Elsevier

Health Policy

Volume 103, Issue 1, November 2011, Pages 47-52
Health Policy

Variations in amenable mortality—Trends in 16 high-income nations

https://doi.org/10.1016/j.healthpol.2011.08.002Get rights and content

Abstract

Background

There has been growing interest in the comparison of health system performance within and between countries, using a range of different indicators. This study examines trends in amenable mortality, as one measure of health system performance, in sixteen high-income countries.

Methods

Amenable mortality was defined as premature death from causes that should not occur in the presence of timely and effective health care. We analysed age-standardised rates of amenable mortality under age 75 in 16 countries for 1997/1998 and 2006/2007.

Results

Amenable mortality remains an important contributor to premature mortality in 16 high-income countries, accounting for 24% of deaths under age 75. Between 1997/1998 and 2006/2007, amenable mortality fell by between 20.5% in the US and 42.1% in Ireland (average decline: 31%). In 2007, amenable mortality in the US was almost twice that in France, which had the lowest levels.

Conclusions

Amenable mortality continues to fall across high-income nations although the USA is lagging increasingly behind other high income countries. Despite its many limitations, amenable mortality remains a useful indicator to monitor progress of nations.

Section snippets

Background

There has been growing interest in comparisons of health system performance within and between countries. Healthcare is a major element of national budgets everywhere and while actual levels of expenditure vary across countries, all have come under increased pressure to ensure that resources are spent efficiently [1]. Assessing performance remains a challenge, however, and while existing frameworks use a range of indicators to capture the different aspects of health systems, frequently used

Data

The principal data source was the WHO mortality database [13], with deaths coded according to the 9th and 10th revisions of the International Classification of Diseases, by sex and five year age bands (with infant deaths listed separately), for the period 1997/1998–2006/2007. To ensure comparability with previous work we extracted data for 13 countries of Western Europe, Australia, New Zealand and Japan; data for Germany were available to 2006 only. Data for the US were only available from this

Results

Amenable mortality remains an important contributor to premature mortality in all 16 countries studied here, accounting, in 2006/2007, for an average of just under one-quarter of total mortality under age 75 for both sexes combined, ranging from 19.2% in France to 27.2% in New Zealand (Table 2) (average men: 21.2%; women: 30.2%).

Between 1997/1998 and 2006/2007, levels of amenable mortality fell by between 20.5% in the US and 42.1% in Ireland. Ten out of 16 countries recorded declines of 30% and

Discussion

Deaths from causes that are considered amenable to timely and effective health care remain an important contributor to the mortality experience under age of 75 in high income countries. Although mortality from these conditions has fallen consistently in all countries between 1997/1998 and 2006/2007, as we have shown previously [12], the scale and pace of improvement has varied. We show that ten out of 16 countries experienced a decline of 30% or more; however in the USA and in Greece this was

Acknowledgements

This study was funded by the Commonwealth Fund, New York (Contract #20100568). We are grateful to Cathy Schoen and Doug McCarthy of the Commonwealth Fund for their valuable comments and suggestions on an earlier version of this paper. We gratefully acknowledge computing support provided by Laura Staetsky.

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