Economics & Sociology

ISSN: 2071-789X eISSN: 2306-3459 DOI: 10.14254/2071-789X
Index PUBMS: f5512f57-a601-11e7-8f0e-080027f4daa0
Article information
Title: The impact of healthcare availability on the amenable mortality: Country study
Issue: Vol. 12, No 3, 2019
Published date: 09-2019 (print) / 09-2019 (online)
Journal: Economics & Sociology
ISSN: 2071-789X, eISSN: 2306-3459
Authors: Beata Gavurova
Technical University of Košice

Peter Toth
Technical University of Košice

Ruta Ciutienė
Kaunas University of Technology

Miriama Tarhanicova
Technical University of Košice
Keywords: healthcare access, amenable mortality, panel data, health production function
DOI: 10.14254/2071-789X.2019/12-3/16
Index PUBMS: cba521aa-f43a-11e9-bbfd-fa163e0fa1a0
Language: English
Pages: 236-250 (15)
JEL classification: I10, I14, I15

This study aims to provide information on the relationship between the accessibility of healthcare and avoidable mortality. Many of the general indicators such as health care expenditures, mortality, life expectancy are insufficient in comparing the national healthcare systems, because they explain only a small amount of diversity caused by socio-economic factors. The study is based on the panel data analysis for the period from 1998 to 2015 in Slovak republic. As the indicator that takes into account socio-economic factors and represents the level of provided healthcare, the depended variable is avoidable mortality. Independent variables represent the availability of healthcare in regions. Models were estimated separately for women and men. The results demonstrate differences between sexes, lower amenable mortality in case of women, correlated to availability of practitioners, dentists, specialists, pharmacies and gynecologists. For men, there is evidence of a relation between amenable mortality and the accessibility of specialists, pediatricians, practitioners and pharmacies.


1. Anand, S., & Bärnighausen, T. (2004). Human resources and health outcomes: cross-country econometric study. Lancet (London, England), 364(9445), 1603-1609. doi:10.1016/S0140-6736(04)17313-3

2. Anderson, R. N., & Rosenberg, H. M. (1998). Age standardization of death rates: implementation of the year 2000 standard. National Vital Statistics Reports: From the Centers for Disease Control and Prevention, National Center for Health Statistics, Nation

3. Andreev, E. M., Nolte, E., Shkolnikov, V. M., Varavikova, E., & McKee, M. (2003). The evolving pattern of avoidable mortality in Russia. International Journal of Epidemiology, 32(3), 437-446.

4. Asandului, L., Roman, M., & Fatulescu, P. (2014). The Efficiency of Healthcare Systems in Europe: A Data Envelopment Analysis Approach. Procedia Economics and Finance, 10, 261-268. doi:10.1016/S2212-5671(14)00301-3

5. Bauer, R. L., & Charlton, J. R. (1986). Area variation in mortality from diseases amenable to medical intervention: the contribution of differences in morbidity. International Journal of Epidemiology, 15(3), 408-412.

6. Benicio, J., & Mello, J. C. S. de. (2015). Productivity Analysis and Variable Returns of Scale: DEA Efficiency Frontier Interpretation. Procedia Computer Science, 55, 341-349. doi:10.1016/j.procs.2015.07.059

7. Carinci, F., Van Gool, K., Mainz, J., Veillard, J., Pichora, E. C., Januel, J. M., … OECD Health Care Quality Indicators Expert Group. (2015). Towards actionable international comparisons of health system performance: expert revision of the OECD framework

8. Charlton, J. R. H., Silver, R., Hartley, R. M., & Holland, W. W. (1983). Geographical variation in mortality from conditions amenable to medical intervention in England and Wales. The Lancet, 321(8326), 691-696. doi:10.1016/S0140-6736(83)91981-5

9. Charlton, J. R., & Velez, R. (1986). Some international comparisons of mortality amenable to medical intervention. British Medical Journal (Clinical Research Edition), 292(6516), 295-301. doi:10.1136/bmj.292.6516.295

10. Croissant, Y., & Millo, G. (n.d.). Panel Data Econometrics in R: The plm Package. Journal of Statistical Software. doi:10.18637/jss.v027.i02

11. Curtin, L. R., & Klein, R. J. (1995). Direct standardization (age-adjusted death rates). Healthy People 2000 Statistical Notes, (6), 1-10.

