Variations in amenable mortality—Trends in 16 high-income 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.
References (29)
- et al.
Geographical variation in mortality from conditions amenable to medical intervention in England and Wales
Lancet
(1983) The contribution of medical care to mortality decline: McKeown revisited
Journal of Clinical Epidemiology
(1996)- et al.
The effect of health services on mortality: decline in death rates from amenable and non-amenable causes in Finland, 1969–1981
Lancet
(1986) - et al.
Avoidable mortality in New Zealand, 1981–97
Australian and New Zealand Journal of Public Health
(2001) - et al.
State political cultures and the mortality of African Americans and American Indians
Health & Place
(2010) Accountability and health systems: toward conceptual clarity and policy relevance
Health Policy and Planning
(2004)- et al.
Does healthcare save lives? Avoidable mortality revisited
(2004) - et al.
Measuring the quality of medical care
New England Journal of Medicine
(1976) European community atlas of ‘avoidable death’
(1988)
NHS Outcomes Framework 2011/12
Mortality amenable to health care in 31 OECD countries: estimates and methodological issues
Measuring the health of the nations: how much is attributable to health care? An analysis of mortality amenable to medical care
British Medical Journal
Measuring the health of nations: updating an earlier analysis
Health Affairs
Cited by (134)
The ‘Healthcare Access and Quality Index’ revisited: A fuzzy data envelopment analysis approach
2024, Expert Systems with ApplicationsImpact of New York state nurse practitioners modernization act on quality of care
2023, Economics LettersSupply-side health policy: The impact of scope-of-practice laws on mortality
2023, Journal of Public Economics