Does increased spending in health care explain the sharp upturn in life expectancy in the Netherlands?
Background: While life expectancy in most high-income countries increased remarkably since the second half of the 20th century, the Netherlands witnessed a longer period of slow improvements during the 1980 s and 90 s followed by a sudden and sharp upturn in the recent decade. It has been suggested that improved health care utilization for the elderly was partly responsible for this change. We explored the possible contribution of increasing health care expenditures, to explain the break point and size of the increase in Dutch life expectancy, which occurred in 2002. Methods: We applied multivariate panel regression to estimate the effect of health care expenditures as % of GDP on sex-specific partial smoking-free life expectancy between age 50 and 85 in 19 OECD countries, including the Netherlands, with data for the years 1980 – 2010. Based on the model estimates we construct the time-trend in Dutch life expectancy if health care expenditures as % of GDP would have remained constant throughout 1980 – 2010. Using segmented regression analysis, we test how this affects the onset and size of the recent increase in the Netherlands compared to a reference country, Sweden, and the average of the 19 countries in our sample. Findings: We find a positive and significant influence of health care expenditures as % of GDP on smoking-free partial life expectancy between age 50 and 85 within our sample of 19 OECD countries. Spending 1% more GDP on health care increased life expectancy in males by 0.05 years and females by 0.12 years on average. In the Netherlands, life expectancy improved in males and females at a rate of 0.16 years per calendar year after 2001. After removing the effect of increasing health care expenditures this was 0.14 in females and 0.11 in males. For females, this explained about 25% of the difference to the time-trend in Sweden after 2001 and for males even 66%. However, the counterfactual life expectancy with constant health care expenditures as % of GDP did not affect the onset of the Dutch increase around the year 2002 and the slow increase in life expectancy before 2001. Interpretation: Having spent more of its GDP on health care helped the Netherlands to increase its life expectancy slightly steeper than in other high-income countries during the recent decade. But variations in health care expenditures do not explain why the Netherlands performed worse than other countries before 2002 and suddenly converged to the universal increase, as observed in other countries, afterwards. The explanation of the exceptional Dutch pattern is beyond the mere change in the quantity of health care spending.