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4 results on '"Ahmed, Kedir Yimam"'

1. 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

Author

Barber, Ryan M., Fullman, Nancy, Sorensen, Reed J. D., Bollyky, Thomas, McKee, Martin, Nolte, Ellen, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M., Abd-Allah, Foad, Abdulle, Abdishakur M., Abdurahman, Ahmed Abdulahi, Abera, Semaw Ferede, Abraham, Biju, Abreha, Girmatsion Fisseha, Adane, Kelemework, Adelekan, Ademola Lukman, Adetifa, Ifedayo Morayo O., Afshin, Ashkan, Agarwal, Arnav, Agarwal, Sanjay Kumar, Agarwal, Sunilkumar, Agrawal, Anurag, Kiadaliri, Aliasghar Ahmad, Ahmadi, Alireza, Ahmed, Kedir Yimam, Ahmed, Muktar Beshir, Akinyemi, Rufus Olusola, Akinyemiju, Tomi F., Akseer, Nadia, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore, Alam, Sayed Saidul, Alemu, Zewdie Aderaw, Alene, Kefyalew Addis, Alexander, Lily, Ali, Raghib, Ali, Syed Danish, Alizadeh-Navaei, Reza, Alkerwi, Ala'a, Alla, Francois, Allebeck, Peter, Allen, Christine, Al-Raddadi, Rajaa, Lallukka, Tea, Meretoja, Atte, Meretoja, Tuomo J., Weiderpass, Elisabete, GBD 2015 Healthcare Access Quality, Clinicum, Department of Public Health, Center for Population, Health and Society, University of Helsinki, Department of Surgery, Department of Oncology, II kirurgian klinikka, HUS Comprehensive Cancer Center, and HUS Neurocenter

Subjects
AVOIDABLE MORTALITY, 3121 General medicine, internal medicine and other clinical medicine, DEVELOPMENT GOALS, SYSTEMATIC ANALYSIS, DEATH, COMPARATIVE RISK-ASSESSMENT, UNITED-STATES, LIFE EXPECTANCY, 3126 Surgery, anesthesiology, intensive care, radiology, EUROPEAN COUNTRIES, TRENDS, MEDICAL-CARE
Abstract

Background 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. Copyright (C) The Author(s). Published by Elsevier Ltd.

Published
2017

2. Evolution and patterns of global health financing 1995-2014 : development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries

Author

Dieleman, Joseph, Campbell, Madeline, Chapin, Abigail, Eldrenkamp, Erika, Fan, Victoria Y., Haakenstad, Annie, Kates, Jennifer, Liu, Yingying, Matyasz, Taylor, Micah, Angela, Reynolds, Alex, Sadat, Nafis, Schneider, Matthew T., Sorensen, Reed, Evans, Tim, Evans, David, Kurowski, Christoph, Tandon, Ajay, Abbas, Kaja M., Abera, Semaw Ferede, Kiadaliri, Aliasghar Ahmad, Ahmed, Kedir Yimam, Ahmed, Muktar Beshir, Alam, Khurshid, Alizadeh-Navaei, Reza, Alkerwi, Ala'a, Amini, Erfan, Ammar, Walid, Amrock, Stephen Marc, Antonio, Carl Abelardo T., Atey, Tesfay Mehari, Avila-Burgos, Leticia, Awasthi, Ashish, Barac, Aleksandra, Alberto Bernal, Oscar, Beyene, Addisu Shunu, Beyene, Tariku Jibat, Birungi, Charles, Bizuayehu, Habtamu Mellie, Breitborde, Nicholas J. K., Cahuana-Hurtado, Lucero, Estanislao Castro, Ruben, Catalia-Lopez, Ferran, Dalal, Koustuv, Dandona, Lalit, Dandona, Rakhi, de Jager, Pieter, Dharmaratne, Samath D., Dubey, Manisha, Meretoja, Atte, Global Burden Dis Hlth Financing, Department of Neurosciences, Neurologian yksikkö, Clinicum, and HUS Neurocenter

