• Robert M Kaplan and Arnold Milstein.
• Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, California bob.kaplan@stanford.edu.
• Ann Fam Med. 2019 May 1; 17 (3): 267-272.

PurposeHealth care expenditures and biomedical research funding are often justified by the belief that modern health care powerfully improves life expectancy in wealthy countries. We examined 4 different methods of estimating the effect of health care on health outcomes.MethodsWe reviewed the contributions of medical care to health outcomes using 4 methods: (1) analyses by McGinnis and Schroeder, (2) Wennberg and colleagues' studies of small area variation, (3) Park and colleagues' analysis of County Health Rankings and Roadmaps, and (4) the RAND Health Insurance Experiment.ResultsThe 4 methods, using different data sets, produced estimates ranging from 0% to 17% of premature mortality attributable to deficiencies in health care access or delivery. Estimates of the effect of behavioral factors ranged from 16% to 65%.ConclusionsThe results converge to suggest that restricted access to medical care accounts for about 10% of premature death or other undesirable health outcomes. Health care has modest effects on the extension of US life expectancy, while behavioral and social determinants may have larger effects.© 2019 Annals of Family Medicine, Inc.

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