The influence of health care spending on life expectancy

Health care expenditures and life expectancy have both been rising in many countries, including in the Netherlands. However, it is unclear to what extent increased health care spending caused the increase in life expectancy. Establishing a causal link between health care expenditures and mortality is difficult for several reasons. In medicine, randomized clinical trials are the gold standard to demonstrate causality and thereby the effectiveness of clinical interventions. However, data from randomized trials are not available to estimate the influence of health care spending on life expectancy. As a result, researchers have tried a variety of methods and data sources to establish a causal link between health care spending and life expectancy. Our review of empirical studies revealed nonetheless that a causal influence of marginal increases in health care spending has been difficult to demonstrate in empirical research, given all methodological issues surrounding the estimates of empirical studies. We conclude therefore that, while it appears likely that increases in health care spending have contributed somewhat to the growth in life expectancy in Western countries, the strength of the effect remains uncertain and may differ between sectors. Also, the mechanisms underlying the causal relationship between health care spending and life expectancy are still unclear. For instance, both the role of specific medical technologies and that of health care reforms seem important in this context, but especially regarding the role of health care reforms sound evidence is lacking. Therefore, further research in this area, which would profit from new data sources and increased possibilities for data linkage, as well as further developments of the methods to exploit these, remain needed.