12. Development Core Team, R. (2011). R: A Language and Environment for Statistical Computing. R. Found. Stat. Comput.. 1.

13. Dopico, F. (1987). Regional Mortality Tables for Spain in the 1860s. Historical Methods: A Journal of Quantitative and Interdisciplinary History, 20(4), 173-179. doi:10.1080/01615440.1987.9955273

14. Dumitrescu, L., Cetină, I., Pentescu, A., & Bilan, Y. (2014). Directly Estimating the Private Healthcare Services Demand in Romania. Journal of International Studies, 7(3), 55-69.

15. Dussault, G., & Franceschini, M. C. (2006). Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce. Human Resources for Health, 4(1). doi:10.1186/1478-4491-4-12

16. Dwyer-Lindgren, L., Bertozzi-Villa, A., Stubbs, R. W., Morozoff, C., Kutz, M. J., Huynh, C., … &Murray, C. J. L. (2016). US County-Level Trends in Mortality Rates for Major Causes of Death, 1980-2014. JAMA, 316(22), 2385-2401. doi:10.1001/jama.2016.13645

17. European Commission. (2013). Revision of the European Standard Population. Publications Office of the European Union. doi:10.2785/11470

18. Feinstein, J. S. (1993). The Relationship between Socioeconomic Status and Health: A Review of the Literature. The Milbank Quarterly, 71(2), 279-322. doi:10.2307/3350401

19. French, K. M., & Jones, K. (2006a). Impact of definition on the study of avoidable mortality: geographical trends in British deaths 1981-1998 using Charlton and Holland’s definitions. Social Science & Medicine (1982), 62(6), 1443-1456. doi:10.1016/j.socsc

20. Gavurová, B., & Vagašová, T. (2015). The Significance of Amenable Mortality Quantification for Financing the Health System in Slovakia. Procedia Economics and Finance, 32, 77-86. doi:10.1016/S2212-5671(15)01367-2

21. Gianino, M. M., Lenzi, J., Fantini, M. P., Ricciardi, W., & Damiani, G. (2017). Declining amenable mortality: a reflection of health care systems? BMC Health Services Research, 17. doi:10.1186/s12913-017-2708-z

22. Hakulinen, T., Hansluwka, H., Lopez, A. D., & Nakada, T. (1986). Global and Regional Mortality Patterns by Cause of Death in 1980. International Journal of Epidemiology, 15(2), 226-233. doi:10.1093/ije/15.2.226

23. Hoffmann, R., Borsboom, G., Saez, M., Mari Dell’Olmo, M., Burström, B., Corman, D., … Borrell, C. (2014). Social differences in avoidable mortality between small areas of 15 European cities: an ecological study. International Journal of Health Geographics

24. Humblet, P. C., Lagasse, R., Moens, G. F. G., Wollast, E., & van de Voorde, H. (1987). La mortalite evitable en Belgique. Social Science & Medicine, 25(5), 485-493. doi:10.1016/0277-9536(87)90172-9

25. James, P. D., Manuel, D. G., & Mao, Y. (2006). Avoidable mortality across Canada from 1975 to 1999. BMC Public Health, 6, 137. doi:10.1186/1471-2458-6-137

26. James, P. D., Wilkins, R., Detsky, A. S., Tugwell, P., & Manuel, D. G. (2007). Avoidable mortality by neighbourhood income in Canada: 25 years after the establishment of universal health insurance. Journal of Epidemiology and Community Health, 61(4), 287-

27. Kabir, M. (2008). Determinants of Life Expectancy in Developing Countries. The Journal of Developing Areas, 41(2), 185-204. Retrieved from

28. Kamarudeen, S. (2010). Amenable mortality as an indicator of healthcare quality - a literature review. Health Statistics Quarterly, (47), 66-80. doi:10.1057/hsq.2010.16

29. Kinge, J. M., Vallejo-Torres, L., & Morris, S. (2015). Income related inequalities in avoidable mortality in Norway: A population-based study using data from 1994-2011. Health Policy (Amsterdam, Netherlands), 119(7), 889-898. doi:10.1016/j.healthpol.2015.

