Going beyond life expectancy in assessments of health systems’ performance: life expectancy adjusted by perceived health status
International comparisons of health systems data have been used to guide health policy. Health systems performance is generally evaluated on how different factors contribute to mortality and longevity. Fewer studies scrutinize the factors that determine morbidity in different countries, partly because indicators that assess morbidity on a country level are not as widely available as mortality and longevity data. We introduce a new health status indicator able to combine mortality and morbidity in a single composite measure for each country and gender at a point in time (LEAPHS), yielding the average number of years that men (women) can expect to live in “good” (or better) health. Using the Sullivan method we combine the mortality risk, calculated for specific age and gender groups, with perceived health status for the same age and gender groups, and we estimate how medical care and various socio-economic, environmental and structural, lifestyle, and technological factors affect LEAPHS and life expectancy at birth for a large panel of thirty OECD countries. We find that some variables (alcohol consumption, urbanization) have a significant effect on both LEAPHS and life expectancy, while one variable (the number of hospitals) has a significant effect for both genders on life expectancy only. However, the effects of many other variables (health expenditure per capita, health expenditure per capita squared, GDP growth, and technology) were only significant predictors for LEAPHS. This leads us to conclude that LEAPHS is able to capture the impact of some health determinants not captured by life expectancy at birth. While we believe this new measure may be useful for health economists and statisticians doing cross-country analyses, further comparisons with other measures may be useful.
KeywordsHealth status indicator Mortality Morbidity Life expectancy Health expenditure per capita Perceived health status OECD countries
JEL ClassificaionC87 I10 I12 O33
- Afonso, A., & St. Aubyn, M. (2005). Non-parametric approaches to education and health efficiency in OECD countries. Journal of Applied Economics, 8(2), 227–246.Google Scholar
- Barlow, R., & Vissandjee, B. (1999). Determinants of national life expectancy. Canadian Journal of Development Studies, 20(1), 9–29.Google Scholar
- Capik, C., & Bahar, Z. (2008). Determination of factors influencing perceived health status among poor and non-poor women in Eastern Turkey. International Journal of Caring Sciences, 1(2), 58–65.Google Scholar
- Davies, A. R., & Ware, J. E. (1981). Measuring health perceptions in the health insurance experiment. Santa Monica, CA: Rand Corporation.Google Scholar
- Economou, C., & Giorno, C. (2009). Improving the performance of the public health care system in Greece. OECD Economics Department Working Papers, No 722.Google Scholar
- European Commission (2010). Health trends in the EU. Directorate-general employment, social affairs and equal opportunities, Unit E1—Social and demographic analysis, report delivered by London School of Economics and Political Science.Google Scholar
- European Health Expectancy Monitoring Unit (EHEMU) (2012). Health expectancy in Portugal, Country Reports, 5. Retrieved November 08, 2012 from http://www.eurohex.eu/pdf/CountryReports_Issue5/Portugal_Issue%205.pdf.
- Eurostat (2015). Retrieved February 08, 2015 from http://ec.europa.eu/eurostat/data/database.
- Grossman, M. (1972b). The demand for health: A theoretical and empirical investigation. New York: Columbia University Press (for the National Bureau for Economic Research).Google Scholar
- Grossman, M. (1976). The correlation between health and schooling. In N. E. Terleckyj (Ed.), Household production and consumption (pp. 147–211). New York: Columbia University Press (for NBER).Google Scholar
- Gudex, C., Kind, P., & Williams, A. (1995). A social tariff for EuroQol: Results from a UK general population survey. York: Centre for Health Economics, University of York.Google Scholar
- Haber, L. D. (1967). Identifying the disabled: Concepts and methods in the measurement of disability. Social Security Bulletin, 30, 17–34.Google Scholar
- Hadley, J. (1982). More medical care, better health?. Washington, DC: Urban Institute.Google Scholar
- Jagger, C. (1997). Health expectancy calculation by the Sullivan method: A practical guide. Leicester: Euro-REVES/University of Leicester.Google Scholar
- Jönsson, B. (1989). What can Americans learn from Europeans? Health Care Financing Review, Annual Supplement, 79–110.Google Scholar
- Joumard, I., André, C., Nicq, C., Chatal, O. (2008). Health status determinants: Lifestyle, environment, health care resources and efficiency. OECD Economics Department Working Papers, 627, OECD, Paris.Google Scholar
- Kumar, A., & Ozdamar, L. (2004). International comparison of healthcare systems. International Journal of Computer, The Internet and Management, 12(13), 81–95.Google Scholar
- Laranjeira, E. (2014). A contemporaneous overview on Health Economics. Porto: Faculdade de Economia da Universidade do Porto, PhD Thesis. http://repositorio-aberto.up.pt/bitstream/10216/75670/2/99363.pdf.
