First-ever global study finds massive health care inequity

By the Institute for Health Metrics and Evaluation (IHME)
EurekAlert, May 18, 2017

A first-ever global study finds massive inequity of access to and quality of health care among and within countries, and concludes people are dying from causes with well-known treatments.

“What we have found about health care access and quality is disturbing,” said Dr. Christopher Murray, senior author of the study and Director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. “Having a strong economy does not guarantee good health care. Having great medical technology doesn’t either. We know this because people are not getting the care that should be expected for diseases with established treatments.”

Professor Martin McKee, from the London School of Hygiene & Tropical Medicine, who participated in the study, commented: “Using deaths that could be avoided as a measure of the quality of a health system is not new but what makes this study so important is its scope, drawing on the vast data resources assembled by the Global Burden of Disease team to go beyond earlier work in rich countries to cover the entire world in great detail, as well as the development of a means to assess what a country should be able to achieve, recognizing that not all are at the same level of development. As the world’s governments move ahead to implement the goal of universal health coverage, to which they committed in the Sustainable Development Goals, these data will provide a necessary baseline from which they can track progress.”

The United States had an overall score of 81, tied with Estonia and Montenegro. As with many other nations, the US scored 100 in treating common vaccine-preventable diseases, such as diphtheria, tetanus, and measles. But the US had nine treatment categories in which it scored in the 60s: lower respiratory infections (60), neonatal disorders (69), non-melanoma skin cancer (68), Hodgkin’s lymphoma (67), ischemic heart disease (62), hypertensive heart disease (64), diabetes (67), chronic kidney disease (62), and the adverse effects of medical treatment itself (68).

“America’s ranking is an embarrassment, especially considering the US spends more than $9,000 per person on health care annually, more than any other country,” Dr. Murray said. “Anyone with a stake in the current health care debate, including elected officials at the federal, state, and local levels, should take a look at where the US is falling short.”

The study was published today in the international medical journal The Lancet, and represents the first effort to assess access and quality of services in 195 countries from 1990 to 2015. Researchers used a Healthcare Access and Quality (HAQ) Index, based on death rates from 32 causes that could be avoided by timely and effective medical care, known as “amenable mortality.”…


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

The Lancet, May 18, 2017

Drawing from GBD 2015 (Global Burden of Diseases, Injuries, and Risk Factors Study), we constructed a novel measure of personal health-care access and quality — the HAQ Index (Healthcare Quality and Access Index) — by using highly standardised estimates of 32 different causes that are amenable to personal health care. Compared with previous efforts, the HAQ Index provides a clearer signal on personal health-care access and quality over time and place because GBD provides enhanced comparability of cause of death data, helps to account for variation due to behavioural and environmental risk factors, and includes 195 countries and territories over time. Our analysis showed large differences in personal health-care access and quality, spanning from a low of 23·1 in Ethiopia in 1990 to higher than 90 in Andorra, Iceland, Switzerland, Norway, and Sweden in 2015. The global HAQ Index improved from 40·7 in 1990 to 53·7 in 2015, and 167 of 195 countries and territories significantly increased their HAQ Index during this time. Although the HAQ Index and SDI (Socio-demographic Index) were highly correlated, we noted substantial heterogeneity for geographies at similar SDI.

The Healthcare Access and Quality Index (HAQ Index) for the highest quartile of the Socio-demographic Index (SDI):

95  Andorra
94  Iceland
92  Switzerland
90  Sweden
90  Norway
90  Australia
90  Finland
90  Spain
90  Netherlands
89  Luxembourg
89  Japan
89  Italy
88  Ireland
88  Austria
88  France
88  Belgium
88  Canada
87  Slovenia
87  Greece
86  Germany
86  Singapore
86  New Zealand
86  South Korea
86  Denmark
86  Israel
85  Cyprus
85  Qatar
85  Malta
85  Czech Republic
85  United Kingdom
85  Portugal
82  Kuwait
82  Croatia
81  Estonia
81  United States
81  Montenegro
80  Lebanon
80  Hungary
80  Poland
79  Saudi Arabia
79  Bermuda
79  Bahrain
79  Slovakia
78  Latvia
78  Taiwan
77  Puerto Rico
77  Lithuania
76  Macedonia
76  Chile
75  Serbia
74  Romania
74  Belarus
74  Cuba
73  Ukraine
72  United Arab Emirates
72  North Mariana Islands
72  Russia
71  Bulgaria
71  Greenland
70  Virgin Islands
70  Brunei
68  Argentina
68  Armenia
67  Barbados
67  Antigua and Barbuda
67  Malaysia
66  Seychelles
64  Azerbaijan
64  The Bahamas
63  Guam
62  Georgia
62  Trinidad and Tobago
61  Kazakhstan
58  Grenada
58  Turkmenistan

The full PDF of this Lancet article (36 pages) can be downloaded for free at this link:…

This study establishes a new landmark in health policy research. It provides a basis of determining how all nations are doing in reducing premature deaths by providing timely and effective health care, that is, in improving their “amenable mortality” rates.

To no surprise for those who follow health policy, the Healthcare Access and Quality Index (HAQ Index) for the United States falls about in the middle of nations in the highest quartile of the Socio-demographic Index (SDI). Although our per capita spending on health care is about twice the average of these nations, our access and quality are only average. We do not have the best health care system in the world, in spite of what reform opponents say.

As Christopher Murray, a senior author of this study, states, “America’s ranking is an embarrassment.” Look at the countries that rank above us. If, like them, we used our public resources more effectively we would no longer have to be ashamed of our performance. Just through the tax system alone we are already spending more per capita than almost all of the other nations do in both public and private spending combined.

It’s not that we need to make a decision to finance health care through our taxes; we already largely do that. Instead we need to improve the allocation of our tax funds plus our private spending. We can do that best by enacting and implementing a well-designed single payer national health program – an improved Medicare for all. With all that we are spending, we should be at the top of the list.