30. Kjellstrand, C. M., Kovithavongs, C., & Szabo, E. (1998). On the success, cost and efficiency of modern medicine: an international comparison. Journal of Internal Medicine, 243(1), 3-14.

31. Krot, K. & Rudawska, I. (2017). Patients’ trust in physiciants as an antecedent of satisfaction with medical servcies. Economics and Sociology, 10(2), 207-216. doi: 10.14254/2071-789X.2017/10-2/15

32. Kunst, A. E., Looman, C. W. N., & Mackenbach, J. P. (1988a). Medical care and regional mortality differences within the countries of the European community. European Journal of Population / Revue Européenne de Démographie, 4(3), 223-245. doi:10.1007/BF017

33. Lankila, T. & Näyhä, Simo & Rautio, Arja & Rusanen, J & Taanila, A & Koiranen, Markku. (2015). Is geographical distance a barrier in the use of public primary health services among rural and urban young adults? Experience from Northern Finland. Public hea

34. Lavergne, M. R., & McGrail, K. (2013). What, If Anything, Does Amenable Mortality Tell Us about Regional Health System Performance? Healthcare Policy, 8(3), 79-90a. Retrieved from

35. Lozano, R., Naghavi, M., Foreman, K., Lim, S., Shibuya, K., Aboyans, V., … Memish, Z. A. (2012). Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.

36. Mackenbach, J. P., Kunst, A. E., Looman, C. W., Habbema, J. D., & Maas, P. J. van der. (1988). Regional differences in mortality from conditions amenable to medical intervention in The Netherlands: a comparison of four time periods. Journal of Epidemiolog

37. Mackenbach, Johan P., Hu, Y., Artnik, B., Bopp, M., Costa, G., Kalediene, R., … Nusselder, W. J. (2017). Trends In Inequalities In Mortality Amenable To Health Care In 17 European Countries. Health Affairs, 36(6), 1110-1118. doi:10.1377/hlthaff.2016.1674

38. Miguel Cruz, A., & Guarín, M. R. (2017). Determinants in the number of staff in hospitals’ maintenance departments: a multivariate regression analysis approach. Journal of Medical Engineering & Technology, 41(2), 151-164. doi:10.1080/03091902.2016.1243168

39. Mosadeghrad, A. M. (2014). Factors Affecting Medical Service Quality. Iranian Journal of Public Health, 43(2), 210-220. Retrieved from

40. Nolte, E., & McKee, M. (2003). Measuring the health of nations: analysis of mortality amenable to health care. British Medical Journal (Clinical Research Edition.), 327(7424), 1129. doi:10.1136/bmj.327.7424.1129

41. Nolte, E., & McKee, M. (2011). Variations in amenable mortality—Trends in 16 high-income nations. Health Policy, 103(1), 47-52. doi:10.1016/j.healthpol.2011.08.002

42. Nolte, E; McKee, M; (2004) Does health care save lives? Avoidable mortality revisited. The Nuffield Trust, p. 139. ISBN 1902089944

43. Office for National Statistics. (2013). Avoidable mortality in England and Wales, 2011. Experimental statistics. Retrieved on 9 October 2018 from

44. Pampalon, R. (1993a). Avoidable mortality in Québec and its regions. Social Science & Medicine, 37(6), 823-831. doi:10.1016/0277-9536(93)90376-F

45. Pampalon, R. (1993b). Avoidable mortality in Québec and its regions. Social Science & Medicine, 37(6), 823-831. doi:10.1016/0277-9536(93)90376-F

46. Persona, A., Battini, D., & Rafele, C. (2008). Hospital efficiency management: The just-in-time and Kanban technique. International Journal of Healthcare Technology and Management, 9(4), 373-391. doi:10.1504/IJHTM.2008.019674

47. Poikolainen, K., & Eskola, J. (1988). Health services resources and their relation to mortality from causes amenable to health care intervention: a cross-national study. International Journal of Epidemiology, 17(1), 86-89.

