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The contribution of medical care to changing life expectancy in Germany and Poland

Author

Listed:
  • Nolte, Ellen
  • Scholz, Rembrandt
  • Shkolnikov, Vladimir
  • McKee, Martin
Abstract
This paper assesses the impact of medical care on changes in mortality in east Germany and Poland before and after the political transition, with west Germany included for comparison. Building upon Rutstein's concept of unnecessary untimely deaths, we calculated the contribution of conditions considered responsive to medical care or health policy to changes in life expectancy between birth and age 75 [e(0-75)] for the periods 1980/1983-1988 and 1991/1992-1996/1997. Temporary life expectancy, between birth and age 75, has been consistently higher in west Germany, intermediate in east Germany and lowest in Poland. Although improving in all three regions between the early 1980s and the late 1990s, the pace of change differed between countries, resulting in a temporary widening of an initial east-west gap by the late 1980s and early 1990s. In the 1980s, in east Germany, 50-60% of the improvement was attributable to declining mortality from conditions responsive to medical care (west Germany: 30-40%). A net positive effect was also observed in Poland, although counterbalanced by deterioration in ischaemic heart disease mortality. In the former communist countries, improvements attributable to medical care in the 1980s were due, largely, to declining infant mortality. In the 1990s, they benefited also adults, specifically those aged 35+ in Poland and 55+ in Germany. A persisting east-west gap in temporary life expectancy in Germany was due, largely, to higher mortality from avoidable conditions in the east, with causes responsive to health policy contributing about half, and medical care 16% (men) to 24% (women) to the differential in 1997. The findings indicate that changes in the health care system related to the political transition were associated with improvements in life expectancy in east Germany and, to a lesser extent, in Poland. Also, differences in the quality of medical care as assessed by the concept of 'unnecessary untimely deaths' appear to contribute to a persisting east-west health gap. Especially in Poland and the former German Democratic Republic there remains potential for further progress that would narrow the health gap with the west.

Suggested Citation

  • Nolte, Ellen & Scholz, Rembrandt & Shkolnikov, Vladimir & McKee, Martin, 2002. "The contribution of medical care to changing life expectancy in Germany and Poland," Social Science & Medicine, Elsevier, vol. 55(11), pages 1905-1921, December.
    • Handle: RePEc:eee:socmed:v:55:y:2002:i:11:p:1905-1921
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    Citations

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    Cited by:

