Explaining the US Health Paradox

Abstract Despite its high health spending, the US shows below-average life expectancy when compared to other OECD -countries. To find explanatory factors for this paradox, this article employs a Nested Analysis combining Large N Analysis ( LNA ) and Small N Analysis ( SNA ). First, it examines how far US life expectancy deviates from OLS model predictions which include a comprehensive set of health determinants. The results show that the established determinants clearly fail to explain the US underperformance. Second, a comparative analysis between the US and Canada identifies three idiosyncratic factors that explain the US deviation: its health care system particularities (1), the opioid crisis and drug-related deaths (2), and the particularly severe impact of the COVID -19 pandemic (3).