Life expectancy at birth and avoidable mortality. Health performance of Liguria region

Introduction. The Italian Health Service, based on the Beveridge's model, has been reformed several times. The recent legislation attributes to the Regions the direct ownership of the Local Health Unit (LHU) (which frequently correspond to the province territory) and is the lower decisional level. Regions are now independently experiencing organizational and functional models of LHU. In a context such this, characterized by the progressive devolution of responsibilities and the main attention paid to reduction of expenses and to improve efficiency, become more important to evaluate the effectiveness of health interventions and services, that is the achievement of objective health gains for the population. The aim is to evaluate performances, intended as gain of health, of the Liguria Region districts in a six year period following the Reform Decree 502/92. Material and methods. We analyzed the population of the Liguria Region and its provinces (counties), comparing with the Italian one. Aggregating data of 1990-1992 and 1996-1999, we diacronously and synchronously compared mortality by a set of indicators: life expectancy at birth, infant mortality, avoidable mortality (standardized rate and years of potential life lost). Results. The Liguria Region and its provinces, have better results than overall Italy in life expectancy at birth and in infant mortality. Liguria generally has lower rates in avoidable mortality, except for AIDS (province of Genoa) and uterus cancer (province of Imperia). A detailed analysis highlights critical situations in the province of Savona (accidents and infectious disease) and Imperia (accidents and respiratory disease). Conclusions. The analysis of outcome made evident substantially positive performances and "critical points": some of them at regional (macro), some others at micro level, The routine use of these indicators gives useful indication to guide the health planning.