Subjects
AFRICA, PLASMODIUM-FALCIPARUM, 3121 General medicine, internal medicine and other clinical medicine, SYSTEMATIC ANALYSIS, PAYMENTS, INSURANCE, LIFE EXPECTANCY, CARE, BURDEN, EXPENDITURE, TRANSITION
Abstract

Background An adequate amount of prepaid resources for health is important to ensure access to health services and for the pursuit of universal health coverage. Previous studies on global health financing have described the relationship between economic development and health financing. In this study, we further explore global health financing trends and examine how the sources of funds used, types of services purchased, and development assistance for health disbursed change with economic development. We also identify countries that deviate from the trends. Methods We estimated national health spending by type of care and by source, including development assistance for health, based on a diverse set of data including programme reports, budget data, national estimates, and 964 National Health Accounts. These data represent health spending for 184 countries from 1995 through 2014. We converted these data into a common inflation-adjusted and purchasing power-adjusted currency, and used non-linear regression methods to model the relationship between health financing, time, and economic development. Findings Between 1995 and 2014, economic development was positively associated with total health spending and a shift away from a reliance on development assistance and out-of-pocket (OOP) towards government spending. The largest absolute increase in spending was in high-income countries, which increased to purchasing power-adjusted $5221 per capita based on an annual growth rate of 3.0%. The largest health spending growth rates were in upper-middle-income (5.9) and lower-middle-income groups (5.0), which both increased spending at more than 5% per year, and spent $914 and $267 per capita in 2014, respectively. Spending in low-income countries grew nearly as fast, at 4.6%, and health spending increased from $51 to $120 per capita. In 2014, 59.2% of all health spending was financed by the government, although in low-income and lower-middle-income countries, 29.1% and 58.0% of spending was OOP spending and 35.7% and 3.0% of spending was development assistance. Recent growth in development assistance for health has been tepid; between 2010 and 2016, it grew annually at 1.8%, and reached US$37.6 billion in 2016. Nonetheless, there is a great deal of variation revolving around these averages. 29 countries spend at least 50% more than expected per capita, based on their level of economic development alone, whereas 11 countries spend less than 50% their expected amount. Interpretation Health spending remains disparate, with low-income and lower-middle-income countries increasing spending in absolute terms the least, and relying heavily on OOP spending and development assistance. Moreover, tremendous variation shows that neither time nor economic development guarantee adequate prepaid health resources, which are vital for the pursuit of universal health coverage.

Published
2017

3. Measuring the health-related Sustainable Development Goals in 188 countries : a baseline analysis from the Global Burden of Disease Study 2015

Author

Lim, Stephen S., Allen, Kate, Bhutta, Zulficiar A., Dandona, Lalit, Forouzanfar, Mohammad H., Fullman, Nancy, Gething, Peter W., Goldberg, Ellen M., Hay, Simon I., Holmberg, Mollie, Kinfu, Yohannes, Kutz, Michael J., Larson, Heidi J., Liang, Xiaofeng, Lopez, Alan D., Lozano, Rafael, McNellan, Claire R., Mokdad, Ali H., Mooney, Meghan D., Naghavi, Mohsen, Olsen, Helen E., Pigott, David M., Salomon, Joshua A., Vos, Theo, Wang, Haidong, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M., Abd-Allah, Foad, Abdulle, Abdishakur M., Abraham, Biju, Abubakar, Ibrahim, Abu-Raddad, Laith J., Abu-Rmeileh, Niveen M. E., Abyu, Gebre Yitayih, Achoki, Tom, Adebiyi, Akindele Olupelumi, Adedeji, Isaac Akinkunmi, Afanvi, Kossivi Agbelenko, Afshin, Ashkan, Agarwal, Arnav, Agrawal, Anurag, Kiadaliri, Aliasghar Ahmad, Ahmadieh, Hamid, Ahmed, Kedir Yimam, Akanda, Ali Shafqat, Meretoja, Atte, Meretoja, Tuomo J., Weiderpass, Elisabete, GBD 2015 SDG Collaborators, Department of Surgery, and Department of Medical and Clinical Genetics

Subjects
MORTALITY, OFFLINE, SYSTEMATIC ANALYSIS, MANAGEMENT, SDG, MENTAL-HEALTH, PROGRESS, MALARIA CONTROL, 3142 Public health care science, environmental and occupational health
Abstract

