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The importance of regional availability of health care for old age survival - Findings from German reunification.

Vogt TC, Vaupel JW - Popul Health Metr (2015)

Bottom Line: We apply cause-deleted life tables and continuous mortality decomposition for the years 1982-2007 to show how reductions in circulatory mortality among the elderly affected the East German catch-up in life expectancy.Improvements in remaining life expectancy at older ages were first seen in towns with university hospitals, where state-of-the-art services became available first.Our results suggest that the modernization of the health care system had a substantial effect on old-age life expectancy and helped to significantly reduce circulatory diseases as the main cause of death in East Germany.

View Article: PubMed Central - PubMed

Affiliation: Max Planck Institute for Demographic Research Konrad-Zuse-Str. 1, 18057 Rostock, Germany.

ABSTRACT

Background: This article investigates the importance of regional health care availability for old age survival. Using German reunification as a natural experiment, we show that spatial variation in health care in East Germany considerably influenced the convergence of East German life expectancy toward West German levels.

Method: We apply cause-deleted life tables and continuous mortality decomposition for the years 1982-2007 to show how reductions in circulatory mortality among the elderly affected the East German catch-up in life expectancy.

Results: Improvements in remaining life expectancy at older ages were first seen in towns with university hospitals, where state-of-the-art services became available first.

Conclusion: Our results suggest that the modernization of the health care system had a substantial effect on old-age life expectancy and helped to significantly reduce circulatory diseases as the main cause of death in East Germany.

No MeSH data available.


East-West ratio and number of cardiac catheterization and percutaneous transluminal coronary angioplasty treatments per one million persons (Source: German Heart Reports 1990-1999)
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Fig2: East-West ratio and number of cardiac catheterization and percutaneous transluminal coronary angioplasty treatments per one million persons (Source: German Heart Reports 1990-1999)

Mentions: This analysis aims to provide greater insight into the role of the change in health care provision as a pivotal determinant in rising life expectancy in East Germany. To show the impact of the availability of modern health care, we focus on the catch-up process in university towns compared to the rural areas and smaller towns of East Germany. We assume that modern medical technologies reached rural areas later than in cities. State-owned university hospitals, located in a few major cities, benefited first from public investments in medical infrastructure and modern health care services, whereas it took some time for a network of specialized private physicians to be established in the East [22, 23]. Consequently, we argue that if modern medicine played a role in the convergence of life expectancy, then mortality would decline first in areas where modern medicine became available first. Unfortunately, data on the regional level of medical treatment do not exist for East Germany for the years around reunification. To illustrate the lower medical standard in the East we therefore have to rely on other relevant indicators. FigureĀ 2 represents the availability of two key treatments for the prevention of cardiovascular mortality. In contrast to other indicators like hospital beds, these indicators show how many patients received a certain treatment and how different age groups were affected.Fig. 2


The importance of regional availability of health care for old age survival - Findings from German reunification.

Vogt TC, Vaupel JW - Popul Health Metr (2015)

East-West ratio and number of cardiac catheterization and percutaneous transluminal coronary angioplasty treatments per one million persons (Source: German Heart Reports 1990-1999)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4588495&req=5

Fig2: East-West ratio and number of cardiac catheterization and percutaneous transluminal coronary angioplasty treatments per one million persons (Source: German Heart Reports 1990-1999)
Mentions: This analysis aims to provide greater insight into the role of the change in health care provision as a pivotal determinant in rising life expectancy in East Germany. To show the impact of the availability of modern health care, we focus on the catch-up process in university towns compared to the rural areas and smaller towns of East Germany. We assume that modern medical technologies reached rural areas later than in cities. State-owned university hospitals, located in a few major cities, benefited first from public investments in medical infrastructure and modern health care services, whereas it took some time for a network of specialized private physicians to be established in the East [22, 23]. Consequently, we argue that if modern medicine played a role in the convergence of life expectancy, then mortality would decline first in areas where modern medicine became available first. Unfortunately, data on the regional level of medical treatment do not exist for East Germany for the years around reunification. To illustrate the lower medical standard in the East we therefore have to rely on other relevant indicators. FigureĀ 2 represents the availability of two key treatments for the prevention of cardiovascular mortality. In contrast to other indicators like hospital beds, these indicators show how many patients received a certain treatment and how different age groups were affected.Fig. 2

Bottom Line: We apply cause-deleted life tables and continuous mortality decomposition for the years 1982-2007 to show how reductions in circulatory mortality among the elderly affected the East German catch-up in life expectancy.Improvements in remaining life expectancy at older ages were first seen in towns with university hospitals, where state-of-the-art services became available first.Our results suggest that the modernization of the health care system had a substantial effect on old-age life expectancy and helped to significantly reduce circulatory diseases as the main cause of death in East Germany.

View Article: PubMed Central - PubMed

Affiliation: Max Planck Institute for Demographic Research Konrad-Zuse-Str. 1, 18057 Rostock, Germany.

ABSTRACT

Background: This article investigates the importance of regional health care availability for old age survival. Using German reunification as a natural experiment, we show that spatial variation in health care in East Germany considerably influenced the convergence of East German life expectancy toward West German levels.

Method: We apply cause-deleted life tables and continuous mortality decomposition for the years 1982-2007 to show how reductions in circulatory mortality among the elderly affected the East German catch-up in life expectancy.

Results: Improvements in remaining life expectancy at older ages were first seen in towns with university hospitals, where state-of-the-art services became available first.

Conclusion: Our results suggest that the modernization of the health care system had a substantial effect on old-age life expectancy and helped to significantly reduce circulatory diseases as the main cause of death in East Germany.

No MeSH data available.