Worldwide healthcare access and quality improved remarkably from 2000-2016 but there are unsurprising disparities between wealthy and poor countries - and countries like the United States which showed high quality but varying levels of access before the federal government took control of medical access with the controversial Obamacare law passed by Democrats.

Some poor countries do quite well, but that highlights limitations of the analysis. Countries with lower abortion rates, like the United States, will show more deaths in childhood or from difficult pregnancies, than countries like Cuba, where abortion is done at any sign of trouble in infants. Those don't count as deaths. Their estimates rely on self-done recording of deaths in each of the 195 countries analyzed.

The authors also do not distinguish between primary and secondary healthcare, and so cannot distinguish if changes in the healthcare access and quality index over time are due to improved primary, secondary or overall care.

Unsurprisingly, the countries with the worst access and quality showed the biggest gains, such low and middle-income countries in sub-Saharan Africa and Southeast Asia, according to the latest data from the Global Burden of Disease study. Others still struggle. Iceland, Norway, and the Netherlands were quite good while the Central African Republic, Somalia and Guinea-Bissau have a lot of room for progress. 

Yet there are new challenges. The same science and technology that have improved healthcare have also improved many aspects of life, like agriculture. As food becomes a smaller part of daily income, many people who remember not having enough will become fat. Obesity might soon overtake smoking as the top noncommunicable disease. 

The study used an index to measure the quality and accessibility of healthcare, based on 32 causes of death which should be preventable with effective medical care. Each of the 195 countries and territories assessed were given a score between 0-100. For the first time, the study also analysed healthcare access and quality between regions within seven countries: Brazil, China, England, India, Japan, Mexico, and the USA.

In 2016, the global average healthcare access and quality score was 54.4, increasing from 42.4 points in 2000. Disparities between countries remained similar in 2016 and 2000, with a 78.5 point gap between the best and worst performing countries in 2016 (18.6 in the Central African Republic and 97.1 in Iceland), compared with 79.3 points in 2000 (13.5 in Somalia and 92.8 in Iceland).

The five countries with the highest levels of healthcare access and quality in 2016 were Iceland (97.1 points), Norway (96.6), the Netherlands (96.1), Luxembourg (96.0), and Finland and Australia (each with 95.9). While the countries with the lowest scores were the Central African Republic (18.6), Somalia (19.0), Guinea-Bissau (23.4), Chad (25.4), and Afghanistan (25.9).