Epidemiology and Social Medicine, General Department of Larissa, University of Thessaly, Larissa, Greece.
Policy Analysis and Public Management, Department of Social and Political Sciences, Bocconi University, Milan, Italy.
Eur J Public Health. 2020 Oct 1;30(5):861-866. doi: 10.1093/eurpub/ckaa058.
Greece experienced the largest reduction in its health care budget of any European country during the economic crisis of 2008-15. Here, we test the hypothesis that budget reductions worsened health system performance in Greece, using the concept of Amenable Mortality to capture deaths which should not occur in the presence of effective and timely health care.
Amenable mortality was calculated from national mortality statistics, using age-standardized deaths from 34 conditions amenable to medical intervention in Greece during 2000-16, with further analysis by sex, age, region and cause. Mortality rate ratios and their 95% CI were also computed. Interrupted time series analyses were performed to compare trends prior to austerity measures (2001-10) with those after (2011-16), adjusting for historical trends.
Prior to austerity measures, amenable mortality rates were declining. After 2011, coinciding with the inception of budget reductions, the slope of decline diminished significantly. The average annual percent of change in standardized death rates was 2.65% in 2001-10, falling to 1.60% in 2011-6. In 10 of 34 conditions, the SDR increased significantly after the crisis onset, and in five more conditions the long-term decline reversed, to increasing after 2011. The age-specific mortality rates observed in 2011-16 were significantly higher than those expected at ages 0-4 and 65-74 but not significantly higher in all other age groups.
Health system performance in Greece worsened in association with austerity measures, leading to a deceleration of the decline in amenable mortality and increased mortality from several conditions amenable to medical interventions.
希腊在 2008-15 年的经济危机期间经历了其医疗保健预算的最大削减，为所有欧洲国家中削减幅度最大的。在此，我们利用可归因性死亡率的概念来检验以下假设，即在希腊，预算削减会导致卫生系统绩效恶化，该概念用于捕捉在有效和及时的医疗保健条件下本不应该发生的死亡。
从国家死亡率统计数据中计算可归因性死亡率，使用 2000-16 年期间希腊 34 种可通过医学干预治愈的疾病的年龄标准化死亡率，进一步按性别、年龄、地区和死因进行分析。还计算了死亡率比率及其 95%CI。进行了中断时间序列分析，以比较紧缩措施（2011-16）之前（2001-10 年）和之后（2011-16 年）的趋势，调整了历史趋势。
在紧缩措施之前，可归因死亡率呈下降趋势。2011 年之后，随着预算削减的开始，下降的斜率显著减小。标准化死亡率的年平均变化百分比在 2001-10 年为 2.65%，在 2011-6 年下降至 1.60%。在 34 种疾病中有 10 种疾病的 SDR 在危机发生后显著上升，在另外 5 种疾病中，长期下降趋势发生逆转，在 2011 年之后呈上升趋势。2011-16 年观察到的特定年龄死亡率明显高于 0-4 岁和 65-74 岁的预期死亡率，但在所有其他年龄组中没有显著更高。
希腊的卫生系统绩效在紧缩措施下恶化，导致可归因性死亡率下降速度放缓，并且可通过医学干预治愈的几种疾病的死亡率增加。
