Abstract
BackgroundSince 2001 the Netherlands has shown a sharp upturn in life expectancy (LE) after a longer period of slower improvement. This study assessed whether changes in healthcare expenditure (HCE) explain this reversal in trends in LE. As an alternative explanation, the impact of changes in smoking behavior was also evaluated.MethodsTo quantify the contribution of changes in HCE to changes in LE, we estimated a health-production function using a dynamic panel regression approach with data on 19 OECD countries (1980–2009), accounting for temporal and spatial correlation. Smoking-attributable mortality was estimated using the indirect Peto-Lopez method.ResultsAs compared to 1990–1999, during 2000–2009 LE in the Netherlands increased by 1.8 years in females and by 1.5 years in males. Whereas changes in the impact of smoking between the two periods made almost no contribution to the acceleration of the increase in LE, changes in the trend of HCE added 0.9 years to the LE increase between 2000 and 2009. The exceptional reversal in the trend of LE and HCE was not found among the other OECD countries.ConclusionThis study suggests that changes in Dutch HCE, and not in smoking, made an important contribution to the reversal of the trend in LE; these findings support the view that investments in healthcare are increasingly important for further progress in life expectancy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2357-2) contains supplementary material, which is available to authorized users.
Highlights
Since 2001 the Netherlands has shown a sharp upturn in life expectancy (LE) after a longer period of slower improvement
Descriptive trends Comparing the Netherlands to the average of the other 18 Organization for economic cooperation and development (OECD) countries shows that Dutch life expectancy increases at a slower rate up until about 2002 and faster thereafter, which was more pronounced for females (Fig. 1)
Trends in the age-standardized lung cancer death rate, which served as input for the estimation of smokingassociated mortality, reveal large gender differences (Fig. 2)
Summary
Since 2001 the Netherlands has shown a sharp upturn in life expectancy (LE) after a longer period of slower improvement. During the second part of the 20th century the rate of increase in most of these countries was very similar, with no disruptions or signs of slowing down [2, 3] This remarkable finding led to the belief that progress in survival is a universal feature largely independent of country-specific aspects, such as the set-up of the health system or differences in healthspecific behavior [2]. In the year 2002 a sudden and strong increase in life expectancy started and has continued until today [8] One hypothesis for this reversal in trend is that additional investments in the health sector led to improvements in survival, at older ages [8]. An exceptionally high impact of damage caused by smoking has frequently been mentioned as a competing explanation, relevant during the stagnation period of Dutch life
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