title: Quantifying the contribution of changes in healthcare expenditures and smoking to the reversal of the trend in life expectancy in the Netherlands.
abstract: BACKGROUND
  Since 2001 the Netherlands has shown a sharp upturn in life expectancy (LE) after a longer period of slower improvement. This study assessed whether changes in healthcare expenditure (HCE) explain this reversal in trends in LE. As an alternative explanation, the impact of changes in smoking behavior was also evaluated.
  
  
  METHODS
  To quantify the contribution of changes in HCE to changes in LE, we estimated a health-production function using a dynamic panel regression approach with data on 19 OECD countries (1980-2009), accounting for temporal and spatial correlation. Smoking-attributable mortality was estimated using the indirect Peto-Lopez method.
  
  
  RESULTS
  As compared to 1990-1999, during 2000-2009 LE in the Netherlands increased by 1.8 years in females and by 1.5 years in males. Whereas changes in the impact of smoking between the two periods made almost no contribution to the acceleration of the increase in LE, changes in the trend of HCE added 0.9 years to the LE increase between 2000 and 2009. The exceptional reversal in the trend of LE and HCE was not found among the other OECD countries.
  
  
  CONCLUSIONS
  This study suggests that changes in Dutch HCE, and not in smoking, made an important contribution to the reversal of the trend in LE; these findings support the view that investments in healthcare are increasingly important for further progress in life expectancy.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. f.peters@erasmusmc.nl.
authors.forename: Frederik
authors.initials: F
authors.lastname: Peters
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. w.nusselder@erasmusmc.nl.
authors.forename: Wilma J
authors.initials: WJ
authors.lastname: Nusselder
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Boston, USA. nreiblin@hsph.harvard.edu.
authors.forename: Nadine
authors.initials: N
authors.lastname: Reibling
authors.affiliation: Wittgenstein Centre for Demography and Global Human Capital (IIASA, VIS/ÖAW, WU), Vienna Institute of Demography/Austrian Academy of Sciences, Vienna, Austria. christian.wegner@oeaw.ac.at.
authors.forename: Christian
authors.initials: C
authors.lastname: Wegner-Siegmundt
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. j.mackenbach@erasmusmc.nl.
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D017678:Sex Distribution; D012907:Smoking / Q000191:economics* / Q000401:mortality*; D055815:Young Adult