Nolte Ellen, Scholz Rembrandt, Shkolnikov Vladimir, McKee Martin
European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Soc Sci Med. 2002 Dec;55(11):1905-21. doi: 10.1016/s0277-9536(01)00320-3.
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.
本文评估了医疗保健对德国东部和波兰政治转型前后死亡率变化的影响，并将德国西部纳入比较范围。基于鲁特斯坦关于不必要过早死亡的概念，我们计算了1980/1983 - 1988年以及1991/1992 - 1996/1997年期间，被认为对医疗保健或卫生政策有反应的疾病状况对出生至75岁预期寿命变化[e(0 - 75)]的贡献。出生至75岁的临时预期寿命在德国西部一直最高，在德国东部居中，在波兰最低。尽管在20世纪80年代初至90年代末这三个地区都有所改善，但各国的变化速度不同，导致在80年代末和90年代初，最初的东西部差距暂时扩大。在20世纪80年代，在德国东部，50% - 60%的改善归因于对医疗保健有反应的疾病死亡率下降（德国西部：30% - 40%）。波兰也观察到了净积极影响，尽管缺血性心脏病死亡率的恶化起到了抵消作用。在前共产主义国家，20世纪80年代医疗保健带来的改善主要归因于婴儿死亡率的下降。在20世纪90年代，成年人也从中受益，特别是波兰35岁及以上和德国55岁及以上的成年人。德国临时预期寿命中持续存在的东西部差距，很大程度上是由于东部可避免疾病的死亡率较高，对卫生政策有反应的原因在差异中占约一半，而医疗保健在1997年对差异的贡献为男性16%至女性24%。研究结果表明，与政治转型相关的医疗保健系统变化与德国东部预期寿命的改善有关，在波兰程度稍低。此外，以“不必要过早死亡”概念评估的医疗保健质量差异似乎也导致了持续的东西部健康差距。特别是在波兰和前德意志民主共和国，仍有进一步缩小与西部健康差距的进步潜力。
