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

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  • Samuel H. Preston
  • Jessica Y. Ho
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    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.

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    Bibliographic Info

    Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 15213.

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    Date of creation: Aug 2009
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    Publication status: published as “Low Life Expectancy in the United States: Is the Health Care System at Fault?” S.H. Preston and Jessica Ho. Pages 259 - 98 in International Differences in Mortality at Older Ages: Dimensions and Sources . Eileen Crimmins, Samuel Preston, and Barney Cohen, editors. 2011. National Academies Press . Washin gton, D.C. 2011
    Handle: RePEc:nbr:nberwo:15213

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    1. Michaud, Pierre-Carl & Goldman, Dana P. & Lakdawalla, Darius N. & Zheng, Yuhui & Gailey, Adam H., 2009. "International Differences in Longevity and Health and Their Economic Consequences," IZA Discussion Papers 4367, Institute for the Study of Labor (IZA).
    2. David Cutler & Edward Glaeser & Jesse Shapiro, 2003. "Why Have Americans Become More Obese?," NBER Working Papers 9446, National Bureau of Economic Research, Inc.
    3. Randall D. Cebul & James B. Rebitzer & Lowell J. Taylor & Mark Votruba, 2008. "Organizational Fragmentation and Care Quality in the U.S. Health Care System," NBER Working Papers 14212, National Bureau of Economic Research, Inc.
    4. Shapiro, Jesse & Glaeser, Edward & Cutler, David, 2003. "Why Have Americans Become More Obese," Scholarly Articles 2640583, Harvard University Department of Economics.
    5. Arie Kapteyn & James P. Smith & Arthur van Soest, 2007. "Vignettes and Self-Reports of Work Disability in the United States and the Netherlands," American Economic Review, American Economic Association, vol. 97(1), pages 461-473, March.
    6. Alan M. Garber & Jonathan Skinner, 2008. "Is American Health Care Uniquely Inefficient?," NBER Working Papers 14257, National Bureau of Economic Research, Inc.
    7. David M. Cutler & Edward L. Glaeser, 2009. "Why Do Europeans Smoke More than Americans?," NBER Chapters, in: Developments in the Economics of Aging, pages 255-282 National Bureau of Economic Research, Inc.
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    Cited by:
    1. David M. Cutler & Dan P. Ly, 2011. "The (Paper)Work of Medicine: Understanding International Medical Costs," Journal of Economic Perspectives, American Economic Association, vol. 25(2), pages 3-25, Spring.
    2. Banks, James & Muriel, Alastair & Smith, James P., 2010. "Disease Prevalence, Disease Incidence, and Mortality in the United States and in England," IZA Discussion Papers 4992, Institute for the Study of Labor (IZA).
    3. Robert Rosenman, 2011. "The public finance of healthy behavior," Public Choice, Springer, vol. 147(1), pages 173-188, April.
    4. Hippu Salk Kristle Nathan & Srijit Mishra, 2010. "Progress in human development: Are we on the right path?," International Journal of Economic Policy in Emerging Economies, Inderscience Enterprises Ltd, vol. 3(3), pages 199-221.

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