RT Journal Article SR Electronic T1 Contributions of Health Care to Longevity: A Review of 4 Estimation Methods JF The Annals of Family Medicine JO Ann Fam Med FD American Academy of Family Physicians SP 267 OP 272 DO 10.1370/afm.2362 VO 17 IS 3 A1 Robert M. Kaplan A1 Arnold Milstein YR 2019 UL http://www.annfammed.org/content/17/3/267.abstract AB PURPOSE Health 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.METHODS We 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.RESULTS The 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%.CONCLUSIONS The 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.