Abstract
BackgroundSome studies have analyzed the association of health care systems variables, such as health service resources or expenditures, with amenable mortality, but the association of types of health care systems with the decline of amenable mortality has yet to be studied. The present study examines whether specific health care system types are associated with different time trend declines in amenable mortality from 2000 to 2014 in 22 European OECD countries.MethodsA time trend analysis was performed. Using Nolte and McKee’s list, age-standardized amenable mortality rates (SDRs) were calculated as the annual number of deaths over the population aged 0–74 years per 100,000 inhabitants. We classified health care systems according to a deductively generated classification by Böhm. This classification identifies three dimensions that are not entirely independent of each other but follow a clear order: the regulation dimension is first, followed by the financing dimension and finally service provision. We performed a hierarchical semi-log polynomial regression analysis on the annual SDRs to determine whether specific health care systems were associated with different SDR trajectories over time.ResultsThe results showed a clear decline in SDRs in all 22 health care systems between 2000 and 2014 although at different annual changes (slopes). Regression analysis showed that there was a significant difference among the slopes according to provision dimension. Health care systems with a private provision exhibited a slowdown in the decline of amenable mortality over time. It therefore seems that ownership is the most relevant dimension in determining a different pattern of decline in mortality.ConclusionsAll countries experienced decreases in amenable mortality between 2000 and 2014; this decline seems to be partially a reflection of health care systems, especially when affected by the provision dimension. If the private ownership is maintained or promoted by health systems, these findings might be considered when thinking about regulation policies to control factors that might influence health care performance.
Highlights
Some studies have analyzed the association of health care systems variables, such as health service resources or expenditures, with amenable mortality, but the association of types of health care systems with the decline of amenable mortality has yet to be studied
This study aimed to examine whether specific health care system types are associated with different patterns of decline in amenable mortality from 2000 to 2014 in 22 Organisation for Economic Cooperation and Development (OECD) European countries
The most used classification by researchers is OECD classification. This classification is based on the extent of coverage, mode of financing and delivery of health care, and distinguishes among three types of health systems: National Health Service (NHS), social health insurance (SHI) and the private health insurance (PHI)
Summary
Some studies have analyzed the association of health care systems variables, such as health service resources or expenditures, with amenable mortality, but the association of types of health care systems with the decline of amenable mortality has yet to be studied. The present study examines whether specific health care system types are associated with different time trend declines in amenable mortality from 2000 to 2014 in 22 European OECD countries. Amenable mortality is defined as premature death from a set of conditions that should not occur in the presence of timely and effective health care [1]. Adequate health care may prevent mortality due to a variety of causes by means of preventive or therapeutic measures [2]. This concept was originally developed by Rutstein et al, who created a list of conditions that were considered either treatable or preventable based on current medical. Gianino et al BMC Health Services Research (2017) 17:735 in amenable mortality in all countries. Gay et al [9] measured the average annual change in amenable mortality in 31 OECD countries between 1997 and 2007 and concluded that amenable mortality declined in all OECD countries; the average annual decline was 3.7%
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