NOTES:

This study compared trends in deaths considered amenable to health care before age seventy-five between 1997�98 and 2002�03 in the United States and in eighteen other industrialized countries.

Such deaths account, on average, for 23 percent of total mortality under age seventy-five among males and 32 percent among females.

The decline in amenable mortality in all countries averaged 16 percent over this period. The United States was an outlier, with a decline of only 4 percent. If the United States could reduce amenable mortality to the average rate achieved in the three top-performing countries, there would have been 101,000 fewer deaths per year by the end of the study period.

The authors also note that "it is difficult to disregard the observation that the slow decline in U.S. amenable mortality has coincided with an increase in the uninsured population, an issue that is now receiving renewed attention in several states and among presidential candidates from both parties.

"It is startling to see the U.S. falling even farther behind on this crucial indicator of health system performance," said Commonwealth Fund Senior Vice President Cathy Schoen. "By focusing on deaths amenable to health care, Nolte and McKee strip out factors such as population and lifestyle differences that are often cited in response to international comparisons showing the U.S. lagging in health outcomes. The fact that other countries are reducing these preventable deaths more rapidly, yet spending far less, indicates that policy, goals, and efforts to improve health systems make a difference".

In 1997�98 the U.S. ranked 15th out of 19 countries on the "mortality amenable to health care" measure. However, by 2002�03 the U.S. fell to last place, with 109 deaths amenable to health care for every 100,000 people. In contrast, mortality rates per 100,000 people in the leading countries were: France (64), Japan (71), and Australia (71). The other countries included in the study were Austria, Canada, Denmark, Finland, Germany, Greece, Ireland, Italy, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden and the United Kingdom.

Study authors state that the measure of deaths amenable to health care is a valuable indicator of health system performance because it is sensitive to improved care, including public health initiatives. It considers a range of conditions from which it is reasonable to expect death to be averted even after the condition develops. This includes causes such as appendicitis and hypertension, where the medical nature of the intervention is apparent; it also includes illnesses that can be detected early with effective screenings such as cervical or colon cancer, and tuberculosis which, while acquisition is largely driven by socio-economic conditions, is not fatal when treated in a timely manner.

"Cross-national studies conducted by The Commonwealth Fund indicate that our failure to cover all Americans results in financial barriers that are much more likely to prevent many U.S. adults from getting the care they need, compared with adults in other countries," said Commonwealth Fund President Karen Davis. "While no one country provides a perfect model of care, there are many lessons to be learned from the strategies at work abroad."