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Am J Public Health. 2014 Nov;104(11):2163-9. doi: 10.2105/AJPH.2013.301494. Epub 2013 Dec 12.

Analyzing whether countries are equally efficient at improving longevity for men and women.

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Douglas Barthold, Arijit Nandi, and José M. Mendoza Rodríguez are with the Institute for Health and Social Policy, McGill University, Montreal, Quebec. Douglas Barthold is also with the Department of Economics, McGill University. Arijit Nandi is also with the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University. Jody Heymann is with the Fielding School of Public Health, University of California, Los Angeles.



We examined the efficiency of country-specific health care spending in improving life expectancies for men and women.


We estimated efficiencies of health care spending for 27 Organisation for Economic Co-operation and Development (OECD) countries during the period 1991 to 2007 using multivariable regression models, including country fixed-effects and controlling for time-varying levels of national social expenditures, economic development, and health behaviors.


Findings indicated robust differences in health-spending efficiency. A 1% annual increase in health expenditures was associated with percent changes in life expectancy ranging from 0.020 in the United States (95% confidence interval [CI] = 0.008, 0.032) to 0.121 in Germany (95% CI = 0.099, 0.143). Health-spending increases were associated with greater life expectancy improvements for men than for women in nearly every OECD country.


This is the first study to our knowledge to estimate the effect of country-specific health expenditures on life expectancies of men and women. Future work understanding the determinants of these differences has the potential to improve the overall efficiency and equity of national health systems.

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