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Krystyna Szafraniec and Wieslaw Jedrychowski Chair of Epidemiology and Preventive Medicine,

IMPACT OF THE HEALTH CARE REFORM ON THE PUBLIC HEALTH IN TRANSFORMATION PERIOD OF EASTERN EUROPEAN COUNTRIES. MORTALITY STUDY IN KRAKOW , POLAND. Krystyna Szafraniec and Wieslaw Jedrychowski Chair of Epidemiology and Preventive Medicine,

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Krystyna Szafraniec and Wieslaw Jedrychowski Chair of Epidemiology and Preventive Medicine,

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  1. IMPACT OF THE HEALTH CARE REFORM ON THE PUBLIC HEALTH IN TRANSFORMATION PERIOD OF EASTERN EUROPEAN COUNTRIES.MORTALITY STUDY IN KRAKOW, POLAND Krystyna Szafraniec and Wieslaw Jedrychowski Chair of Epidemiology and Preventive Medicine, Jagiellonian University, Krakow, Poland

  2. What do we know about human lifespan with regard to the length or shortness of life?The information to be had is small, observation careless and tradition based on fables.Francis Bacon, Historia Vitae et Mortis, 1645

  3. Background The pattern of mortality by cause (but not the numbers) in Poland is quite similar to that in Western Europe: nearly two thirds of deaths were caused by the first three leading causes of death (circulatory diseases, cancer and injury). However, life expectancy, infant mortality rates and death rates fell behind most western countries. Krakow, the third large city in Poland was known for decades for its poor environmental conditions. Surprisingly, indices of residents’ health status are better than one may expected when compared to other Polish towns.

  4. Improvements that have been made in 1975-1999:

  5. Long-term trends in all causes mortality* in Krakow population SMR per 100 000 SMR per 100 000 1400 810 1300 760 1200 710 1100 Males Females 1000 660 */ standardized to age 75 80 85 90 95 75 80 85 90 95

  6. Long-term trends in cardiocirculatory mortality* in Krakow population Ischaemic heart diseases Cardiovascular diseases */ standardized to age

  7. Males Females

  8. Objective • Describe health status of population, including prediction of trends with respect to implementation in 1999 health care reform and their impact on population health • Assess the short-term health effects of functioning of the new system

  9. Material • Study place: Krakow, Poland 750 000 inhabitants • Study period: 1991-2000 • Data: death certificates for Krakow residents

  10. Methods • Age-adjusted mortality rates (with the Krakow population in 1990 as a standard) were calculated • linear regression was employed for assessing trends in mortality • the rates from 1991-1998 were used for calculating expected level of mortality in 1999 • excess mortality was defined as a ratio of observed vs. expected rates

  11. Description of mortality of Krakow inhabitants Male/Female ratio Total mortality:6700 deaths per year 27% before 65 49% in men Cancer mortality:27% of total deaths 36% before 65 52% in men Cardiovascular 49% of all deaths mortality18% before 65 43% in men Ishaemic heart13.5% of all deaths disease mortality:22% before 65 55% in men

  12. Selected indicators of mortality from leading causes of death among Krakow inhabitants in two year period before and after the health care reform were introduced

  13. Excess in mortality* from all causes and cardiovascular diseases in males over the last 10 years Males */ standardized to age

  14. Mortality* from all causes and cardiovascular diseases in females over the last 10 years Females */ standardized to age

  15. Excess (?) in mortality* from cancer in males and females with respect to trends over the last 10 years */ standardized to age

  16. Excess in mortality* from heart attack in males and females with respect to trends over the last 10 years Males Linear trend: y= -10.7x+173.7, p=0.000, R2 =0.84 510 deaths more than expected Females Linear trend: R2 =0.30 Nonlinear (parabolic) trend: R2 =0.82 282 deaths less than expected */ standardized to age

  17. Is there any change for the place to die?

  18. Conclusions • The results are more pronounced in men. Particularly, men in their early middle age have suffered from the effect of transition. In situation of acute social and economic changes they are more vulnerable than women. • The excess in heart attacks indicates that emergency service may not work efficiently enough under the new circumstances.

  19. Conclusions • Although the data obtained for this study, regarding quality of recording and coding deaths, are in a good quality, the result must be treated with some caution because of short observation time. • More analytical work, including broad social and environmental determinants of health, is needed to understand the present trends.

  20. Has health care improved for the average Pole today? - Definitely, yes. People are encouraged to think of their own health, take part in screening programs and ensure themselves to have the regular check-ups.

  21. So, if health care reform is beneficial, what is behind the numbers?Things are likely to get worse before that get better.We have a hope this is the case here.

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