Socioeconomic equity in amenable mortality in Finland 1992–2008

This study presents an approach to assess socioeconomic equity in the effectiveness of health services. As an indicator of health system performance we use amenable mortality which captures premature deaths that should not occur in the presence of effective and timely health care. Data on amenable deaths by income groups in Finland in 1992–2008 came from the National Causes of Death Register which was linked to sociodemographic data in population registers. We evaluate the extent of and trends in socioeconomic differences with two widely used inequity indices, the concentration index and the slope index of inequality, and also for different categories of amenable mortality. By categorizing conditions according to the level of intervention associated with the conditions it is possible to evaluate the effect of types of health interventions. Causes of death attributable to specialized and primary care interventions comprise the main groups. By this approach of decomposing equity in amenable mortality in Finland we detected major and increasing socioeconomic inequities and also greater inequity among deaths amenable to specialized health care interventions. Moreover, we saw that inequity increased at a faster pace among deaths amenable to specialized health care interventions yet primary health care interventions made a greater contribution to overall inequity. Although the overall rate of amenable mortality decreased notably during the follow-up, the time trends of socioeconomic differences in amenable health care indicate a substantial increase in inequities in health care in Finland.

► We present an approach based on inequity indices to investigate socioeconomic trends in mortality amenable to health care.
► In 1992–2008, amenable mortality in Finland fell by around 40%, yet the decrease was slower among low income groups.
► Relative inequities were larger and increased faster in mortality amenable to specialized than primary health care.
► Deaths amenable to primary care however had a more substantial impact on overall inequities.
► In line with earlier research, our study suggests a major failure in reaching the equity goals in Finnish health care.