Lífslíkur, Social Determinants of Health, Pediatrics, anzsrc-for: 4206 Public Health, Global Burden of Disease, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, Cancer, Mælitæki, anzsrc-for: 42 Health Sciences, global burden of disease, Medical care, Folkhälsovetenskap, global hälsa och socialmedicin, 11 Medical And Health Sciences, anzsrc-for: 4203 Health Services and Systems, aged, health care quality, priority journal, health care policy, Medicine, AMENABLE MORTALITY, Public Health, 19·0 (14·3–23·7) in Somalia, TRANSITION, Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, 610, 613, Communicable Diseases, Article, maternal disease, Clinical Research, Health Services and Systems, Biodefense, XXXXXX - Unknown, Health Sciences, Noncommunicable Diseases, INDICATOR, healthcare access and quality index, and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations, Prevention, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, Health sciences, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), Public Health, Global Health and Social Medicine, Noncommunicable Diseases / epidemiology, TRENDS, Salut pública, Wounds and Injuries/epidemiology, Morbiditat, such as total health spending per capita. Findings In 2016, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, while India saw a 30·8-point disparity, Trends, Morbidity, Dánartíðni, from 64·8 (59·6–68·8) in Goa to 34·0 (30·3–38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), and 100 as the 99th percentile (best), burden of disease, Medical and Health Sciences, MEXICO, disease burden, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, RA0421, Cause-specific mortality, we set these thresholds at the country level, Salud pública., Public health., Healthcare Access; Peformance; Quality, R, Public Health, Global Health, Social Medicine and Epidemiology, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, UNIVERSAL COVERAGE, 4203 Health Services and Systems, newborn disease, 2700 Medicine, as well as subnational locations in seven countries, Life Sciences & Biomedicine, GBD 2016, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, Coverage, universal health coverage; access quality health care; health care access and quality index, Vaccine Related, Nations, with 0 as the first percentile (worst) observed between 1990 and 2016, Global Burden of Disease Study 2016, Life Science, but these relationships were quite heterogeneous, health care system, 42 Health Sciences, Noncommunicable Diseases/epidemiology, Health-care quality, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, Heilbrigðisþjónusta, anzsrc-for: 32 Biomedical and clinical sciences, Good Health and Well Being, anzsrc-for: 11 Medical and Health Sciences, 306, Epidemiological Research, Wounds and Injuries, Assistència mèdica, Medical care., Optometry, Biomedical and clinical sciences, Life expectancy, environmental exposure, communicable disease, Health Services Accessibility, Universal health coverage, healtchare, Psychology, cancer survival, Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, to values as low as 18·6 (13·1–24·4) in the Central African Republic, 19·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1–93·6) in Beijing to 48·0 (43·4–53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6–68·8) in Goa to 34·0 (30·3–38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations., GBD 2016 Healthcare Access and Quality Collaborators, public health, NATIONS, as well as health systems inputs, Communicable Diseases/epidemiology, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, Sálfræði, quality, high risk behavior, 4206 Public Health, performance measurement system, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, Wounds and Injuries / epidemiology, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, Operational Research, we risk-standardised cause-specific deaths due to non-cancers by location-year, a summary measure of overall development. As derived from the broader GBD study and other data sources, performance ranged from 91·5 (89·1–93·6) in Beijing to 48·0 (43·4–53·2) in Tibet (a 43·5-point difference), CHINA, healthcare access, Humans, human, Quality of Health Care, States, Science & Technology, Health care, STATES, Generic health relevance, Asistencia sanitaria., GBD,, health care delivery, Serveis sanitaris, healtchare, access, quality, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, EMC NIHES-02-65-01, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, EMC NIHES-02-65-02, access, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, cancer mortality, health service, Health-care access, Healthcare Access and Quality Index, whereas in Brazil, quality index, Injuries, GBD 2016 ; healthcare access ; quality index ; burden of disease, Medicine (all), most notably vaccine-preventable diseases. Overall, 3 Good Health and Well Being, Þjóðir, General medicine, to values as low as 18·6 (13·1–24·4) in the Central African Republic, medical care, Amenable mortality, Transition, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, INEQUALITIES, injury, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, General & Internal, health care access, General & Internal Medicine, cancer registry, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, Communicable Diseases / epidemiology, whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), we examined relationships between national HAQ Index scores and potential correlates of performance, non communicable disease, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Indicator, adolescent, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, Women's Health, global disease burden, Inequalities, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, ddc: ddc: