The quality of medical care, behavioral risk factors, and longevity growth
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The quality of medical care, behavioral risk factors, and longevity growth Frank R. Lichtenberg
Received: 2 April 2010 / Accepted: 3 December 2010 / Published online: 25 December 2010 © Springer Science+Business Media, LLC 2010
Abstract The rate of increase of longevity has varied considerably across U.S. states since 1991. This paper examines the effect of the quality of medical care, behavioral risk factors (obesity, smoking, and AIDS incidence), and other variables (education, income, and health insurance coverage) on life expectancy and medical expenditure using longitudinal statelevel data. We examine the effects of three different measures of the quality of medical care. The first is the average quality of diagnostic imaging procedures, defined as the fraction of procedures that are advanced procedures. The second is the average quality of practicing physicians, defined as the fraction of physicians that were trained at top-ranked medical schools. The third is the mean vintage (FDA approval year) of outpatient and inpatient prescription drugs. Life expectancy increased more rapidly in states where (1) the fraction of Medicare diagnostic imaging procedures that were advanced procedures increased more rapidly; (2) the vintage of self- and provider-administered drugs increased more rapidly; and (3) the quality of medical schools previously attended by physicians increased more rapidly. States with larger increases in the quality of diagnostic procedures, drugs, and physicians did not have larger increases in per capita medical expenditure. We perform several tests of the robustness of the life expectancy model. Controlling for per capita health expenditure (the “quantity” of healthcare), and eliminating the influence of infant mortality, has virtually no effect on the healthcare quality coefficients. Controlling for the adoption of an important nonmedical innovation also has little influence on the estimated effects of medical innovation adoption on life expectancy. Keywords
Longevity · Mortality · Innovation · Health expenditure
JEL Classification
I12 · J11 · H51 · H75 · O33 · O51 · P46
F. R. Lichtenberg (B) Graduate School of Business, Columbia University, 3022 Broadway, 504 Uris Hall, New York, NY 10027, USA e-mail: [email protected] F. R. Lichtenberg National Bureau of Economic Research, Cambridge, MA, USA
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Fig. 1 Increase in life expectancy at birth 1991–2004, by state
During the twentieth century, U.S. life expectancy at birth increased by almost 30 years (63%), from 47.3 years in 1900 to 77.0 years in 2000. Nordhaus (2002) estimated that, “to a first approximation, the economic value of increases in longevity over the twentieth century is about as large as the value of measured growth in non-health goods and services” (p. 17). Murphy and Topel (2005) observed that “the historical gains from increased longevity have been enormous. Over the 20th century, cumulative gains in life expectancy were worth over $1.2 million per person for both men and women. Between 1
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