Duke 2008 | ASHE | Equity and Efficiency in Health and Healthcare

This paper builds on insights by demographers and epidemiologists as well as recent work by economists. It is motivated by three basic facts about life expectancy in the U.S. First, life expectancy has increased steadily since 1900. Although the rate of increase slowed somewhat between 1950 and 1970, the rate has grown at a faster and fairly constant rate since then. Second, life expectancy in the U.S. is lower than in many other developed nations. Third, future improvements in life expectancy will have to come primarily from reductions in mortality from chronic diseases because mortality rates for infants and from infectious diseases are already very low.

We consider whether improvements in U.S. life expectancy can be accelerated - and the gap between the U.S. and other countries narrowed - by quicker adoption of currently available medical technologies and prevention interventions. We examine the 15 leading causes of death in the U.S., as measured by the Centers for Disease Control and Prevention. From the cost-effectiveness literature, we identify the most cost-effective interventions for reducing the mortality rate for each cause. Using nationally representative survey and discharge data, we calculate the current take-up rate for each intervention. We then calculate the potential increase in life expectancy - as well as the accompanying increase in costs - if the take-up rate is increased to 100%. As Murphy and Topol have noted, improvements in mortality for one cause have complementary effects on mortality from other causes. We calculate the magnitude of these complementary effects. Finally, we estimate the potential gains in life expectancy for fixed increases in costs, as in the case of a policymaker with a fixed budget.