48. Ramkissoon, F. E. (2013). Commentary on “In Amenable Mortality - Deaths Avoidable Through Health Care - Progress in the US Lags That of Three European Countries.” Annals of Medicine and Surgery, 2(1), 5-7. doi:10.1016/S2049-0801(13)70018-9

49. Reid, J. W., Johnson, A. P., Entwisle, F. N., & Angers, W. P. (1962). A Four-Year Study of the characteristics of engineering students. The Personnel and Guidance Journal, 41(1), 38-43. doi:10.1002/j.2164-4918.1962.tb02230.x

50. Reidpath, D. D., & Allotey, P. (2003). Infant mortality rate as an indicator of population health. Journal of Epidemiology & Community Health, 57(5), 344-346. doi:10.1136/jech.57.5.344

51. Rudawska, I. (2017). Towards more integrated health care - the review of the international experience. Problemy Zarządzania (Management Issue), 15(3), part 1, 130-145. doi:10.7172/1644-9584.69.9

52. Rutstein, D. D., Berenberg, W., Chalmers, T. C., Child, C. G., Fishman, A. P., & Perrin, E. B. (1976). Measuring the quality of medical care. A clinical method. The New EnglandJournal of Medicine, 294(11), 582-588. doi:10.1056/NEJM197603112941104

53. Rutstein, D. D., Berenberg, W., Chalmers, T. C., Fishman, A. P., Perrin, E. B., & Zuidema, G. D. (1980). Measuring the quality of medical care: second revision of tables of indexes. The New England Journal of Medicine, 302(20), 1146.

54. Schoenbaum, S. C., Schoen, C., Nicholson, J. L., & Cantor, J. C. (2011). Mortality amenable to health care in the United States: The roles of demographics and health systems performance. Journal of Public Health Policy, 32(4), 407-429. doi:10.1057/jphp.20

55. Simionescu, M., Bilan, S., Gavurova, B., & Bordea, E.-N. (2019). Health Policies in Romania to Reduce the Mortality Caused by Cardiovascular Diseases. Int. J. Environ. Res. Public Health, 16(17), 3080.

56. Staňková, P., Horkelová, J., Lučzewská, J., Tichá, J., Zimčíková, S., & Černobila, J. (2017). The Key Factors Influencing Clients´ Decision-making in the Market of Selected Planned Healthcare in the Czech Republic. Journal of Competitiveness, 9(4), 94-113

57. Sundmacher, L. (2013). Trends and levels of avoidable mortality among districts: “healthy” benchmarking in Germany. Health Policy (Amsterdam, Netherlands), 109(3), 281-289. doi:10.1016/j.healthpol.2012.07.003

58. Treurniet, H. F., Looman, C. W., van der Maas, P. J., & Mackenbach, J. P. (1999). Variations in “avoidable” mortality: a reflection of variations in incidence?. International Journal of Epidemiology, 28(2), 225-232.

59. Wang, H., Dwyer-Lindgren, L., Lofgren, K. T., Rajaratnam, J. K., Marcus, J. R., Levin-Rector, A., …, & Murray, C. J. (2012). Age-specific and sex-specific mortality in 187 countries, 1970-2010: a systematic analysis for the Global Burden of Disease Study

60. Wheller, L., Baker, A., Griffiths, C., & Rooney, C. (2007). Trends in avoidable mortality in England and Wales, 1993-2005. Health Statistics Quarterly, (34), 6-25.