Medical expansion has become a prominent dynamic in today’s societies as the biomedical model becomes increasingly dominant in the explanation of health, illness, and other human problems and behavior. Medical expansion is multidimensional and represented by expansions in three major components of the healthcare system: increasing medical investment, medical professionalization/specialization, and the relative size of the pharmaceutical industry. Using Organisation for Economic Co-operation and Development health data and World Development Indicators 1981 to 2007, we find medical investment and medical professionalization/specialization significantly improve all three measures of life expectancy and decrease mortality rate even after controlling for endogeneity problems. In contrast, an expanded pharmaceutical industry is negatively associated with female life expectancy at age 65 and positively associated with the all-cause mortality rate. It further compromises the beneficial effect of medical professionalization/specialization on population health. In general, medical professionalization/specialization and gross domestic product per capita have similar and stronger effects than medical investment.
ArellanoManuelBondStephen R.1991. “Some Tests of Specification for Panel Data: Monte Carlo Evidence and an Application to Employment Equations.” Review of Economic Studies58(2):277–97.
2.
BarondessJeremiah A.2000. “Specialization and the Physician Workforce: Drivers and Determinants.” Journal of American Medical Association284(10): 1299–301.
3.
BarskyArthur J.BorusJonathan F.1995. “Somatization and Medicalization in the Era of Managed Care.” Journal of the American Medical Association274:1931–34.
4.
BartholdDouglasNandiArijitMendoza-RodriguezJose M.HeymannJody. 2014. “Analyzing Whether Countries Are Equally Efficient at Improving Longevity for Men and Women.” American Journal of Public Health104(11):216–69.
5.
BouvyJacoline C.DeBruinMarie L.KoopmanschapMarc A.2015. “Epidemiology of Adverse Drug Reactions in Europe: A Review of Observational Studies.” Drug Safety38(5):437–53.
6.
BradyDavidBeckfieldJasonSeeleib-KaiserMartin. 2005. “Economic Globalization and the Welfare State in Affluent Democracies, 1975–2001.” American Sociological Review70(6):921–48.
7.
CaseAnneDeatonAngus. 2016. “Rising Morbidity and Mortality in Midlife among White Non-Hispanic Americans in the 21st Century.” PNAS112(49):15078–83.
8.
Centers for Disease Control and Prevention. 2012. “CDC Grand Rounds: Prescription Drug Overdoses. A U.S. Epidemic.” MMWR Morbidity and Mortality Weekly Report61(01):10–13.
9.
ChenJerseyRadfordMartha J.WangYunKrumholzHarlan M.2000. “Care and Outcomes of Elderly Patients with Acute Myocardial Infarction by Physician Specialty: The Effects of Comorbidity and Functional Limitations.” American Journal of Medicine108(6):460–69.
10.
ClarkeAdele E.ShimJanet K.MamoLauraFosketJennifer R.FishmanJennifer R.2003. “Biomedicalization: Technoscientific Transformations of Health, Illness, and U.S. Biomedicine.” American Sociological Review68(2):161–94.
11.
CochraneA.LegerA.MooreS. F.1978. “Health Service ‘Input’ and Mortality ‘Output’ in Developed Countries.” Journal of Epidemiology and Community Health32(3):200–205.
12.
ColgroveJames. 2002. “The McKeown Thesis: A Historical Controversy and Its Enduring Influence.” American Journal of Public Health92(5):725–29.
13.
ConradPeter. 2005. “The Shifting Engines of Medical Expansion.” Journal of Health and Social Behavior46(1):3–14.
14.
CremieuxPierre-YvesQuellettePierrePilonCaroline. 1999. “Health Care Spending as Determinants of Health Outcomes.” Health Economics8(7):627–39.
15.
CrouchleyR.DaviesR. B.1999. “A Comparison of Population Average and Random-effect Models for the Analysis of Longitudinal Count Data with Base-line Information.” Journal of the Royal Statistical Society162(3):331–47.
16.
CutlerDavidMillerGrant. 2005. “The Role of Public Health Improvements in Health Advances: The Twentieth-century United States.” Demography42(1):1–22.
FreidsonEliot. 1968. “The Impurity of Professional Authority.” Pp. 25–34 in Institutions and the Person, edited by edited by BeckerH. S.GeerB.RiesmanD.WeissR. S.Chicago: Aldine.
19.
FuchsVictor R.2013. “How and Why US Health Care Differs from That in Other OECD Countries.” JAMA309(1):33–34.
20.
GravelleH.BackhouseM.1987. “International Cross-section Analysis of the Determination of Mortality.” Social Science & Medicine25(5):427–41.
21.
GrilliR.MinozziS.TinazziA.LabinacaR.SheldonT.A.LiberatiA.1998. “Do Specialists Do It Better? The Impact of Specialization on the Processes and Outcomes of Care for Cancer Patients.” Annals of Oncology9(4):365–74.
22.
HalabyCharles N.2004. “Panel Models in Sociological Research: Theory into Practice.” Annual Review of Sociology30:507–44.
23.
HashemAhmadChiMichelene T. H.FriedmanCharles P.2003. “Medical Errors as a Result of Specialization.” Journal of Biomedical Informatics 36(1/2):61–69.
24.
HeatonTim B.2015. “Are Improvements in Child Health Due to Increasing Status of Women in Developing Nations?” Biodemography and Social Biology61(3):252–65.
25.
HonakerJamesKingGary. 2010. “What to Do about Missing Values in Time Series Cross-section Data.” American Journal of Political Science54(3):561–81.
26.
HouseJames S.2015. Beyond Obamacare: Life, Death, and Social Policy. New York: Russell Sage Foundation.
