A widely cited statistic suggests that health care services account for only a small percentage of the variation in American life expectancy. However, the methodology supporting the finding has been challenged. To explore the robustness of the finding, a new report examined four methods that rely on different outcome measures, analytic techniques, and data sets, to consider the percentage of premature deaths or poor health outcomes attributable to various factors including health care. Estimates from the four methods suggest that health care accounts for between 5% and 15% of the variation in premature death. In contrast, behavioral and social factors account for a much higher percentage of variation in premature mortality, ranging from 16% to 65%. According to the authors, this analysis affirms previous findings that health care is only one component of a larger set of influences on health outcomes. They suggest that a more diversified portfolio of national investments would generate a higher health yield. For example, spending on non-medical social services for each dollar spent on medical care averages about two dollars in wealthy countries that report data to the Organization for Economic Cooperation and Development compared to 55 cents in the United States. According to the authors, the recently enacted Chronic Care Act allowing Medicare Advantage plans to cover interventions beyond traditionally defined health care is a step in the right direction. Extending similar coverage to pregnant women and children enrolled in Medicaid may generate even higher yields, they state.
Contributions of Health Care to Longevity: A Review of 4 Estimation Methods
Robert M. Kaplan, PhD and Arnold Milstein, MD, MPH.
Stanford University School of Medicine
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