Use of amenable mortality indicators to evaluate the impact of financial crisis on health system performance in Greece

Abstract

Background Greece experienced the largest reduction in its health care budget of any European country during the economic crisis of 2008–15. Here, we test the hypothesis that budget reductions worsened health system performance in Greece, using the concept of Amenable Mortality to capture deaths which should not occur in the presence of effective and timely health care. Methods Amenable mortality was calculated from national mortality statistics, using age-standardized deaths from 34 conditions amenable to medical intervention in Greece during 2000–16, with further analysis by sex, age, region and cause. Mortality rate ratios and their 95% CI were also computed. Interrupted time series analyses were performed to compare trends prior to austerity measures (2001–10) with those after (2011–16), adjusting for historical trends. Results Prior to austerity measures, amenable mortality rates were declining. After 2011, coinciding with the inception of budget reductions, the slope of decline diminished significantly. The average annual percent of change in standardized death rates was 2.65% in 2001–10, falling to 1.60% in 2011–6. In 10 of 34 conditions, the SDR increased significantly after the crisis onset, and in five more conditions the long-term decline reversed, to increasing after 2011. The age-specific mortality rates observed in 2011–16 were significantly higher than those expected at ages 0–4 and 65–74 but not significantly higher in all other age groups. Conclusions Health system performance in Greece worsened in association with austerity measures, leading to a deceleration of the decline in amenable mortality and increased mortality from several conditions amenable to medical interventions.

Changes in Socioeconomic Inequalities in Amenable Mortality after the Economic Crisis in Cities of the Spanish Mediterranean Coast

“…Although both all-cause and amenable mortality have decreased, amenable mortality shows a more pronounced decreasing trend. This pattern had already been described in a similar way in other studies in Europe [23,38,39]. In the Spanish case, this might suggest that the decrease could be due to preventive measures in risk factors and advances in treatments and health technology [6], as well as the entry into force of law 42/2010 on sanitary measures against smoking that regulates the sale, supply, consumption, and advertising of tobacco [34,40].…”

“…This reduction struck unevenly depending on the position of the people and social groups in the social structure and depending on geographical location (rural/urban, centre/peripheral, outskirts, etc.). Therefore, as amenable mortality depends directly on the response capacity of the health system, its use is not only relevant as an indicator of the crisis impact, but also as an indicator of the inequalities of that impact at different socioeconomic or educational levels, sex/gender, age, ethnic group, or geographical area; so reveal recent studies in Spain [6,22] and Europe [23].…”

Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019

“…Amenable mortality, or deaths from causes that should not occur in the presence of high-quality health care, 15 , 16 has been used as a measure of the health-care dimension of health system performance for nearly 50 years. 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 The most widely used list of causes of mortality amenable to health care was developed by Nolte and McKee, and has since been used to compare high-income countries' performances at length. 10 , 18 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 A recent study by Kruk and colleagues 34 used case-fatality rates for causes included in the McKee and Nolte list and additional diseases to estimate the separate effects of utilisation versus quality for 137 countries.…”

Gender and Age Differences in Socio‐economic Inequalities in Total and Avoidable Mortality in Portugal: A Trend Analysis*

“…In the short term, some studies found an association with premature mortality, 41 suicide, 42 homicide 43 and death amenable to health care. 44 The impact of the recession on the population's health is not yet fully clear, as socio-economic consequences of the recession are still developing. 45 This is in keeping with recent international studies identifying long-term effects on health inequalities, 46 mortality, 47 child mortality 48 and life expectancy.…”