NATIONAL BUREAU OF ECONOMIC RESEARCH
NATIONAL BUREAU OF ECONOMIC RESEARCH

Low Life Expectancy in the United States: Is the Health Care System at Fault?

Samuel H. Preston, Jessica Y. Ho

NBER Working Paper No. 15213
Issued in August 2009
NBER Program(s):   AG   HC

Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral or social factors. This paper presents evidence on the relative performance of the US health care system using death avoidance as the sole criterion. We find that, by standards of OECD countries, the US does well in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and strokes, and medication of individuals with high levels of blood pressure or cholesterol. We consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have been developed and where behavioral factors do not play a dominant role. We show that the US has had significantly faster declines in mortality from these two diseases than comparison countries. We conclude that the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system.

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A non-technical summary of this paper is available in the 2009 number 4 issue of the NBER Bulletin on Aging and Health. You can sign up to receive the NBER Bulletin on Aging and Health by email.

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Document Object Identifier (DOI): 10.3386/w15213

Published: “Low Life Expectancy in the United States: Is the Health Care System at Fault?” S.H. Preston and Jessica Ho. Pages 259 - 98 in International Differences in Mortality at Older Ages: Dimensions and Sources . Eileen Crimmins, Samuel Preston, and Barney Cohen, editors. 2011. National Academies Press . Washin gton, D.C. 2011

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