- Leu, R. E. (1986). The public-private mix and international health care costs. In A. J. Culyer & B. Jönsson (Eds.), Public and Private Health Services (pp. 41–63). Oxford: Basil Blackwell.Google Scholar
- Lichtenberg, F. R. (2002). Sources of U.S. longevity increase, 1960–1997. National Bureau of Economic Research Working Paper, 8755, Cambridge, MA.Google Scholar
- Masseria, C., Allin, S., Sorenson, C., Papanicolas, I., & Mossialos, E. (2007). What are the methodological issues related to measuring health and drawing comparisons across countries? European Commission: Brussels.Google Scholar
- Miller, R. D., & Frech, H. E. (2002). The productivity of healthcare and pharmaceuticals: Quality of life, cause of death and the role of obesity. Economics Department, University of California, Santa Barbara. Retrieved August 20, 2012 from www.escholarship.org/uc/item/4b55f1xp.
- Murray, C. J., & Lopez, A. D. (1996). The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Global Burden of disease and Injury Series (Vol. 1). Cambridge: Harvard University Press.Google Scholar
- Nardo, M., Saisana, M., Saltelli, A., & Tarantola, S. (2005). Tools for composite indicators building. European Commission, Ispra.Google Scholar
- National Institute for Heath and Care Excellence (NICE) (2013). Retrieved January 2013, from http://www.nice.org.uk/website/glossary/glossary.jsp?alpha=Q.
- Or, Z. (2000). Determinants of health outcomes in industrialized countries: A pooled, cross-country, time series analysis. OECD Economic Studies, 30(1), 53–78.Google Scholar
- Organisation for Economic Co-operation and Development. (2001). A comparative analysis of 30 countries. OECD: Paris.Google Scholar
- Organization for Economic Co-operation and Development. (2009). Health at a glance 2009: OECD indicators. OECD: Paris.Google Scholar
- Organisation for Economic Co-operation and Development (2012). Retrieved August 2012, from http://www.oecd.org/health/healthdata.
- Organisation for Economic Co-operation and Development (2014). Retrieved August 2014, from https://data.oecd.org/healthstat/potential-years-of-life-lost.htm.
- Ricci, F., & Zachariadis, M. (2008). Longevity and education externalities: A macroeconomics perspective. LERNA, University of Toulouse. Retrieved September 8, 2012 from www2.toulouse.inra.fr/lerna/travaux/cahiers2009/09.02.278.pdf.
- Robalino, D. A., Picazo, O., & Voetberg, A. (2001). Does fiscal decentralization improve health outcomes? Evidence from a cross-country analysis. World Bank Policy Research Working Paper, 2565.Google Scholar
- Salomon, J. A., Tandon, A., & Murray, C. J. (2001). Using vignettes to improve cross-population comparability of health surveys: concepts, design, and evaluation techniques. Global Programme on Evidence for Health Policy Discussion Paper, 41. Geneva: World Health Organization.Google Scholar
- Santerre, R. E., Stephen, G. G., & Andrew, J. S. (1991). Government intervention in health care markets and health care outcomes: Some international evidence. Cato Journal, 11(1), 1–12.Google Scholar
- Schwellnus, C. (2009). Achieving higher performance: enhancing spending efficiency in health and education in Mexico. OECD Economics Department Working Papers, 732.Google Scholar
- Shaw, J. W., Horrace, W. C., & Vogel, R. J. (2002). The productivity of pharmaceuticals in improving health: An analysis of the OECD Health Data. WUSTL Economics Working Paper, HEW series. Retrieved August 10, 2012 from http://188.8.131.52/eps/hew/papers/0206/0206001.pdf.
- Siddiqui, R., & Mahmood, M. A. (1994). The determinants of health status: A cross country analysis. Pakistan Development Review, 745–758.Google Scholar
- Silver, M. (1972). An econometric analysis of spatial variations in mortality rates. In V. Fuchs, Ed., Essays in the economics of health and medical care (pp. 161–227). National Bureau of Economic Research: Colombia University Press, New York.Google Scholar
- Sullivan, D. F. (1971b). Disability data components for an index of health. Vital and Health Statistics, 2(42), 1–40.Google Scholar
- World Health Organization (1948). Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June, signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 19.Google Scholar
- World Health Organization (2013). Retrieved February 2013, from www.who.int/healthinfo/statistics/indhale/en/.
- World Health Organization (2015) Retrieved February 28, 2015, from http://apps.who.int/gho/data/node.main.688.