Abstract
This paper addresses the question whether regional mortality differences within developed countries reflect differences in characteristics of medical care service. It adds two new elements to previous studies on this subject: it concentrates on selected ‘avoidable’ causes of death, and it makes parallel analyses for ten EC countries. The results show that levels of medical care supply contribute little to the explanation of regional differences in mortality from the selected conditions. It is concluded that if regional mortality differences are related to health care, factors other than the level of supply are probably involved.
Résumé
Cet article cherche à voir s'il y a des liens entre les différences régionales de mortalité, dans les pays développés, et les différences qui caractérisent les sevices de soins medicaux. Il ajoute deux nouveaux élements aux études antérieures : il permet de mieux observer des causes particulière de décès ‘évitables’, et de réaliser des analyses semblables dans dix pays de la Communauté Economique Européenne. Les résultats montrent que les différences de mortalité, sous diverses conditions, sont peu expliquées par l'importance des services de soins médicaux. On en conclut que, si les différences régionales de mortalité sont reliées aux services sanitaires, des facteurs autres que l'importance de ces services sont probablement en cause.
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Acknowledgements: The research reported here would not have been possible without our participation in the EC Concerted Action Project ‘Health Services and Avoidable Deaths’. The project group is chaired by W.W. Holland (England); representatives of EC member countries are: K. Juel (Denmark), K. Kern and D. Borgers (Federal Republic of Germany), P. Morosini (Italy), F. Hatton and M. Bouvier-Colle (France), G. Moens and R. Lagasse (Belgium), J. Mackenbach (The Netherlands), A. Lakhani and J. Evans (England and Wales), V. Carstairs (Scotland) and T.V. O'Dwyer (Ireland). The representatives supplied raw data to the Department of Community Medicine of United Medical and Dental Schools, St. Thomas's Campus (London, U.K.), where data processing and calculation of SMRs took place. We gratefully acknowledge the contribution of the participants in the EC Project and members of the Department of Community Medicine to the creation of the data file and the valuable comments we received from them on an earlier version of this paper. We also thank Azim Lakhani of the same Department of Community Medicine for kindly supplying us with some additional socioeconomic indicators for regions in England and Wales.
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Kunst, A.E., Looman, C.W.N. & Mackenbach, J.P. Medical care and regional mortality differences within the countries of the European community. Eur J Population 4, 223–245 (1988). https://doi.org/10.1007/BF01796895
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DOI: https://doi.org/10.1007/BF01796895