American Sociological Association

Does Medical Expansion Improve Population Health?


Photo by Natanael Melchor on Unsplash
March 5, 2018

The escalating influence of modern biomedical conceptions of health and illness—increasingly going beyond traditional medical illness to “explain” behavioral problems and general societal ills—now dominate developed nations’ healthcare delivery.  A new study finds that this expanding “medical industrial complex” is not straightforwardly responsible for improved life expectancy and mortality in first-world nations.

Medical expansion is multidimensional and represented by expansions in three major components of the healthcare system during the last half century: caregiver/physician professionalization/specialization, medical infrastructure investment, and growth of the pharmaceutical industry.

The study published in the Journal of Health and Social Behavior, a peer-reviewed journal, finds —through the examination of multiple life expectancy indices and mortality data—that the success of this “medical expansion” in advancing public health and delivering effective treatment was indeed positively linked with desired health impacts.  But, it also revealed some critically important and nonintuitive disconnects between health outcomes and the biomedical model’s expansive investment in Western economies. 

Using health data from 30 OECD (Organisation for Economic Co-operation and Development) countries and data from the World Bank’s World Development Indicators, sociologists Hui Zheng, Ohio State University, and Linda George, Duke University, find that both the level of medical investment and medical professionalization/specialization were significantly positively associated with improvement in all three traditional measures of life expectancy and decreased mortality rate, even when correcting for possible unobserved factors that differ across the 30 nations. 

“To our knowledge, this is the first study to examine the relationships between multiple measures of socioeconomic development and medical expansion and multiple measures of mortality/longevity, using data from a sizeable number of countries,” while controlling for intercountry socioeconomic differences (e.g., GDP), said Zheng.

Zheng and George find that while medical investment and medical professionalization have significant positive associations with their three measures of life expectancy and a negative association with mortality rate, the expansion of the drug industry was, in contrast, negatively associated with female life expectancy at age 65 and positively associated with the all-cause mortality rate.

“Medical expansion, especially health care spending and professionalization/specialization of providers, has positive consequences for population health, although medical expansion also has the potential to pose health risks,” said Zheng.

Pharma’s growth is linked with a reduction in the beneficial effect of medical professionalization/specialization on population health.  The researchers find that, in general, medical professionalization/specialization and gross domestic product (GDP) per capita have similar and stronger impacts on population health than medical investment increases. 

Accelerating healthcare costs, explosive growth in the number of hospitals and health facilities, a burgeoning and increasingly specialized medical workforce, expansion of the pharmaceutical industry, and the extension of the disease model and medical treatments highlight the importance of Hui and George’s findings.

In the United States, for example, total health expenditures as a percentage of GDP increased from 5.1% in 1960 to 17.1% in 2014; in Australia, medical workforce employment increased from 12.5 per 1,000 persons in 1960 to 36.7 per 1,000 persons in 2006; the United Kingdom, the number of doctors increased from 0.8 per 1,000 persons in 1960 to 2.7 per 1,000 persons in 2009; and in Switzerland, the number of medical specialists increased from 0.5 per 1,000 persons in 1960 to 2.7 per 1,000 persons in 2006, according to OECD.

These trends have been driven by a biomedical model that pushes “medical investment by stressing the importance of healthcare, health services, and medical advances in improving population health. This creates societies with a propensity to aggressively screen for disease, treat less serious conditions, and invest heavily in the development of new medical technologies,” explain Zheng and George.

A question all nations face is how to afford healthcare for all—a focus of intense political debate among U.S. policymakers.  Some may welcome, therefore, some proposals for redirecting the focus from medicalization to social and economic determinants of health.  This study was undertaken to help fill the void in systematic assessments of medical expansion on selected positive population health indicators and to help clarify the strength of the relationships.

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