Comparative efficiency of health systems, corrected for selected lifestyle factors (2014)
final report
The MACELI (Macro Cost Effectiveness corrected for Lifestyle) project studied the cost-effectiveness of European health systems, and the impact of differences in lifestyle, specifically smoking, overweight and alcohol consumption.
Baseline analyses without standardizing for lifestyle showed on average more health spending was associated with better health. This effect was clearest for countries with lower levels of spending. Standardization towards a better lifestyle meant an upward shift of the health production function, but did not much alter the comparative efficiency of countries.
The study covered the EU-28 Member States, Iceland, and Norway. Individual-level data were used to describe lifestyle across age and gender and to analyse its impact on health outcomes and health care use. Health outcomes and health spending were standardized for differences in lifestyle using a lifetable model (reference year 2010).
Results were put into further perspective by additional qualitative research and through several sensitivity analyses, including an indirect disease-based approach. Finally, a systematic literature review was performed to investigate potential interventions to achieve lifestyle changes.
Several shortcuts were taken to allow consistent estimates across a large number of countries, which imply that the results should be interpreted with care.