Rok Hrzic1, Genc Burazeri1, Helmut Brand1
1Maastricht University, Care and Public Health Research Institute – CAPHRI, Department of International Health, The Netherlands.
Aim: Treatable (amenable) mortality is a headline indicator of Member State health system performance in European Union (EU) health reporting and governance processes. It directly influences European Semester country-specific recommendations, which may include binding commitments of future health system reform. However, treatable mortality was not initially developed for the purpose of cross-national comparisons. We reviewed the available evidence on the robustness of treatable mortality in cross-national comparisons.
Methods: A rapid literature review was performed. The search included scientific databases and websites of international and national institutions that perform health system performance assessments.
Results: The search uncovered 43 relevant publications. The literature highlights that geographic variation in treatable mortality is associated with the quality of health care provided. However, the variation is also associated with cross-national differences related to socioeconomic development, such as health information quality, population composition, prevalence of risk factors and diseases, availability of medical technology (including medicines), and access to health care. As of February 2020, a comprehensive empirical evaluation of the relative impact of these factors had not been reported.
Conclusion: The use of treatable mortality for cross-national comparisons may lead to biased results, particularly if the comparison includes countries with different levels of socioeconomic development. In the context of the EU, this has become particularly important considering the recent accessions of central and eastern European countries. Methods of adjusting treatable mortality need to be developed if the indicator is to be used for comparative health system performance assessment in the enlarged EU.
Keywords: amenable mortality, cross-national comparison, European Union, health indicators, treatable mortality.