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.