Background In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015). Methods We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices. Findings In 2015, the median health-related SDG index was 59.3 (95% uncertainty interval 56.8-61.8) and varied widely by country, ranging from 85.5 (84.2-86.5) in Iceland to 20.4 (15.4-24.9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r(2) = 0.88) and the MDG index (r(2) = 0.2), whereas the non-MDG index had a weaker relation with SDI (r(2) = 0.79). Between 2000 and 2015, the health-related SDG index improved by a median of 7.9 (IQR 5.0-10.4), and gains on the MDG index (a median change of 10.0 [6.7-13.1]) exceeded that of the non-MDG index (a median change of 5.5 [2.1-8.9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened. Interpretation GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs.

Published
2016

4. 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

Author

Barber R. M. a, Fullman N. a, Sorensen R. J. D. a, Bollyky T. f, McKee M. i, Nolte E. g, Abajobir A. A. j, Abate K. H. n, Abbafati C. o, Abbas K. M. p, Abd-Allah F. q, Abdulle A. M. r, Abdurahman, A. A. ac, Abera, S. F. ad, ah Abraham, B. ai, Abreha, G. F. ad, Adane, K. af, Adelekan, A. L. aj, ak Adetifa, I. M. O. i al, Afshin A. a, Agarwal, A. ao, ap Agarwal, S. K. aq, S. ar, Agrawal, A. as, Ahmad Kiadaliri, A. au, Ahmadi, A. ax, Ahmed, K. Y. ay, Ahmed M. B. m, Akinyemi, R. O. ak, az Akinyemiju, T. F. ba, Akseer, N. am, bc Al-Aly, Z. bd, Alam, K. be, bf dn, dq Alam, N. bg, S. S. bh, Alemu, Z. A. ay, Alene, K. A. bi, Alexander L. a, Ali, R. bm, S. D. bn, bo bp, Alizadeh-Navaei, R. bq, Alkerwi, A. bs, Alla, F. bt, Allebeck, P. bu, Allen C. a, Al-Raddadi, R. cb, Alsharif, U. cd, Altirkawi, K. A. ce, Alvarez Martin, E. cf, Alvis-Guzman, N. cg, Amare, A. T. ch, cj gr, Amini E. s, t wy, Ammar, W. cl, Amo-Adjei, J. cm, cn Amoako, Y. A. co, Anderson B. O. e, Androudi, S. cq, Ansari, H. cr, Ansha, M. G. cs, Antonio, C. A. T. ct, Ärnlöv, J. bv, cv Artaman, A. cw, Asayesh, H. cx, Assadi, R. cy, Astatkie, A. cz, Atey, T. M. ag, Atique, S. da, Atnafu, N. T. dc, dd Atre, S. R. de, Avila-Burgos, L. df, Avokpaho, E. F. G. A. dg, Ayala Quintanilla, B. P. di, dj Awasthi, A. dk, Ayele, N. N. dl, Azzopardi, P. dm, dn dr, Ba Saleem, H. O. dt, Bärnighausen, T. du, dz ea, Bacha, U. eb, Badawi, A. an, ec Banerjee, A. ed, Barac, A. eg, Barboza, M. A. ej, ek Barker-Collo, S. L. el, Barrero, L. H. en, Basu, S. eo, Baune, B. T. ch, gr Baye, K. eq, Bayou, Y. T. er, Bazargan-Hejazi, S. es, et Bedi, N. eu, Beghi, E. ev, Béjot, Y. ew, Bello, A. K. ex, Bennett, D. A. bm, Bensenor, I. M. ez, Berhane, A. fa, Bernabé, E. fd, Bernal, O. A. fe, Beyene, A. S. ff, ki Beyene, T. J. eq, fi Bhutta, Z. A. bc, fj