSteiner, CaitlynSteinke, SabineStokes, Mark AndrewStranges, SaverioStrong, MarkStroumpoulis, KonstantinosSturua, LelaSufiyan, Muawiyyah BabaleSuliankatchi, Rizwan AbdulkaderSun, JiandongSur, PatrickSwaminathan, SoumyaSykes, Bryan LTabarés-Seisdedos, RafaelTabb, Karen MTaffere, Getachew RedaeTalongwa, Roberto TchioTarajia, MusharafTavakkoli, MohammadTaveira, NunoTeeple, StephanieTegegne, Teketo KassawTehrani-Banihashemi, ArashTekelab, TesfalidetTekle, Dejen YemaneShifa, Girma TemamTerkawi, Abdullah SuliemanTesema, Azeb GebresilassieThakur, JSThomson, Alan JTillmann, TaaviTiruye, Tenaw YimerTobe-Gai, RuoyanTonelli, MarcelloTopor-Madry, RomanTortajada, MiguelTroeger, ChristopherTruelsen, ThomasTura, Abera KenayUchendu, Uche SUkwaja, Kingsley NUndurraga, Eduardo AUneke, Chigozie JesseUthman, Olalekan Avan Boven, Job F MVan Dingenen, RitaVarughese, SantoshVasankari, TommiVenketasubramanian, NarayanaswamyViolante, Francesco SVladimirov, Sergey KVlassov, Vasiliy VictorovichVollset, Stein EmilVos, TheoWagner, Joseph AWakayo, TolassaWaller, Stephen GWalson, Judd LWang, HaidongWang, Yuan-PangWatkins, David AWeiderpass, ElisabeteWeintraub, Robert GWen, Chi-PangWerdecker, AndreaWesana, JoshuaWesterman, RonnyWhiteford, Harvey AWilkinson, James DWiysonge, Charles SheyWoldeyes, Belete GetahunWolfe, Charles D AWon, SunghoWorkicho, AbdulhalikWorkie, Shimelash BitewWubshet, MamoXavier, DenisXu, GelinYadav, Ajit KumarYaghoubi, MohsenYakob, BereketYan, Lijing LYano, YuichiroYaseri, MehdiYimam, Hassen HamidYip, PaulYonemoto, NaohiroYoon, Seok-JunYounis, Mustafa ZYu, ChuanhuaZaidi, ZoubidaEl Sayed Zaki, MaysaaZambrana-Torrelio, CarlosZapata, TomasZenebe, Zerihun MenlkalewZodpey, SanjayZoeckler, LeoZuhlke, Liesl JoannaMurray, Christopher J L2020-02-242020-02-242017-07-15Barber, R. M., Fullman, N., Sorensen, R. J. D., Bollyky, T., McKee, M., Nolte, E., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abdulle, A. M., Abdurahman, A. A., Abera, S. F., Abraham, B., Abreha, G. F., Adane, K., Adelekan, A. L., Adetifa, I. M. O., … Quality, G. 2015 H. A. (2017). Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: A novel analysis from the Global Burden of Disease Study 2015. LANCET, 390(10091), 231–266. https://doi.org/10.1016/S0140-6736(17)30818-80140-67361474-547X (eISSN)https://hdl.handle.net/20.500.11815/1548Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r= 0.88), an index of 11 universal health coverage interventions (r= 0.83), and human resources for health per 1000 (r= 0.77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28.6 to 94.6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40.7 (95% uncertainty interval, 39.0-42.8) in 1990 to 53.7 (52.2-55.4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21.2 in 1990 to 20.1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73.8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-systemcharacteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world.231-266eninfo:eu-repo/semantics/openAccessPublic healthPublic health systemsHealth services accessibilityHealth status indicatorsQuality of health careHealth insuranceStatisticsStandardsRisk assessmentMethodsMortalityLife expectancyDiseasesInjuriesÞjóðirLýðheilsaHeilbrigðiskerfiHeilbrigðisþjónustaGæðastjórnunSjúkratryggingarStaðlarTölfræðiStaðtölurÁhættugreiningAðferðafræðiDánartíðniLífslíkurSjúkdómarÁverkarHeilbrigðisstefnaSálfræðiPsychologyGlobal burden of diseaseHealth policyinfo:eu-repo/semantics/articleThe Lancet10.1016/S0140-6736(17)30818-8