title: [Amenable mortality as indicator of effectiveness of health care services in Spain before and after transferences].
abstract: OBJECTIVE
  To describe the evolution of amenable mortality (MRASS) in Spain and to evaluate differences in trend patterns before and after health care services were transferred to local authorities.
  
  
  METHODS
  MRASS was defined from a list of causes of death used in other studies. We analyzed the change in sex-age-standardized death rates of MRASS in two periods: 1999-2001 and 2006-2008, just before, and five years after, the health care transfers were completed.
  
  
  RESULTS
  MRASS represented 24% of deaths in persons from 0 to 74 years old. MRASS has seen a reduction (19.4%) between the two periods over and above other causes of mortality (14.5%). The group of causes of mortality which showed most reduction: ischemic heart disease (28%), other vascular disease (27%), surgical conditions and surgical-medical errors (26%), and diabetes (22.5%). Although there were differences between the districts, health care transfers have not created significant variations in MRASS. Navarra and Madrid showed lower rates of MRASS, and the Canary Islands, Asturias, Andalusia, Ceuta and Melilla had higher rates. The Balearic Islands showed the greatest reduction in MRASS.
  
  
  CONCLUSIONS
  MRASS constitutes an important proportion of trends of mortality in persons between 0-74 years. It has declined in all districts. Even though there were large differences between districts, there does not appear to be any direct influence due to health care transfer in amenable mortality trends. In spite of limitations, MRASS is an indicator to be considered when monitoring and detecting weaknesses in the effectiveness of health care systems.
authors.affiliation: Servicio de Medicina Preventiva y Salud Pública, Hospital Clínico Universitario de Zaragoza, Zaragoza, España. jbarrasa@salud.aragon.es
authors.forename: J I
authors.initials: JI
authors.lastname: Barrasa Villar
authors.forename: S
authors.initials: S
authors.lastname: Castán Ruiz
authors.forename: F R
authors.initials: FR
authors.lastname: Estupiñán Romero
authors.forename: M
authors.initials: M
authors.lastname: Valderrama Rodríguez
authors.forename: F J
authors.initials: FJ
authors.lastname: Moliner Lahoz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D009313:National Health Programs / Q000458:organization & administration*; D011057:Politics; D011314:Preventive Health Services / Q000458:organization & administration*; D015397:Program Evaluation; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D013030:Spain / Q000453:epidemiology; D055815:Young Adult