Avoidable Mortality: What It Means And How It Is Measured

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.