How Much Does Health Care Matter?

Austin Frakt reviews the literature supporting the idea that health care has a large impact on health.

Robin Hanson gives the other side:

So I want to say loudly and clearly what has yet to be said loudly and clearly enough: In the aggregate, variations in medical spending usually show no statistically significant medical effect on health. (At least they do not in studies with enough good controls.) It has long been nearly a consensus among those who have reviewed the relevant studies that differences in aggregate medical spending show little relation to differences in health, compared to other factors like exercise or diet. I not only want to make this point clearly; I want to date other health policy experts to either publicly agree or disagree with this claim and its apparent policy implications.

Comments (13)

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  1. Hostanliv says:

    “statistically significant” I am interested in the raw data and the statistic model

  2. Linda Gorman says:

    Judging from this post alone, Frakt is talking about effect of health care’s impact on health. Which, duh! Don’t spend money repairing that tooth and see how you feel.

    Hanson is talking about whether variations in US medical spending have an effect on health. Never mind that careful studies do show that variations affect health (look at the hospital mortality studies) and that the Dartmouth group ignores poverty and only looks at dead people.

    Only in health policy is this hard. Do the thought experiment. Eliminate spending on vaccines, surgery, imaging, joint replacements, hospitals, doctors, dentistry, and pharmaceuticals and imagine US health.

    Presto, you get health in Ethiopia or Afghanistan.

    But no, we’re supposed to believe that the science is settled and health spending doesn’t matter.

  3. Devon Herrick says:

    Frakt and Hanson’s disagreement is interesting. For instance, what are the diminishing returns of additional health care spending? How valuable is one cholesterol drug? How much better would adding another cholesterol drug be on the condition? Would twice as many physician visits make a difference?

    My interest isn’t so much whether additional spending is very beneficial, marginally beneficial or not beneficial. My interest is whether the additional spending brings more marginal utility than using the dollars for something else. We could spend our entire GPD on health care — but life would be rather drab if that crowded out housing, transportation, vacations and other activities of daily life.

  4. Jimbino says:

    I couldn’t agree more. Western “medicine” represents squandered wealth; insurance to purchase Western “medicine” represents squandered wealth squared.

  5. Thomas says:

    “In the aggregate, variations in medical spending usually show no statistically significant medical effect on health.”

    I can agree with this, because individuals in the aggregate are not ill enough to require significant medical spending. Most people are not sick, but for those who are, medical spending contributes greatly to health.

    • Matthew says:

      If most people were diabetics, then there would be a different outcome. As for comparing the population as a whole, spending on health care won’t improve health as much.

  6. James M. says:

    “Children are told that medicine is the reason we live longer than our ancestors, and our media tell us constantly of promising medical advances.”

    It is from medical advances. I can’t see how vaccines and pharmaceuticals don’t lead to longer lives.

    • Walter Q. says:

      I think the article is to put an emphasis on healthy behaviors rather than advancements in health care. However, I think both correlate to longer lives.

    • Buddy says:

      Take away vaccines then see how long we live. Like the outbreak of measles in New York due to parents not vaccinating their kids.

  7. Wilson F says:

    If I understand this post correctly, is saying that regardless of what the country spends on health care, health won’t change as much. If this is true, why are we investing in an industry that is not making a statistically significance difference in our lives?

  8. Floccina says:

    Note, Robin Hanson does not consider vaccinations and antibiotics to be healthcare. Also he does admit that evidence is strong that trauma care does save lives.