27.
Institute of Medicine. 2013. U.S. Health in International Perspective: Shorter Lives, Poorer Health. Washington, DC: Author.
28.
KanavosPanosFerrarioAlessandraVandorosSotirisAndersonGerard F.2013. “Higher US Branded Drug Prices and Spending Compared to Other Countries May Stem Partly from Quick Uptake of New Drugs.” Health Affairs32(4):753–61.
29.
KararZ. AhsanAlamN.Kim StreatfieldP. 2009. “Epidemiologic Transition in Rural Bangladesh, 1986–2006.” Global Health Action. doi.org/10.3402/gha.v21.1904.
LantzPaula M.LichtensteinRichard L.PollackHarold A.2007. “Health Policy Approaches to Population Health: The Limits of Medical expansion.” Health Affairs26(5):1253–57.
32.
LeeJi-HyunHerzogThaddeus A.MeadeCathy D.WebbMonica S.BrandonThomas H.2007. “The Use of GEE for Analyzing Longitudinal Binomial Data: A Primer Using Data from a Tobacco Intervention.” Additive Behaviors32(1):187–93.
33.
LiangKung-YeeZegerScott L.1986. “Longitudinal Data Analysis Using Generalized Linear Models.” Biometrika73(1):13–22.
34.
LichtenbergFrank R.2005. “The Impact of New Drug Launches on Longevity: Evidence from Longitudinal, Disease-level Data from 52 Countries, 1982–2001.” International Journal of Health Care Finance and Economics5(1):47–73.
35.
LightDonald W.2010. “Bearing the Risks of Prescription Drugs.” Pp. 1–39 in The Risks of Prescription Drugs, edited by LightD. W.New York: Columbia University Press.
36.
LightDonald W.LexchinJoelDarrowJonathan J.2013. “Institutional Corruption of Pharmaceuticals and the Myth of Safe and Effective Drugs.” Journal of Law and Medical Ethics14(3):590–610.
37.
LinkBruce G.PhelanJo C.2002. “McKeown and the Idea that Social Conditions Are Fundamental Causes of Disease.” American Journal of Public Health92(5):730–32.
38.
MartinStephenRiceNigelSmithPeter C.2008. “Does Health Care Spending Improve Health Outcomes? Evidence from English Programme Budgeting Data.” Journal of Health Economics27(4):826–42.
39.
McKeownThomas. 1976. The Role of Medicine: Dream, Mirage, or Nemesis?London: Nuffield Provincial Hospitals Trust.
40.
McKeownThomasRecordR. G.TurnerR. D.1975. “An Interpretation of the Decline in Mortality in England and Wales during the Twentieth Century.” Population Studies29(3):391–422.
41.
McKinlayJohn B.MarceauLisa D.2002. “The End of the Golden Age of Doctoring.” International Journal of Health Services32(2):379–416.
42.
MurrayChristopher J. L.VosTheoLozanoRafael, et al. 2013. “Disability-adjusted Life Years (DALYs) for 291 Diseases and Injuries in 21 Regions, 1990–2010: A Systematic Analysis for the Global Burden of Disease Study 2010.” Lancet380(9859):2197–223.
43.
NixonJohnUlmannPhilippe. 2006. “The Relationship between Health Care Expenditure and Health Outcomes.” European Journal of Health Economics7(1):7–18.
OlshanskyS. JayAultA. Brian. 1986. “The Fourth Stage of the Epidemiologic Transition: The Age of Delayed Degenerative Diseases.” Milbank Quarterly64(3):355–91.
46.
OmranAbdel R.1971. “The Epidemiologic Transition: A Theory of the Epidemiology of Population Change.” Milbank Memorial Fund Quarterly49(4):509–38.
47.
SchoeniRobert F.HouseJames S.KaplanGeorge A.PollackHarold. 2008. Making Americans Healthier: Social and Economic Policy as Health Policy. New York: Russell Sage Foundation.
48.
SchusterDanielaLaggnerChristianLangerThierry. 2005. “Why Drugs Fail: A Study on Side Effects in New Chemical Entities.” Current Pharmaceutical Design11(27):3545–59.
49.
ShiLeiyu. 1994. “Primary Care, Specialty Care, and Life Chances.” International Journal of Health Services24(3):431–58.
50.
StarfieldBarbaraShiLeiyuGroverAtulMacinkoJames. 2005. “The Effects of Specialist Supply on Populations’ Health: Assessing the Evidence.” Health AffairsW5:97–107. doi:10.1377/hlthaff.W5.97.
51.
WaitzkinHowardBrittTheron. 1989. “A Critical Theory of Medical Discourse: How Patients and Health Professionals Deal with Social Problems.” International Journal of Health Services19(4):577–97.
52.
WeingarternScott R.LloydLynneChiouChiun-FangBraunsteinGlenn D.2002. “Do Subspecialists Working outside of Their Specialty Provide Less Efficient and Lower-quality Care to Hospitalized Patients Than Do Primary Care Physicians?” Archives of Internal Medicine162(5):527–32.
53.
WilliamePeterDuMontMichel. 2015. “Machines That Go ‘Ping’: Medical Technology and Health Expenditures in OECD Countries.” Health Economics24(8):1027–41.
54.
WeisbartEd. 2012. “A Single-payer System Would Reduce US Health Care Costs.” AMA Journal of Ethics14(11):897–903.
55.
WooldridgeJeffrey M.2002. Econometric Analysis of Cross Section and Panel Data. Cambridge, MA: MIT Press.
56.
UyangaJoseph. 1990. “Economic Development Strategies: Maternal and Child Health.” Social Science & Medicine31(6):649–59.
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