1 The Ohio State University, Columbus, OH, USA.
2 Duke University, Durham, NC, USA.
J Health Soc Behav. 2018 Mar;59(1):113-132. doi: 10.1177/0022146518754534. Epub 2018 Feb 1.
Medical expansion has become a prominent dynamic in today's societies as the biomedical model becomes increasingly dominant in the explanation of health, illness, and other human problems and behavior. Medical expansion is multidimensional and represented by expansions in three major components of the healthcare system: increasing medical investment, medical professionalization/specialization, and the relative size of the pharmaceutical industry. Using Organisation for Economic Co-operation and Development health data and World Development Indicators 1981 to 2007, we find medical investment and medical professionalization/specialization significantly improve all three measures of life expectancy and decrease mortality rate even after controlling for endogeneity problems. In contrast, an expanded pharmaceutical industry is negatively associated with female life expectancy at age 65 and positively associated with the all-cause mortality rate. It further compromises the beneficial effect of medical professionalization/specialization on population health. In general, medical professionalization/specialization and gross domestic product per capita have similar and stronger effects than medical investment.
随着生物医学模式在解释健康、疾病和其他人类问题及行为方面越来越占主导地位,医学扩张已成为当今社会的一个突出动态。医学扩张是多维度的,表现在医疗保健系统的三个主要组成部分的扩张:增加医疗投资、医学专业化/专门化以及制药业的相对规模。我们利用经济合作与发展组织的卫生数据和 1981 至 2007 年的世界发展指标,发现即使在控制了内生性问题之后,医疗投资和医学专业化/专门化也显著提高了所有三个预期寿命衡量指标,并降低了死亡率。相比之下,制药业的扩张与女性 65 岁时的预期寿命呈负相关,与全因死亡率呈正相关。它进一步损害了医学专业化/专门化对人口健康的有益影响。总的来说,医学专业化/专门化和人均国内生产总值的影响与医疗投资相似且更强。