Global Healthcare Quality Assessment

Drawing from methods established in GBD 2015,²⁰ (link) our analysis involved four steps: mapping the Nolte and McKee cause list to GBD causes; constructing MIRs for cancers and risk-standardising non-cancer deaths to remove variations in mortality not directly amenable to health care; calculating the HAQ Index on the basis of principal components analysis (PCA), providing an overall score of personal health-care access and quality on a scale of 0–100; and examining associations between national HAQ Index scores and potential correlates of performance.
Our study draws from GBD 2016 results,31 (link), 32 (link), 33 (link) which entail several improvements since GBD 2015, including 169 new country-years of vital registration data, 528 new cancer-registry years with a total of 92 countries' cancer registries,³¹ (link) five new risk factors,³² (link) and cause-specific mortality modelling updates (eg, cancers, tuberculosis).³¹ (link) Further information can be found in the appendix (pp 12–89) and the GBD 2016 capstone series.31 (link), 32 (link), 33 (link)
In addition to national and aggregated HAQ Index results, we report estimates at the subnational level for Brazil (26 states and the Federal District), China (33 provinces and special administrative regions), England (nine regions and 150 local government areas), India (31 states and union territories), Japan (47 prefectures), Mexico (32 states), and the USA (50 states and the District of Columbia).
As with all GBD revisions, GBD 2016 HAQ Index estimates for the full time series published here supersede previous iterations. This analysis complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER);³⁴ (link) additional information is found in the appendix (pp 5–7).