    1. Agnieszka Fihel & Marketa Pechholdová, 2017. "Between ‘Pioneers’ of the Cardiovascular Revolution and Its ‘Late Followers’: Mortality Changes in the Czech Republic and Poland Since 1968," European Journal of Population, Springer;European Association for Population Studies, vol. 33(5), pages 651-678, December.
    2. Mühlichen, Michael & Lerch, Mathias & Sauerberg, Markus & Grigoriev, Pavel, 2023. "Different health systems – Different mortality outcomes? Regional disparities in avoidable mortality across German-speaking Europe, 1992–2019," Social Science & Medicine, Elsevier, vol. 329(C).
    3. Roland Rau & Eugeny Soroko & Domantas Jasilionis & James W. Vaupel, 2008. "Continued Reductions in Mortality at Advanced Ages," Population and Development Review, The Population Council, Inc., vol. 34(4), pages 747-768, December.
    4. Haan, Peter & Prowse, Victoria, 2014. "Longevity, life-cycle behavior and pension reform," Journal of Econometrics, Elsevier, vol. 178(P3), pages 582-601.
    5. Domantas Jasilionis & France Meslé & Vladimir M. Shkolnikov & Jacques Vallin, 2011. "Recent Life Expectancy Divergence in Baltic Countries," European Journal of Population, Springer;European Association for Population Studies, vol. 27(4), pages 403-431, November.
    6. Afschin Gandjour, 2023. "A Model-Based Estimate of the Cost-Effectiveness Threshold in Germany," Applied Health Economics and Health Policy, Springer, vol. 21(4), pages 627-635, July.
    7. Vogt, Tobias C. & Kluge, Fanny A., 2015. "Can public spending reduce mortality disparities? Findings from East Germany after reunification," The Journal of the Economics of Ageing, Elsevier, vol. 5(C), pages 7-13.
    8. Pavel Grigoriev & Markéta Pechholdová, 2017. "Health Convergence Between East and West Germany as Reflected in Long-Term Cause-Specific Mortality Trends: To What Extent was it Due to Reunification?," European Journal of Population, Springer;European Association for Population Studies, vol. 33(5), pages 701-731, December.
    9. Sandiford, P. & Vivas Consuelo, D. & Rouse, P. & Bramley, D., 2018. "The trade-off between equity and efficiency in population health gain: Making it real," Social Science & Medicine, Elsevier, vol. 212(C), pages 136-144.
    10. Bambra, Clare & Smith, Katherine E. & Pearce, Jamie, 2019. "Scaling up: The politics of health and place," Social Science & Medicine, Elsevier, vol. 232(C), pages 36-42.
    11. Ya-Hui Huang & Chien-Chiang Lee & Chun-Ping Chang, 2016. "Medical Personnel and Life Expectancy: New Evidence from Taiwan," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 128(3), pages 1425-1447, September.
    12. Jinwook Bahk & Kyunghee Jung-Choi, 2020. "The Contribution of Avoidable Mortality to the Life Expectancy Gains in Korea between 1998 and 2017," IJERPH, MDPI, vol. 17(18), pages 1-10, September.
    13. Anna Sagan & Marina Karanikolos & Małgorzata Gałązka-Sobotka & Martin McKee & Monika Rozkrut & Iwona Kowalska-Bobko, 2022. "The Devil Is in the Data: Can Regional Variation in Amenable Mortality Help to Understand Changes in Health System Performance in Poland?," IJERPH, MDPI, vol. 19(7), pages 1-11, March.
    14. Simona-Andreea Apostu & Valentina Vasile & Valentin Sava, 2021. "Do Cardiovascular Diseases Significantly Influence Healthy Aging?," IJERPH, MDPI, vol. 18(14), pages 1-15, July.
    15. Magdalena Muszyñska & Roland Rau Roland, 2014. "Did Men Benefit More from Medical Progress in Recent Decades? Cause-of-Death Contributions to the Decreasing Sex-Gap in Life Expectancy in the United States," Working Papers 72, Institute of Statistics and Demography, Warsaw School of Economics.
    16. Michael Mühlichen, 2019. "Avoidable Mortality in the German Baltic Sea Region Since Reunification: Convergence or Persistent Disparities?," European Journal of Population, Springer;European Association for Population Studies, vol. 35(3), pages 609-637, July.
    17. Eva U. B. Kibele & Sebastian Klüsener & Rembrandt D. Scholz, 2014. "Regional mortality disparities in Germany: long-term dynamics and possible determinants," MPIDR Working Papers WP-2014-009, Max Planck Institute for Demographic Research, Rostock, Germany.
    18. Paolo Roffia & Alessandro Bucciol & Sara Hashlamoun, 2023. "Determinants of life expectancy at birth: a longitudinal study on OECD countries," International Journal of Health Economics and Management, Springer, vol. 23(2), pages 189-212, June.
    19. Eun, Sang Jun, 2019. "Avoidable, amenable, and preventable mortalities in South Korea, 2000–2017: Age-period-cohort trends and impact on life expectancy at birth," Social Science & Medicine, Elsevier, vol. 237(C), pages 1-1.
    20. Hanewald, Katja, 2008. "Beyond the business cycle: Factors driving aggregate mortality rates," SFB 649 Discussion Papers 2008-031, Humboldt University Berlin, Collaborative Research Center 649: Economic Risk.
    21. 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.
    22. 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.
    23. Rok Hrzic & Tobias Vogt & Helmut Brand & Fanny Janssen, 2021. "The Short-Term Effects of European Integration on Mortality Convergence: A Case Study of European Union’s 2004 Enlargement," European Journal of Population, Springer;European Association for Population Studies, vol. 37(4), pages 909-931, November.
    24. Mine Kühn & Christian Dudel & Tobias C. Vogt & Anna Oksuzyan, 2017. "Trends in gender differences in health and mortality at working ages among West and East Germans," MPIDR Working Papers WP-2017-009, Max Planck Institute for Demographic Research, Rostock, Germany.

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