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Healthcare access, quality improved globally but gaps remain, study shows

The worldwide quality of, and access to, healthcare improved from 2000 to 2016 but some countries saw progress slow or stall over this period, a study published in The Lancet medical journal showed.

The Global Burden of Diseases, Injuries and Risk Factors Study 2016 analyzed and measured the healthcare performance of 195 countries and territories during the period based on the Healthcare Access and Quality Index.

Using 32 causes of death which should be preventable if effective medical care was available, such as vaccine-preventable diseases, the countries assessed were given scores ranging from zero to 100. For the cancer data, they used mortality-to-incidence ratios instead of risk-standardized death rates due to the major advancements in cancer estimation and data availability.

As non-communicable diseases and cancers become more prevalent, the researchers also looked at how some countries' health systems evolved or stalled within the given time period.

Country performance rankings

In 2016, the top five countries with the highest levels of healthcare quality and access were Iceland, Norway, the Netherlands, Luxembourg, with Finland and Australia tied on the fifth spot. Meanwhile, the five countries at the bottom of the index were Central African Republic, Somalia, Guinea-Bissau, Chad and Afghanistan.

According to the study, the global average healthcare access and quality score was 54.4 points in 2016, up from the 42.4 points recorded for 2000. At the same time, there was a 78.5-point gap between the best and worst performing countries, Iceland with 97.1 points and the Central African Republic with 18.6 points, respectively.

The U.S. only ranked 29th on the list, with considerable disparities among states as quality and access was highest in the northeastern states, Minnesota and Washington state.

The two countries with the widest gaps in local healthcare access and quality were China and India, which ranked 48th and 145th, respectively. Beijing scored 91.5 points versus Tibet's 48.0 points, while India's Goa had 64.8 points compared to the 34.0 points in Assam.

"These results emphasize the urgent need to improve both access to and quality of health care across service areas and for all populations; otherwise, health systems could face widening gaps between the health services they provide and the disease burden experienced by local communities," said senior author Rafael Lozano from Institute for Health Metrics and Evaluation at the University of Washington.

Beyond the numbers

Despite having the lowest index scores, many countries in the sub-Saharan African region, along with Southeast Asian nations, showed the largest gains in healthcare access and quality, with Ethiopia, Rwanda, Equatorial Guinea, Myanmar and Cambodia exhibiting the biggest improvements. This was not the case, however, for several countries in Latin America which showed stagnancy after having considerable progress between 1990 and 2000.

The researchers attributed the stagnant or minimal improvements to the complexities encountered by the countries in reorganizing both their primary and secondary healthcare services to go beyond the limited scope of the Millennium Development Goals.

Furthermore, results of the study could also possibly shed light to the challenges faced by and within countries in terms of the access and quality of healthcare.

Authors of the research cited the U.K. as an example, where the National Health Service was established with the goal of minimizing financial hurdles to accessing healthcare. In the cases of China and India, the inequalities reflect numerous factors such as the differences in physical access to health facilities, health system infrastructure and modernity of medical technologies, as well as provision of effective services across all ranges of care.

The study ended by highlighting the importance of ensuring that all populations are given the opportunity to have good access to quality healthcare services if the global goal of universal health coverage by 2030 is to be reached on a timely manner.

"To strengthen and deliver health systems for the next generation, national and international health agencies alike must focus on improving health-care access and quality across health service areas and reaffirm their commitment to accelerating progress for the world's poorest populations," the study concluded.