Biadgilign, S. fk, Bikbov, B. fl, Birlik, S. M. fm, Birungi, C. ef, Biryukov S. a, Bisanzio, D. bk, Bizuayehu, H. M. fn, Bose, D. fo, Brainin, M. fp, Brauer M. a, fq Brazinova, A. fr, fs Breitborde, N. J. K. fu, Brenner, H. fw, Butt, Z. A. fx, Cárdenas, R. fy, Cahuana-Hurtado, Campos-Nonato, I. R. df, dx Car, J. fz, Carrero, J. J. bw, Casey D. a, Caso, V. ga, Castañeda-Orjuela, C. A. gb, Castillo Rivas, J. gd, ge Catalá-López, F. gf, gg Cecilio, P. gh, Cercy K. a, Charlson F. J. a, j gi, Chen A. Z. a, Chew A. a, Chibalabala, M. gj, Chibueze, C. E. gk, Chisumpa, V. H. gl, gm Chitheer, A. A. gn, Chowdhury, R. go, Christensen, H. gp, Christopher, D. J. gq, Ciobanu, L. G. ci, Cirillo, M. gs, Coggeshall M. S. a, Cooper, L. T. gt, Cortinovis, M. fl, Crump, J. A. gu, Dalal, K. gv, Danawi, H. gw, Dandona L. a, gy Dandona, R. a gy, Dargan, P. I. gz, Das Neves, J. ha, hb Davey, G. hd, Davitoiu, D. V. he, Davletov, K. hf, De Leo, D. hh, Del Gobbo, L. C. eo, Del Pozo-Cruz, B. em, Dellavalle, R. P. hi, Deribe, K. ep, hj Deribew, A. al, Des Jarlais, D. C. hk, hl Dey, S. hm, Dharmaratne, S. D. hn, Dicker D. a, Ding, E. L. dx, Dokova, K. ho, Dorsey, E. R. hp, Doyle, K. E. hq, hr Dubey, M. hs, Ehrenkranz R. a, Ellingsen, C. L. hu, Elyazar, I. hv, Enayati, A. hw, Ermakov, S. P. hx, hy Eshrati, B. hz, ia Esteghamati, A. t wz, Estep K. a, Fürst T. h, ic ie, Faghmous I. D. A. i, Fanuel, F. B. B. cz, if Faraon, E. J. A. cu, ig Farid, T. A. ih, Farinha, C. S. E. S. ii, ij Faro, A. ik, Farvid, M. S. dw, il Farzadfar, F. u xa, Feigin, V. L. im, Feigl, A. B. du, Fereshtehnejad, S. -M. bx, Fernandes, J. G. in, J. C. io, Feyissa, T. R. ip, Fischer, F. iq, Fitzmaurice C. a, b ir, Fleming T. D. a, Foigt, N. is, Foreman K. J. a, ib Forouzanfar, M. H. it, Franklin, R. C. iu, Frostad J. a, Ghiwot T. T. n, Gakidou E. a, Gambashidze, K. iv, Gamkrelidze, A. iv, Gao, W. ix, Garcia-Basteiro, A. L. iy, iz Gebre, T. ja, Gebremedhin A. T. n, jb Gebremichael, M. W. ag, Gebru, A. A. ag, jc Gelaye, A. A. jd, Geleijnse, J. M. fh, Genova-Maleras, R. je, jf Gibney, K. B. jg, Giref, A. Z. eq, Gishu, M. D. fg, jh Giussani, G. ev, Godwin W. W. a, Gold A. a, Goldberg E. M. a, Gona, P. N. ji, Goodridge, A. jj, Gopalani, S. V. jk, Goto, A. jl, Graetz N. a, Greaves, F. ib, jm Griswold, M. a Guban, P. I. jn, Gugnani, H. C. jo, Gupta, P. C. jp, R. jq, R. jr, T. js, V. jt, Habtewold, T. D. fb, jv Hafezi-Nejad, N. t xb, Haile, D. eq, Hailu, A. D. ep, jx Hailu, G. B. ag, jc Hakuzimana, A. jz, ka Hamadeh, R. R. kb, Hambisa, M. T. ff, Hamidi, S. kc, Hammami, M. kd, Hankey, G. J. ke, kf kg, Hao, Y. kh, Harb, H. L. cl, Hareri, H. A. eq, Haro, J. M. mw, Hassanvand M. S. w, xc Havmoeller, R. ca, Hay, R. J. fd, kk Hay, S. I. a bl, Hendrie, D. kl, Heredia-Pi, I. B. df, Hoek, H. W. ju, km