More Evidence that Medical Care Improves Life?

A great deal of medical care is wasteful, we are told, because doctors do too much, patients want too much, and death comes anyway.

Yet, even if medical spending does not prolong life it may nevertheless do a lot to reduce the years that people spend disabled. Many people would consider money spent reducing disability money well spent.

Evidence for Significant Compression of Morbidity in the Elderly is a new NBER Working Paper by David M. Cutler, Kaushik Ghosh, and Mary Beth Landrum. Its authors report that although Americans over 65 have more diseases than they used to, disability “has been compressed into the period just before death.” Their results show that although life expectancy increased .7 years (from 17.5 to 18.2) between 1992 and 2005, disability free life expectancy increased 1.6 years (from 8.8 to 10.4).

Throughout the sample period, they find that the prevalence of major disease in the elderly was relatively constant. About 80 percent of the elderly had at least one major condition in the year before death. Many suffered from more than one. Heart disease afflicted about 38 percent of the elderly 12 months before death. Cancer, Alzheimer’s disease, pulmonary disease, heart attacks, and stroke each afflicted about 25 percent. Hip fracture rates afflicted about 9 percent, and Parkinson’s rates about 4 percent.

The increase in disability free life expectancy occurred despite the fact that the prevalence of chronic disabling conditions like Alzheimer’s and pulmonary disease increased. Though medicine may be able to alleviate the suffering of those with these conditions, the increase in disability free life expectancy may have resulted from progress in preventing heart disease, strokes, and hip fracture. The proportion of the elderly population affected by those acute conditions fell from about 40 percent of the population in 1991 to 30 percent in 2009.

The authors are agnostic about whether medical care has caused the improvement, noting that other unnamed “social and environmental factors” might be also be responsible for at least part of the trend.

Comments (15)

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  1. Jackson says:

    Makes sense. Most people fear disability more than disease, so it seems like more research and funding would go into ending that.

    • Billy says:

      Exactly. People fear them more because while heart disease will likely kill you, Alzheimer’s makes you and your loved ones suffer before you die.

  2. Stewart T. says:

    And these gains in medicine and quality of life will only improve under ACA.

  3. Billy says:

    “(from 17.5 to 18.2)”

    Why are these numbers so low for life expectancy? Shouldn’t we see something like 67.5 to 68.2?

  4. Tom G. says:

    “The authors are agnostic about whether medical care has caused the improvement”

    Sounds like some honest scientists for once. Or at least some scientists that are just looking to do science without proving pre-conceived notions.

    • Adam says:

      When scientists turn blindly to dogma and proving what they already believe to be true then it loses the fundamental aspect that makes it scientific.

  5. Perry says:

    Not to disparage modern medicine at all, but I think
    social and environmental could certainly play a large part in this.

    • Linda Gorman says:

      So could joint replacement, advances in cardiac care, minimally invasive surgery, and the fact that modern diagnostic imaging has significantly reduced exploratory surgery.

  6. Bob Hertz says:

    I have been part of a large extended family for 65 years. What follows is not scientific, but I welcome others to confirm if I am on point.

    When I attended family gatherings in 1965, many uncles and aunts had recently died in their 50’s or 60’s, and the few who survived were not physically active at all.

    When I go to family gatherings today, there are many 80 years olds doing swimming or aerobics and extremely active.

    This all do to better medicine and Medicare. The gene pool has not changed a whit.

    The question is, can the nation afford it? An elderly person who lives 10 years longer collects a lot more in benefits but adds virtually nothing in new taxes. Plus their children inherit less money and inherit it much later, although that kind of effect varies wildly among families.

  7. Stella Baskomb says:

    “When I go to family gatherings today, there are many 80 years olds doing swimming or aerobics and extremely active . . . The question is, can the nation afford it?”

    Now that you mention it, probably not.

    So when will you shoot all your relatives?