Trends of amenable deaths due to healthcare within the European Union countries. Exploring the association with the economic crisis and education

Abstract

The study of premature deaths from causes that are generally preventable given the current availability of healthcare – called amenable deaths due to healthcare – provides information on the quality of services. However, they are not only impacted by healthcare characteristics: other factors are also likely to influence. Therefore, identifying the association between amenable deaths due to healthcare and health determinants, such as education, might be the key to preventing these deaths in the future. Still unclear however, is how this works and how amenable deaths due to healthcare are distributed and evolve within the European Union (EU) below the national level. We therefore studied the geographical and temporal patterns of amenable deaths due to healthcare in the 259 EU regions from 1999 to 2016, including the 2007–2008 financial crisis and the post-2008 economic downturn, and identified whether any association with education exists. A cross-sectional ecological study was carried out. Using a hierarchical Bayesian model, we estimated the average smoothed Standardized Mortality Ratios (sSMR). A regression model was also applied to measure the relative risks (RR) at 95% credible intervals for cause-specific mortality association with education. Results show that amenable deaths due to healthcare decreased globally. Nevertheless, the decrease is not the same across all regions, and inequalities within countries do persist, with lower mortality ratios seen in regions from Central European countries and higher mortality ratios in regions from Eastern European countries. Also, the evolution trend reveals that after the financial crisis, the number of these deaths increased in regions across almost all EU countries. Moreover, educational disparities in mortality emerged, and a statistical association was found between amenable deaths due to healthcare and early exit from education and training. These results confirm that identifying and understanding the background of regional differences may lead to a better understanding of the amenable deaths due to healthcare and allow for the application of more effective policies.

Efficiency and Productivity Differences in Healthcare Systems: The Case of the European Union

“…Scientists have even demonstrated the connection between economic crises and the growth of amenable deaths. Research also indicates differences between European countries, with Eastern European countries lagging far behind in the quality of healthcare provision [3]. This inequality is also reflected in the efficiency of countries, but it must be stressed that even countries whose healthcare is perceived at a high level may not be efficient [4].…”

The Devil Is in the Data: Can Regional Variation in Amenable Mortality Help to Understand Changes in Health System Performance in Poland?

“…The early work focused on the link between social and economic changes post-transition and a rapid decline in deaths from cardio-vascular disease (although interrupted by a brief increase in deaths from external causes) [ 4 , 5 , 6 ], soon complemented by research on the contribution of a reformed health system [ 7 ]. This more recent body of work mostly looked at Poland as a whole, typically comparing it with its neighbours, [ 8 , 9 ], with a few studies of patterns within the country [ 7 , 10 ]. The latter use data that are at least a decade old and do not capture the most recent trends and/or focus on more granular geographical variations in amenable mortality, which may be more reflective of primary healthcare (PHC) provision.…”