The quality of medical care, behavioral risk factors, and longevity growth

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 state-level 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.

Endogenous technological change in medicine and its impact on healthcare costs: evidence from the pharmaceutical market in Taiwan

“…Lichtenberg [16] shows that a higher quality of health care increases life expectancy, though it does increase health expenditures per capita. Therefore, creating a virtuous cycle between technological innovation and health expenditure by adopting new technology based on the cost-effective evidence would be an avenue for policy makers to shape their health care policy.…”

Has Pharmaceutical Innovation Reduced Social Security Disability Growth?

“…Lichtenberg (2010) found that changes in life expectancy were inversely correlated across states with changes in all three of these variables during the period 1991-2004. Table 1 shows the distribution of these prescriptions by therapeutic group, as defined in RED BOOK Drug References.…”

“…However, we think that there are good reasons to doubt this claim. As discussed in Lichtenberg (2010), even if the distribution of disease incidence across states were stable over time, different rates of medical innovation for different diseases would result in interstate variation in health changes. Moreover, the growth or decline in incidence of various diseases, such as HIV/AIDS, varies considerably across states.…”

Physician Quality and Health Care for the Poor and Uninsured

“…Doyle, Ewer, and Wagner (2008) showed that patients treated by physicians from higher ranked schools have shorter and less expensive stays than patients assigned to physicians from lower ranked institutions. Lichtenberg (2009) found that increases in life expectancy were more rapid in states where the number of physicians trained in top medical schools was growing. Physicians from lower ranked medical schools or residencies were also more likely to be sued for medical malpractice (Weycker and Jensen 2000).…”