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New Article in “Social Science & Medicine” • 23.06.2023Different Health Systems = Different Mortality Levels?
A new paper has been published by Michael Mühlichen, Markus Sauerberg and Pavel Grigoriev from our REDIM team in cooperation with Mathias Lerch (from Swiss Federal Institute of Technology in Lausanne) in the scientific journal “Social Science & Medicine”, analysing the regional differences in amenable and preventable mortality across the German-speaking area in Central Europe.
Evaluating the impact of health systems on premature mortality across different countries is a very challenging task, as it is hardly possible to disentangle it from the influence of contextual factors such as cultural differences. In this respect, the German-speaking area in Central Europe (Austria, Germany, South Tyrol and large parts of Switzerland) represents a unique ‘natural experiment’ setting: While being exposed to different health policies, they share a similar culture and language.
To assess the impact of different health systems on mortality differentials across the German-speaking area, the authors relied on the concept of avoidable mortality. Based on official mortality statistics, they aggregated causes of death below age 75 that are either 1) amenable to health care or 2) avoidable through primary prevention. They calculated standardised death rates and constructed cause-deleted life tables for 9 Austrian, 96 German, 1 Italian and 5 Swiss regions from 1992 to 2019, harmonised according to the current territorial borders.
The authors found strong north-south and east-west gradients in amenable and preventable mortality across the studied regions to the advantage of the southwest. However, the Swiss regions still show significantly lower mortality levels than the neighbouring regions in southern Germany. Eliminating avoidable deaths from the life tables reduces spatial inequality in life expectancy in 2017/2019 by 30% for men and 28% for women.
They concluded that the efficiency of health policies in assuring timely and adequate health care and in preventing risk-relevant behaviour has room for improvement in all German regions, especially in the north, west and east, and in eastern Austria as well.
Mühlichen, Michael; Lerch, Mathias; Sauerberg, Markus; Grigoriev, Pavel (2023): Different health systems – Different mortality outcomes? Regional disparities in avoidable mortality across German-speaking Europe, 1992–2019. Social Science & Medicine 329(115976): 1–17.