Amenable mortality as an indicator of healthcare quality — a literature review

Abstract

In 2008, the Office for National Statistics (ONS) suggested that research should be undertaken into whether amenable mortality - deaths considered avoidable due to medical intervention - could be used as an indicator of healthcare quality. The aim of this paper is to review the literature on amenable mortality in order to determine the extent to which the observed fall in amenable mortality is due to the healthcare system. The literature reviewed covers mainly the Organisation for Economic Co-operation and Development (OECD) countries and can be broadly categorised into: (a) trends across OECD countries (b) pooled time series cross-country analyses of OECD countries and (c) cross-section or time series analyses within countries. There is no consensus in the literature on exactly what constitutes amenable mortality, thereby making the concept in itself imprecise. However, there has been a fall in amenable mortality in the past few decades in most OECD countries including the UK. Since the fall in amenable mortality has been at a faster rate than that of 'unavoidable' mortality, some studies have directly attributed this to the healthcare system. Others have tested the relationship between healthcare outcomes and healthcare inputs to determine the magnitude and direction of the relationship. No study has explicitly used a healthcare activity or quality variable in their analyses. This implies that the evidence that amenable mortality is an indicator of healthcare quality is far from overwhelming or clear. At this stage, it is premature to use amenable mortality in ONS's healthcare output calculations. We welcome comments from those interested in this field, and suggestions to improve understanding in this area.