Low Life Expectancy in the United States: Is the Health Care System at Fault?

Abstract

Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral or social factors. This paper presents evidence on the relative performance of the US health care system using death avoidance as the sole criterion. We find that, by standards of OECD countries, the US does well in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and strokes, and medication of individuals with high levels of blood pressure or cholesterol. We consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have been developed and where behavioral factors do not play a dominant role. We show that the US has had significantly faster declines in mortality from these two diseases than comparison countries. We conclude that the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system. Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral or social factors. This paper presents evidence on the relative performance of the US health care system using death avoidance as the sole criterion. We find that, by standards of OECD countries, the US does well in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and strokes, and medication of individuals with high levels of blood pressure or cholesterol. We consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have been developed and where behavioral factors do not play a dominant role. We show that the US has had significantly faster declines in mortality from these two diseases than comparison countries. We conclude that the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system.

Trends in Causes of Death in Low‐Mortality Countries: Implications for Mortality Projections

“…This finding is partly attributable to wider screening and more aggressive treatment of cancer-in particular of prostate and breast cancer-in the US (Preston and Ho 2010).…”

International Comparisons in Health Economics: Evidence from Aging Studies

“…Similarly in the same age groups PSA tests in the prior year for men were 27.1% in Europe compared to 42.2% in the US. Preston and Ho (2010) document that these screening differences between America and Europe are long-standing.…”

The Hurrider I Go the Behinder I Get: The Deteriorating International Ranking of U.S. Health Status

“…The limited impact on health of medical care is presented in a variety of reputable sources from reviews (48) to public health textbooks (53) and various analyses (16,17,50,60,84,85,108). The benefits of universal health care coverage in advancing population health are similarly of limited effect (114).…”

“…The United States ranks twenty-ninth for remaining years of life at age 50, e 50 , using 2006 WHO data (108). U.S. life expectancy improvements at age 50 have been modest since 1980 especially for women, in contrast to many other developed nations.…”