Horino, M. ko, Horita, N. kp, Hosgood, H. D. kq, Htet, A. S. kr, ks Hu, G. kt, Huang, H. ku, J. J. kv, Huntley B. M. a, Huynh C. a, Iburg, K. M. kw, Ileanu, B. V. kx, Innos, K. ky, Irenso, A. A. fg, kj Jahanmehr, N. kz, Jakovljevic, M. B. lb, James, P. dv, S. L. lc, Javanbakht, M. ld, Jayaraman, S. P. le, Jayatilleke, A. U. lf, lg Jeemon, P. gx, lh li, nh Jha, V. bm, lk John, D. ll, Johnson C. a, Johnson S. C. a, Jonas, J. B. lm, Juel, K. ln, Kabir, Z. lo, Kalkonde, Y. lp, Kamal, R. lq, Kan, H. ls, Karch, A. lt, lu Karema, C. K. id, lv Karimi, S. M. lw, Kasaeian A. t, y xd, Kassebaum N. J. a, lx Kastor, A. hs, Katikireddi, S. V. ly, Kazanjan, Keiyoro, P. N. lz, ma Kemmer, L. a Kemp, A. H. mc, me Kengne, A. P. jz, mf Kerbo, A. A. if, Kereselidze, M. iv, Kesavachandran, C. N. lq, Khader, Y. S. mg, Khalil I. a, Khan, A. R. ih, E. A. mh, G. mi, Khang, Y. -H. mj, Khoja, A. T. A. ml, Khonelidze, I. iv, Khubchandani, J. mm, Kibret, G. D. ay, Kim, D. mn, Kim P. a, Y. J. mo, Kimokoti, R. W. mp, Kinfu, Y. mq, Kissoon, N. fq, Kivipelto, M. by, Kokubo, Y. mr, Kolk, A. ms, Kolte, D. mt, Kopec, J. A. fq, Kosen, S. mu, Koul, P. A. mv, Koyanagi, A. mw, Kravchenko, M. mx, Krishnaswami, S. my, Krohn K. J. a, Kuate Defo, B. mz, Kucuk Bicer, B. nb, Kuipers, E. J. nd, Kulkarni, V. S. ne, Kumar, G. A. lj, Kumsa, F. A. fg, kj Kutz, M. a Kyu, H. H. a Lager, A. C. J. nf, Lal, A. ng, D. K. ni, Lalloo R. k, Lallukka, T. nj, Lan, Q. nl, Langan S. M. i, Lansingh, V. C. nm, nn Larson, H. J. a h, Larsson, A. no, Laryea, D. O. cp, Latif, A. A. np, Lawrynowicz, A. E. B. nq, Leasher, J. L. nr, Leigh, J. bf, Leinsalu, M. ky, nt Leshargie, C. T. ay, Leung J. e, j Leung, R. nu, Levi, M. nv, Liang, X. nw, Lim S. S. a, Lind M. a, Linn, S. nx, Lipshultz, S. E. ny, nz Liu, P. a Liu, Y. oa, L. -T. ob, oc Logroscino, G. od, Lopez, A. D. do, Lorch, S. A. oe, Lotufo, P. A. ez, Lozano, R. df, Lunevicius, R. of, og Lyons, R. A. mb, Macarayan, E. R. K. kv, Mackay, M. T. oh, Magdy Abd El Razek, H. oi, M. oj, Mahdavi, M. ok, ol Majeed, A. ib, Malekzadeh R. z, xe Malta, D. C. on, Mantovani LG, Manyazewal, T. op, Mapoma, C. C. gl, Marcenes, W. oq, Marks, G. B. md, ns Marquez, N. a Martinez-Raga, J. or, os Marzan, M. B. ot, Massano, J. hc, ou Mathur, M. R. ni, Maulik, P. K. ov, Mazidi, M. ow, McAlinden, C. ox, oy McGrath, J. J. l McNellan, C. a Meaney, P. A. oz, pa Mehari, A. pb, Mehndiratta, M. M. pc, Meier, T. pd, Mekonnen, A. B. bf, bj Meles, K. G. ad, Memish, Z. A. pe, pf Mengesha, M. M. ff, Mengiste, D. T. ae, Mengistie M. A. n, Menota, B. G. eq, Mensah, G. A. pg, Mereta S. T. n, Meretoja, A. dp, ph Meretoja, T. J. nk, pi Mezgebe, H. B. ag, Micha, R. pj, Millear A. a, Mills, E. J. pl, Minnig S. a, Mirarefin M. a, pm