BACKGROUND Post-communist health care reforms and the break-up of Czechoslovakia have been studied from various perspectives, but little research has addressed the impact on health system performance. This paper investigates the quality and performance of the Slovak and Czech health systems before and after 1989, including the year of separation in 1993, using the concept of 'avoidable' mortality. METHODS Age-standardized mortality rates for mortality from 'avoidable' and other (non-avoidable) causes have been calculated through indirect standardization to study national and regional trends between 1971 and 2008. RESULTS The paper shows that 'avoidable' mortality in both countries has been continuously decreasing while mortality from other causes has remained unchanged or increased slightly. For some 'avoidable' conditions, mortality rates of the two countries converge while for others divergence can be observed, with either the Czech Republic or Slovakia performing better. CONCLUSION Declines in overall 'avoidable' mortality suggest improvements in the health system's performance and quality of care in both countries, compared with mortality from other causes where factors outside the control of the health care system may be stronger determinants. For conditions where 'avoidable' mortality rates stagnate or increase, more in-depth research should be carried out to identify problems in the delivery of timely and effective prevention and treatment, and to establish steps that would reduce the numbers of unnecessary deaths.

LSE Health London School of Economics and Political Science London UK

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