The Health Record Rights Index: Who Holds the Record in 198 Countries?

What it is. We scored 198 countries and territories (all 193 UN member states, plus Greenland, Kosovo, Palestine, Taiwan and Vatican City) from 0 to 100 on one question: does a person get to see, control and share their own health record? Eight weighted categories cover access to the full record, control and consent, privacy and security, protection from commercial use, a connected care journey, clinician access at the point of care, research consent, and clinical AI governance. How it was built. Research agents built on Anthropic's Claude models did the research and scoring against a written rubric, and the authors ruled on every finding and every change. The rubric requires an agent to open every source it cites; a later check of every cited link found 7156 cited links checked: 7011 opened, 0 dead (HTTP 404 or 410), 88 blocked by bot protection and 57 unreachable, unresolved or answering with a server error. Every score cites the public pages it rests on: 5147 cited sources (978 undated). What we found. Finland (71), Denmark (70), Estonia (68), Hungary (68) and Sweden (67) have the highest scores; allowing for scoring error, each of them is first, alone or tied, in at least 5% of draws. The median is 39, and scores track national income closely: Spearman +0.72 (95% interval +0.64 to +0.79, n 188). By band, with the range each count takes when weights and scores are varied: 9 Strong (7 to 14 across draws), 66 Mixed (58 to 72), 111 Weak (101 to 115) and 12 Poor (10 to 19). No country reaches the top band in any draw; 12 countries are Poor as published (10 to 19 across draws). How far to trust it. A blind re-scoring of 58 sampled cells from the first 65 countries by a separate session of the same model family, run before the 2 October re-research, agreed with the scores at that time at an intraclass correlation of 0.82, and a second, of 108 cells from the 133 countries added on 2 October 2026, at 0.84, though single access scores there agree less well (0.68); no human rater has scored the index. A single cell can move by about 17 points. Once a country's scoring error and the weights are both allowed for, a country's likely rank typically spans 43 places. Confidence labels are computed from each country file by a fixed rule: 27 high, 105 medium and 66 low. Who holds the keys. We also classed where control over the record sits by default, which we call who holds the keys: 51 Shared, 81 Institutional and 66 State; 0 Individual. No country gives the person the default say over who sees the record; our definition of that class requires that nothing flow into a state or provider system by default, which no national system does. Our own audit, and context. An audit of our own scores found that the same legal situation was sometimes scored differently in different regions. We tightened the rubric, rescored, and report every change. A separate context layer, which changes no score, asks whether strained public systems push care to private providers whose records do not reach the public record. Alongside the scores we collected 446 published accounts of real problems with health records. They illustrate the scores and do not change them. The paper and data are released under CC BY 4.0 and the code under the MIT licence. Working paper, version 1.0, not peer reviewed. 2 October 2026. Interactive index: https://healthrecordrights.com. Data and code: https://github.com/evil-robot/who-holds-the-record-open and the linked dataset record.