**1. Introduction**

Health systems play an important role in improving population health what closely relates to assessing the effectiveness of health care systems as one of the main dimensions of health

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system performance. Evaluating the effectiveness of health care systems requires pre‐defined objectives or the expected health outcomes that are usually measured by mortality and morbidity. More specifically, length of life and quality of life are examined. These aggregate indicators are not able to capture a clear impact of health care activities, especially quality of health care, on the health status of population. Therefore, more specific health outcome indicators were developed, e.g. avoidable mortality by selected causes of death, infant mortality, prevalence or incidence of chronic diseases, avoidable hospitalisations, and others [1].

The question of how much health care contributes to the health of populations has been discussed for several decades. Although there is no indicator that would comprehensively reflect the performance of health care system, nevertheless, the suitable measurement seems to be a concept of avoidable mortality. The concept of avoidable mortality, as an indicator for the quality of health care services, defines premature deaths from selected disease groups that are considered either treatable through the medical services or preventable by influencing the population characteristics [2].

From the beginning 1970s, many researchers have tried to renew the list of causes of death considered as amenable by health care or preventable by health interventions (see Chapter 2). Unfortunately, many studies did not demonstrate the selection process of avoidable causes of death. This is a bias that raises a question if this concept is not influenced by subjective approach of the given researchers. Has this concept a potential to be applied both at national and international levels?

The main objective of this study is to analyse the impact of the four lists of causes of death on amenable mortality by country, sex and cause of death. By application of several methods of avoidable mortality, we have an ambition to point out possible fluctuations in their results and limitations of international comparison. These raise an appeal for confrontation of the scientific teams at national and international levels and for the development of comparative international baseline. The most innovative part of the study is disputation whether the concept of avoidable mortality is reliable for international health systems comparison or not.

This chapter consists of six sections. Theoretical background of avoidable, amenable and preventable mortality, together with a literature review follows Section 1. Section 3 presents the description of the two recent modifications of the concept including cause of death structure. Section 4 deals with the empirical analyses of amenable mortality differentials across the European Union countries and describes the data and methods used. Section 5 provides a discussion about the potentials or limitations of the concept applied. The most meaningful conclusions are summarised at the end of the chapter.