Mirrakhimov, E. M. pn, po Mock, C. N. c Mohammad, K. A. pp, Mohammed, S. ea, pq Mohanty, S. K. hs, Mokdad A. H. a, Mola, G. L. D. pr, Molokhia, M. fd, Monasta, L. ps, Montico, M. ps, Moradi-Lakeh M. a, pt Moraga, P. pz, Morawska, L. pv, pw Mori, R. qa, Moses M. a, Mueller, U. O. qc, Murthy, S. fq, Musa, K. I. qd, Nachega, J. B. qe, qf qg, Nagata, C. qh, Nagel, G. qj, Naghavi M. a, Naheed, A. bh, Naldi, L. qk, Nangia, V. ql, Nascimento, B. R. qm, qn Negoi, I. qo, Neupane, S. P. ks, Newton, C. R. qp, Ng M. a, Ngalesoni, F. 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Js, Thakur, Alan, Thomson, Taavi, Tillmann, Tenaw, Yimer, Tiruye, Ruoyan, Tobe Gai, Marcello, Tonelli, Roman, Topor Madry, Miguel, Tortajada, Christopher, Troeger, Thomas, Truelsen, Abera, Kenay, Tura, Uche, Uchendu, Kingsley, N, Ukwaja, Eduardo, Undurraga, Chigozie, Jesse, Uneke, Olalekan, Uthman, Job, F, Van, Boven, Rita, Van, Dingenen, Santosh, Varughese, Tommi, Vasankari, Narayanaswamy, Venketasubramanian, Francesco, Violante, Sergey, Vladimirov, Vasiliy, Victorovich, Vlassov, Stein, Emil, Vollset, Theo, Vo, Joseph, Wagner, Tolassa, Wakayo, Stephen, Waller, Judd, Walson, Haidong, Wang, Yuan Pang, Wang, David, Watkin, Elisabete, Weiderpa, Robert, Weintraub, Chi Pang, Wen, Andrea, Werdecker, Joshua, Wesana, Ronny, Westerman, Harvey, Whiteford, James, Wilkinson, Charles, Shey, Wiysonge, Belete, Getahun, Woldeye, Charles, Wolfe, Sungho, Won, Abdulhalik, Workicho, Shimelash, Bitew, Workie, Mamo, Wubshet, Denis, Xavier, Gelin, Xu, Ajit, Kumar, Yadav, Mohsen, Yaghoubi, Bereket, Yakob, 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Subjects
Dánartíðni, Lífslíkur, Life expectancy, Diseases, Health insurance, Globan Burden of Disease, Healthcare Access, DEVELOPMENT GOALS, Methods, Psychology, LIFE EXPECTANCY, Risk assessment, Public health, Globan Burden of Disease, Injuries, Tölfræði, Sjúkdómar, Statistics, DEATH, Þjóðir, Staðtölur, 11 Medical And Health Sciences, Healthcare access, Health status indicators, Health policy, Global burden of disease, Gæðastjórnun, Sálfræði, COMPARATIVE RISK-ASSESSMENT, Lýðheilsa, Life Sciences & Biomedicine, Standards, UNITED-STATES, Sjúkratryggingar, Medicine, General & Internal, General & Internal Medicine, Heilbrigðisstefna, SYSTEMATIC ANALYSIS, Mortality, Public health systems, medicine (all), Áhættugreining, Science & Technology, Health services accessibility, Staðlar, TRENDS, Heilbrigðisþjónusta, MEDICAL-CARE, AVOIDABLE MORTALITY, Áverkar, Aðferðafræði, Quality of health care, EUROPEAN COUNTRIES, Heilbrigðiskerfi
Abstract

Background 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., Bill & Melinda Gates Foundation.

Published
2017

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