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The Devil Is in the Data: Can Regional Variation in Amenable Mortality Help to Understand Changes in Health System Performance in Poland?

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  • Anna Sagan

    (European Observatory on Health Systems and Policies, London School of Economics and Political Science, London WC2A 2AE, UK
    European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK)

  • Marina Karanikolos

    (European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK)

  • Małgorzata Gałązka-Sobotka

    (Institute of Healthcare Management, Faculty of Economics and Management, Lazarski University, 02-662 Warszawa, Poland)

  • Martin McKee

    (European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK)

  • Monika Rozkrut

    (Department of Econometrics and Statistics, Institute of Economics and Finance, University of Szczecin, 70-453 Szczecin, Poland)

  • Iwona Kowalska-Bobko

    (Institute of Public Health, Faculty of Health Sciences, Jagiellonian University, 31-007 Kraków, Poland)

Abstract

The contribution of health systems to health is commonly assessed using levels of amenable mortality. Few such studies exist for Poland, with analyses of within-the-country patterns being particularly scarce. The aim of this paper is to analyse differences in amenable mortality levels and trends across Poland’s regions using the most recent data and to gain a more nuanced understanding of these differences and possible reasons behind them. This can inform future health policy decisions, particularly when it comes to efforts to improve health system performance. We used national and regional mortality data to construct amenable mortality rates between 2002 and 2019. We found that the initially observed decline in amenable mortality stagnated between 2014 and 2019, something not seen elsewhere in Europe. The main driver behind this trend is the change in ischemic heart disease (IHD) mortality. However, we also found that there is a systematic underreporting of IHD as a cause of death in Poland in favour of heart failure, which makes analysis of health system performance using amenable mortality as an indicator less reliable. We also found substantial geographical differences in amenable mortality levels and trends across Poland, which ranged from −3.3% to +8.1% across the regions in 2014–2019. These are much bigger than variations in total mortality trends, ranging from −1.5% to −0.2% in the same period, which suggests that quality of care across regions varies substantially, although some of this effect is also a coding artefact. This means that interpretation of health system performance indicators is not straightforward and may prevent implementation of policies that are needed to improve population health.

Suggested Citation

  • Anna Sagan & Marina Karanikolos & Małgorzata Gałązka-Sobotka & Martin McKee & Monika Rozkrut & Iwona Kowalska-Bobko, 2022. "The Devil Is in the Data: Can Regional Variation in Amenable Mortality Help to Understand Changes in Health System Performance in Poland?," IJERPH, MDPI, vol. 19(7), pages 1-11, March.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:7:p:4129-:d:783892
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    References listed on IDEAS

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    1. Sagan, Anna & Kowalska-Bobko, Iwona & Badora-Musiał, Katarzyna & Gałązka-Sobotka, Malgorzata, 2022. "A reform proposal from 2019 aims to improve coordination of health services in Poland by strengthening the role of the counties," Health Policy, Elsevier, vol. 126(9), pages 837-843.

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