Mortality Amenable to Health Care in European Union Countries and Its Limitations

By Jarčuška, Peter; Janičko, Martin et al. | Central European Journal of Public Health, December 2017 | Go to article overview

Mortality Amenable to Health Care in European Union Countries and Its Limitations


Jarčuška, Peter, Janičko, Martin, Barták, Miroslav, Gavurová, Beáta, Vagašová, Tatiana, Central European Journal of Public Health


INTRODUCTION

There has been growing interest in the determination of health systems' performance between countries and in their contribution to health of population. It is partially determined by various health outcomes indicators, commonly considering length of life. General mortality data and consequently life expectancy are accessible for the longest time period within the health status data. They are generally considered the most reliable health outcomes indicators for international comparison across countries. However, general mortality data represents a rough health status indicator that is itself insufficient for the assessment of medical care benefits. As for premature deaths, not all reflect the accessibility and effectiveness of health care system. For decades, researchers have been looking for the ways how to measure the proportion of the health care system to health status of population. Although, there is no indicator that would comprehensively reflect the performance of health care system, nevertheless, the suitable measurement seems to be the concept of avoidable mortality.

The concept of avoidable mortality, as an indicator for the quality of healthcare services, was firstly developed by Rutstein et al. (1), who defined deaths from selected disease groups that are considered either treatable, or preventable through the medical services. Further, they divided the avoidable mortality into the two subsets of amenable mortality with the timely and effective health care services (e.g. diabetes mellitus treated with insulin), and preventable mortality by interventions programs (e.g. lung cancer prevented by smoking elimination). Their list of causes of death included about 80 diseases. Many researches have tried to renew the list over time adjusting to the new medical and technological advances (2-9). Gay et al. (10) estimated amenable mortality for 31 OECD countries and assessed this indicator by comparing the two widely used lists of causes of death: Nolte and McKee from 2008 (8) and Tobias and Yeh from 2009 (9). The results of the lists were similar. The highest amenable mortality rates were identified in the Eastern European countries and Mexico, on the contrary to the Japan, France, Italy, and Sweden with the lowest values. The recent study "Amenable mortality in the European Union: toward better indicators for the effectiveness of health systems" (AMIEHS) from 2011 (11) introduces a new way of selecting diseases into the lists of causes of death that are amenable to health care. Based on previous studies, the Office for National Statistics in England (12) defines amenable and preventable mortality as follows. „A death is amenable if, in the light of medical knowledge and technology at the time of death, all or most deaths from that cause (subject to age limits if appropriate) could be avoided through good quality health care. A death is preventable if, in the light of understanding of the determinants of health at time of death, all or most deaths from that cause (subject to age limits if appropriate) could be avoided by public health interventions in the broadest sense."

Most studies applied the list of causes of death by Nolte and McKee (8) or by Tobias (9) for amenable mortality analyses (13-16). The latest study on amenable mortality, AMIEHS project (11), provides trends of standardised mortality rates in European countries according to the recent list of causes of deaths over the period 2001-2009 by the electronic atlas of amenable mortality (17). In this research, Eastern European countries had higher rates of causes of death amenable to health care than Northern and Western European countries. To date, there have been no studies conducted to update the evolution of amenable mortality up to the latest available year 2013, in addition, the relationships between amenable mortality and others health indicators are missing.

The main objectives of this paper are:

* to evaluate differences in amenable mortality across European Union (EU) countries between 2002 and 2013,

* to reveal the relative position of countries with relation to the European Union average for the leading causes of death in amenable mortality,

* to determine the associations between amenable mortality and life expectancy at birth. …

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