Avoidable mortality in South Eastern Europe: inequalities between and within countries

Abstract

Despite a number of health system reforms and the rise of health expenditures, most South Eastern European (SEE) countries have not been able to reach the levels of health outcomes attained in (other) EU countries. In the current analysis I apply the concept of ‘amenable mortality’ in order to explore health inequalities in SEE countries. I add to previous evidence by estimating avoidable mortality for five more SEE countries until around 2009. Age and cause specific mortality rates are estimated to take account of changes in life expectancy in SEE over time and its differences across SEE countries. A technique to decompose life expectancies in SEE (Arriaga’s method), according to amenable mortality of different age groups, is also used. The analysis uses a benchmark country from within SEE, Greece, which is the country with the highest life expectancy in the region. Moreover, I focus on health inequalities in Greece, while I give an overview of the main challenges for future SEE health policy in the context of the EU health policy and the next programme period for the years 2014-2020. Results show the rise in population health gap between SEE and the EU-15 average in 2007/09.In terms of overall mortality rates only Slovenia has achieved similar levels to Greece. Although avoidable mortality has declined in absolute terms, it plays a significant role in the health gap. Furthermore, between SEE countries there are considerable differences, even though relatively high rates of treatable mortality (mortality amenable through effective health care interventions), among men exist. Preventable mortality (amenable through broader intersectoral policies) has become the major type of avoidable mortality in many SEE countries. On the other hand, since 2002/03, a notable improvement has taken place in IHD mortality in most SEE countries, even though levels for men remain high and differences between SEE countries exist. Health inequalities also exist within Greece, since differences in mortality rates among areas are systematically related to economic circumstances. Since 2000/02 health inequality due to treatable mortality has actually risen, especially for men. Men living in more deprived areas in Greece have systematically worse outcomes in terms of mortality that could be amenable through effective medical interventions. Present analysis suggests similarities between SEE countries in terms of priority setting in health policy exist. A priority for health policy makers in most SEE countries should be to focus to health care investments for adults and older ages. The need for a more coherent approach and actions through intersectoral health policies is also evident. Evidence from Greece suggests that policy actions have also to focus on more deprived areas. Policy makers have the difficult task to choose a proper mixture of health policy. A way forward for health systems in SEE is to take advantage of the possibilities that the European Union (EU) provides them with.