The quality of medical care, behavioral risk factors, and longevity growth
The quality of medical care, behavioral risk factors, and longevity growth
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医疗质量、行为风险因素和寿命增长
DOI：
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
F. Lichtenberg
中科院分区：
文献类型：
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作者：
F. Lichtenberg
自1991年以来，美国各州的寿命增长速度差别很大。本文使用纵向州级数据检验了医疗质量、行为风险因素(肥胖、吸烟和艾滋病发病率)和其他变量(教育、收入和医疗保险覆盖范围)对预期寿命和医疗支出的影响。我们考察了三种不同的医疗质量衡量标准的效果。第一个是诊断成像程序的平均质量，定义为高级程序的程序的比例。第二是执业医生的平均素质，定义为在一流医学院接受培训的医生所占比例。第三是门诊和住院处方药的平均年份(FDA批准年份)。预期寿命在以下州增长得更快：(1)先进的联邦医疗保险诊断成像程序的比例增长更快；(2)自我和提供者管理的药物的年份增长更快；以及(3)以前由医生就读的医学院的质量增长更快。诊断程序、药品和医生的质量增幅较大的州，人均医疗支出增幅不大。我们对预期寿命模型的稳健性进行了几个测试。控制人均卫生支出(卫生保健的“数量”)，并消除婴儿死亡率的影响，实际上对卫生保健质量系数没有影响。对一项重要的非医疗创新的采用进行控制，对医疗创新采用对预期寿命的估计影响也很小。
The rate of increase of longevity has varied considerably across U.S. states since 1991. This paper examines the effect of the quality of medical care, behavioral risk factors (obesity, smoking, and AIDS incidence), and other variables (education, income, and health insurance coverage) on life expectancy and medical expenditure using longitudinal state-level data. We examine the effects of three different measures of the quality of medical care. The first is the average quality of diagnostic imaging procedures, defined as the fraction of procedures that are advanced procedures. The second is the average quality of practicing physicians, defined as the fraction of physicians that were trained at top-ranked medical schools. The third is the mean vintage (FDA approval year) of outpatient and inpatient prescription drugs. Life expectancy increased more rapidly in states where (1) the fraction of Medicare diagnostic imaging procedures that were advanced procedures increased more rapidly; (2) the vintage of self- and provider-administered drugs increased more rapidly; and (3) the quality of medical schools previously attended by physicians increased more rapidly. States with larger increases in the quality of diagnostic procedures, drugs, and physicians did not have larger increases in per capita medical expenditure. We perform several tests of the robustness of the life expectancy model. Controlling for per capita health expenditure (the “quantity” of healthcare), and eliminating the influence of infant mortality, has virtually no effect on the healthcare quality coefficients. Controlling for the adoption of an important nonmedical innovation also has little influence on the estimated effects of medical innovation adoption on life expectancy.
影响因子：
9.7
作者：
Meara, Ellen R.;Richards, Seth;Cutler, David M.
通讯作者：
Cutler, David M.