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Avoidable mortality: what it means and how it is measured


  • Adriana Castelli

    (Centre for Health Economics, University of York, UK)

  • Olena Nizalova

    (Kyiv School of Economics and Kyiv Economics Institute)


We explore in this research paper the concept of avoidable mortality and how the way it is measured has evolved over time. Starting from an earlier review by Nolte and McKee (2004), we review the empirical studies which have been produced since then. Finally we appraise the empirical applications of the most recent literature. The concept of “avoidable mortality” refers, broadly speaking, to all those deaths that, given current medical knowledge and technology, could be avoided by the healthcare system through either prevention and/or treatment. It originates from the pioneering work by Rutstein, Berenberg et al. (1976) which introduced the notion of 'unnecessary untimely deaths' as a new way to measuring the quality of medical care. The most recent empirical literature shows that the notion of avoidable mortality continues to be used to establish the extent to which people are dying from amenable conditions within and/or across countries and over time, and whether socio-economic status and ethnicity are related to mortality from amenable conditions. Most studies use data taken from national death registries, with only two which link the concept of avoidable mortality to routinely collected administrative data of healthcare provision, such as hospitals. A number of criticisms are raised, with probably the most remarkable being the lack of association found between avoidable mortality and healthcare inputs. No study has actually attempted to use the concept of avoidable mortality within the original aim envisaged by Rutstein, i.e. as a quality indicator of healthcare provision. We recommend for future work in this area to focus on investigating the link between the provision of healthcare and the concept of avoidable mortality, with a particular emphasis on using routinely collected administrative data, such as hospital discharge data.

Suggested Citation

  • Adriana Castelli & Olena Nizalova, 2011. "Avoidable mortality: what it means and how it is measured," Working Papers 063cherp, Centre for Health Economics, University of York.
  • Handle: RePEc:chy:respap:63cherp

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    References listed on IDEAS

    1. Tang, Kam Ki & Chin, Jackie T.C. & Rao, D.S. Prasada, 2008. "Avoidable mortality risks and measurement of wellbeing and inequality," Journal of Health Economics, Elsevier, vol. 27(3), pages 624-641, May.
    2. FFF1Ellen NNN1Nolte & FFF2Martin NNN2McKee & FFF2Rembrandt D. NNN2Scholz, 2004. "Progress in health care, progress in health?," Demographic Research Special Collections, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 2(6), pages 139-162, April.
    3. Wood, Evan & Sallar, Anthony M. & Schechter, Martin T. & Hogg, Robert S., 1999. "Social inequalities in male mortality amenable to medical intervention in British Columbia," Social Science & Medicine, Elsevier, vol. 48(12), pages 1751-1758, June.
    4. Schwierz, Christoph & Wübker, Ansgar, 2009. "Determinants of Avoidable Deaths from Ischaemic Heart Diseases in East and West Germany," Ruhr Economic Papers 119, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    5. FFF1France NNN1Meslé, 2004. "Mortality in Central and Eastern Europe," Demographic Research Special Collections, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 2(3), pages 45-70, April.
    6. Petrie, Dennis & Tang, Kam Ki & Prasada Rao, D. S., 2009. "Measuring Avoidable Health Inequality with Realization of Conditional Potential Life Years (RCPLY)," SIRE Discussion Papers 2009-36, Scottish Institute for Research in Economics (SIRE).
    7. Carr, Willine & Szapiro, natan & Heisler, Toni & Krasner, Melvin I., 1989. "Sentinel health events as indicators of unmet needs," Social Science & Medicine, Elsevier, vol. 29(6), pages 705-714, January.
    8. repec:zbw:rwirep:0119 is not listed on IDEAS
    9. Kam Ki Tang & Dennis Petrie & D. S. Prasada Rao, 2009. "Measuring health inequality with realization of potential life years (RePLY)," Health Economics, John Wiley & Sons, Ltd., vol. 18(S1), pages 55-75, April.
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    1. Kinge, Jonas Minet & Vallejo-Torres, Laura & Morris, Stephen, 2015. "Income related inequalities in avoidable mortality in Norway: A population-based study using data from 1994–2011," Health Policy, Elsevier, vol. 119(7), pages 889-898.
    2. Hugh Gravelle & Giuseppe Moscelli & Rita Santos & Luigi Siciliani, 2014. "Patient choice and the effects of hospital market structure on mortality for AMI, hip fracture and stroke patients," Working Papers 106cherp, Centre for Health Economics, University of York.
    3. Dennis Petrie & Kam Tang & D. Rao, 2015. "Measuring Health Inequality with Realization of Conditional Potential Life Years (RCPLY)," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 122(1), pages 21-44, May.
    4. Richard Heijink & Xander Koolman & Gert Westert, 2013. "Spending more money, saving more lives? The relationship between avoidable mortality and healthcare spending in 14 countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(3), pages 527-538, June.

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