PHA-Exchange> Does Healthcare Save Lives? Avoidable Mortality Revisited

[Claudio]

From: Ruggiero, Mrs. Ana Lucia (WDC) 


DOES HEALTHCARE SAVE LIVES? - AVOIDABLE MORTALITY REVISITED


Ellen Nolte is a Lecturer in Public Health in the European Centre on Health of Societies in Transition at the London School of Hygiene and Tropical Medicine and Research Fellow at the European Observatory on Health Care Systems.

Martin McKee is Professor of European Public Health in the European Centre on Health of Societies in Transition at the London School of Hygiene and Tropical Medicine and Research Director at the European Observatory on Health Care Systems.
The Nuffield Trust, 2004



Available online as PDF file [139p.] at:

http://www.nuffieldtrust.org.uk/policy_themes/docs/avoidablemortality.pdf 



"....Does health care save lives? Commentators such as McKeown and Illich, writing in the 1960s, argued that it played very little part, and might even be harmful. However they were writing about a period when health care had relatively little to offer compared to today. Since then, several writers have described often quite substantial improvements in death rates from conditions for which effective interventions have been introduced. But the debate continues, with some arguing that health care is making an increasingly important impact on overall levels of health while others contend that it is in the realm of broader policies, such as education, transport and housing, that we should look to for future advances in health. Inevitably this is to a considerable extent a false dichotomy. 



Both are important. But how much does health care contribute to population health? One way in which this question has been addressed previously is to look at deaths that should not occur in the presence of effective and timely health care, so-called 'avoidable' mortality. However much of this work was undertaken in the 1980s and early 1990s, since when health care has advanced considerably. In addition, 'avoidable' deaths were often limited to those before, for example, the age of 65, a figure that seems inappropriately low in the light of life expectancies that are now about 80 in many countries.



In this review the authors have traced the evolution of the concept of 'avoidable' mortality from its inception in the 1970s. The authors have undertaken a detailed methodological critique of this concept, examining questions of attribution, issues relating to comparisons over time and place, and relationships with other indicators of health service provision. 



This publication is in three parts. 
Part I reviews the existing literature on 'avoidable' mortality to create a framework for analysis that takes account of contemporary circumstances. 
Part II applies this framework to routinely available mortality data in European countries. 
Part III provides a comprehensive, annotated review of empirical studies of 'avoidable' mortality that have been undertaken worldwide so far.."



Content: 



Executive summary Background 

PART I: THE CONCEPT OF 'AVOIDABLE' MORTALITY 

Methods 

Evolution of the concept of 'avoidable' mortality 

Empirical studies of 'avoidable' mortality 

Scope and nature 

Variation between places 

Variation between social groups 

Variation over time 

Conceptual problems 

Relationship to health care inputs 

Interpreting trends in deaths from amenable mortality over time 

Selection of 'avoidable' conditions and the attribution of health outcomes 

The changing concept of avoidability 

Treatment or prevention 

Contribution of amenable conditions to overall mortality 

Underlying disease incidence and disease severity at presentation 

Other limitations 

Alternative approaches to assess the contribution of medical care to population health 

Future directions 


PART II: AVOIDABLE MORTALITY IN THE EUROPEAN UNION 

Introduction Methods Data Selection of causes of death 

Analysis .

Results 

Trends in life expectancy at birth 

Amenable mortality in the 1980s and 1990s 

Discussion 

Trends in temporary life expectancy 

The contribution of amenable mortality to changing life expectancy 

Next steps 


PART III: EMPIRICAL STUDIES OF 'AVOIDABLE' MORTALITY 

Glossary 





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