Although healthcare plays a role, behavioral and social factors have significantly more influence on longevity of people in the U.S., according to a new study published in the Annals for Family Medicine.
Researchers from the Stanford University School of Medicine's Clinical Excellence Research Center in California who examined just how much healthcare affects the risk for premature death by using four research methods and data sets.
All four methods came to the same conclusion: Healthcare accounts for between 5% and 15% of premature deaths, while behavioral and social factors account for between 16% and 65% of premature deaths in the U.S.
As a result, the authors believe healthcare policy and spending may be focusing on the wrong places.
In the report, the authors cite previous research comparing the amount of money the U.S. spends on non-medical social services with the amount other wealthy countries that are part of the Organization for Economic Co-operation and Development (OECD) spend on those services.
On average, other OECD members spend about $2 on social service programs for every $1 spent on medical care. In the U.S., for every $0.55 spent on non-medical services, $1 is spent on medical care. On average, the U.S. spending on services that might improve life expectancy falls in the middle of what the other countries spend, said Robert Kaplan, research director of the Clinical Excellence Research Center (CERC) and a co-author, in the report.
"We don’t want to limit access to medical care, particularly for underserved populations," Kaplan said. "But, in order to bring the U.S. health back in line with other rich countries, we need more than medicine. That may require other programs that address the social and behavioral determinants of health."
There are a few steps being taken by policymakers to try and swing the pendulum such as the Chronic Care Act—legislation that allows Medicare Advantage plans to cover interventions beyond those considered traditional healthcare, such as bathroom grab bars or wheelchair ramps or additions to homes to make them safer.
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In an editorial written along with the report, Dr. Steven Woolf, MD, Virginia Commonwealth University, also points out that more money put into science and spending on healthcare has slowed the decline in Americans’ health.
“The average lifespan of Americans will probably continue to shorten unless society quickly shifts its focus from healthcare to root causes," he said.
He also writes in the editorial that healthcare systems need to do their part, such as paying attention to the social needs of their patients in order to help lower emergency department visits and hospital admissions. Woolf points to three levels in which payers can address social needs: Assessing the social needs of members, connecting patients with assistance and resources and supporting community partners to improve social conditions.
“Healthcare is necessary but not sufficient to improve population health or correct health inequities," he wrote. "Spending lavishly on healthcare will not solve the U.S. health disadvantage."