Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019

GBD 2019 Healthcare Access and Quality Collaborators, Annie Haakenstad, Jamal Akeem Yearwood, Nancy Fullman, Corinne Bintz, Kelly Bienhoff, Marcia R Weaver, Vishnu Nandakumar, Jonah N Joffe, Kate E LeGrand, Megan Knight, Cristiana Abbafati, Mohsen Abbasi-Kangevari, Amir Abdoli, Roberto Ariel Abeldaño Zuñiga, Isaac Akinkunmi Adedeji, Olatunji O Adetokunboh, Muhammad Sohail Afzal, Saira Afzal, Marcela Agudelo-BoteroBright Opoku Ahinkorah, Sajjad Ahmad, Ali Ahmadi, Sepideh Ahmadi, Ali Ahmed, Tarik Ahmed Rashid, Budi Aji, Wuraola Akande-Sholabi, Khurshid Alam, Hanadi Al Hamad, Robert Kaba Alhassan, Liaqat Ali, Vahid Alipour, Syed Mohamed Aljunid, Edward Kwabena Ameyaw, Tarek Tawfik Amin, Hubert Amu, Dickson A Amugsi, Robert Ancuceanu, Pedro Prata Andrade, Afifa Anjum, Jalal Arabloo, Morteza Arab-Zozani, Hany Ariffin, Judie Arulappan, Zahra Aryan, Tahira Ashraf, Desta Debalkie Atnafu, Alok Atreya, Mariam Molokhia, Yanzhong Wang

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BACKGROUND: Health-care needs change throughout the life course. It is thus crucial to assess whether health systems provide access to quality health care for all ages. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019), we measured the Healthcare Access and Quality (HAQ) Index overall and for select age groups in 204 locations from 1990 to 2019. METHODS: We distinguished the overall HAQ Index (ages 0-74 years) from scores for select age groups: the young (ages 0-14 years), working (ages 15-64 years), and post-working (ages 65-74 years) groups. For GBD 2019, HAQ Index construction methods were updated to use the arithmetic mean of scaled mortality-to-incidence ratios (MIRs) and risk-standardised death rates (RSDRs) for 32 causes of death that should not occur in the presence of timely, quality health care. Across locations and years, MIRs and RSDRs were scaled from 0 (worst) to 100 (best) separately, putting the HAQ Index on a different relative scale for each age group. We estimated absolute convergence for each group on the basis of whether the HAQ Index grew faster in absolute terms between 1990 and 2019 in countries with lower 1990 HAQ Index scores than countries with higher 1990 HAQ Index scores and by Socio-demographic Index (SDI) quintile. SDI is a summary metric of overall development. FINDINGS: Between 1990 and 2019, the HAQ Index increased overall (by 19·6 points, 95% uncertainty interval 17·9-21·3), as well as among the young (22·5, 19·9-24·7), working (17·2, 15·2-19·1), and post-working (15·1, 13·2-17·0) age groups. Large differences in HAQ Index scores were present across SDI levels in 2019, with the overall index ranging from 30·7 (28·6-33·0) on average in low-SDI countries to 83·4 (82·4-84·3) on average in high-SDI countries. Similarly large ranges between low-SDI and high-SDI countries, respectively, were estimated in the HAQ Index for the young (40·4-89·0), working (33·8-82·8), and post-working (30·4-79·1) groups. Absolute convergence in HAQ Index was estimated in the young group only. In contrast, divergence was estimated among the working and post-working groups, driven by slow progress in low-SDI countries. INTERPRETATION: Although major gaps remain across levels of social and economic development, convergence in the young group is an encouraging sign of reduced disparities in health-care access and quality. However, divergence in the working and post-working groups indicates that health-care access and quality is lagging at lower levels of social and economic development. To meet the needs of ageing populations, health systems need to improve health-care access and quality for working-age adults and older populations while continuing to realise gains among the young. FUNDING: Bill & Melinda Gates Foundation.

Original languageEnglish
Pages (from-to)e1715-e1743
JournalThe Lancet Global Health
Issue number12
Early online date16 Nov 2022
Publication statusPublished - 1 Dec 2022


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