摘要：Objectives. We examined the efficiency of country-specific health care spending in improving life expectancies for men and women. Methods. 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. Results. 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. Conclusions. 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. Growth in health expenditures has outpaced growth in gross domestic product (GDP) across countries in the Organisation for Economic Co-operation and Development (OECD) since the 1970s, 1 contributing, in some countries, to structural deficits and expanding national debts. In the United States, publicly-financed health care costs rose from $646 billion in 2001 to $1141 billion in 2009. 2 High rates of growth characterize most of the Group of Twenty leading economies, where health care spending continues to be a major contributor to public debt. 3 Combined with the fiscal constraints imposed by the recent economic downturn, the long-term debt situation is becoming unsustainable in some countries. 3,4 It is increasingly accepted that health care reform must be part of the solution for mitigating debt growth. Proposals for reducing costs by increasing the efficiency of the health care system have been at the center of public discourse concerning health care reform. In previous research, the most accepted method for assessing health system efficiency has been to investigate the relation between health spending and life expectancy. 5,6 This notion of efficiency is predicated on the ability of nations to strategically finance their health systems to attain key health goals. As is common in the literature, efficiency is defined by the changes in life expectancy that result from variation in health expenditures. 7 International comparisons of health care efficiency allow researchers to identify stronger and weaker performers and may yield policies for improving health care efficiency. Earlier studies that have examined health care efficiency among OECD countries demonstrated large international differences in spending, and unequal effectiveness of health interventions, suggesting that the productive efficiency of health systems may vary across nations. 5,8 However, prior work has not accounted for social expenditures across countries, which are associated with population health in the OECD. 9 The identification of differential health-spending efficiencies across genders has been limited to the important contribution of Asiskovitch, who found that men gain more per dollar spent than women on average across the OECD. 7 Our study furthers this investigation by analyzing country-specific health expenditures. This is important because it addresses a fundamental question: is the gender disparity the same in every country? Answering this question provides insight into the extent to which they can be altered. Additionally, although Asiskovitch used health expenditures as percent of GDP, we analyze health expenditures per capita, in purchasing-power parity equivalent 2000 US dollars, to ensure international comparability, simultaneously avoiding fluctuations from inflation or exchange rates. In this study, we estimated the relation between health expenditures and life expectancy in 27 OECD countries, using a health production model that controlled for social expenditures and overall levels of economic development. Furthermore, we assessed whether the efficiency of health care expenditures within countries varied for men and women. To the best of our knowledge, this study is the first to examine the efficiency of health expenditures in improving longevity of men and women in individual countries.
