Have we reached the point where more spending on health care and other forms of social protection is not producing better health as measured by reductions in population mortality? Drawing on two decades of research and mortality statistics (1995–2015) for 17 OECD countries, our analysis confirms and builds on the observed relationship between the returns and investments in health and social welfare spending. First, the results suggest that there is a differential effect of socioeconomic, lifestyle and demography variables on total and cause-specific mortality rates. Second, the basic premise of an association between health care expenditure and mortality rates is reinforced in models that take into account public-only health expenditure and its impact on older age groups. Third, a strong protective effect of government-sponsored welfare expenditure on infant mortality was observed. This effect is weaker on other causes of death and suggests that older individuals, in this sample of developed countries, may have reached a stage of the epidemiological transition in which health improvement is indifferent to government assistance and depends largely on behavioural change.
Auster, R. – Leveson, I. – Sarachek, D. (1969): The Production of Health, an Exploratory Study. Journal of Human Resources 4 (4): 411–436.
Balia, S. – Jones, A. (2008): Mortality, Life-Style, and Socio-Economic Status. Journal of Health Economics 27: 1–26.
Barefoot, J. – Morten Grønbæk, J. – Feaganes, R. – McPherson, R. – Williams, I. – Siegler, C. (2002): Alcoholic Beverage Preference, Diet, and Health Habits in the UNC, Alumni Heart Study. American Journal of Clinical Nutrition 76: 466–472.
Bradley, E. –Taylor, L. (2013): The American Paradox: Why Spending More Is Getting Us Less. Philadelphia: Public Affairs.
Bradley, E. – Elkins, B. – Herrin, J. – Elbel, B. (2011): Health and Social Services Expenditures: Associations with Health Outcomes. BMJ Quality and Safety 20 (10): 826–831.
Brainerd, E. – Cutler, D. (2005): Autopsy on an Empire: Understanding Mortality in Russia and the Former Soviet Union. Journal of Economic Perspectives 19: 107–130.
Bunker, J. (2001): Medicine Matters after All: Measuring the Benefits of Medical Care, a Healthy Lifestyle, and a Just Social Environment. London: The Nuffield Trust.
Cummins, S. – Stafford, M. – Macintyre, S. et al. (2005): Neighborhood Environment and Its Association with Self-Rated Health: Evidence from Scotland and England. Journal of Epidemiology and Community Health 59: 207–213.
Cutler, D. – Deaton, A. – Lleras-Muney, A. (2006); The Determinants of Mortality. Journal of Economic Perspectives 20 (3): 97.
Dehejia, R. – Lleras-Muney, A. (2004): Booms, Busts, and Babies' Health. Quarterly Journal of Economics 119 (3): 1091–1130.
Dixon, J. – Lewis, R. – Rosen, R. – Finlayson, B. – Gray, D. (2004): Managing Chronic Disease: What can We Learn from the US Experience. London: King's Fund.
Emberson, J. – Bennett, D. (2006): Effect of Alcohol on Risk of Coronary Heart Disease and Stroke: Causality, Bias, or a Bit of Both? Vascular Health Risk Management 2 (3): 239–249.
Ferreira, E. – Monteiro, J. – Manso, J. (2018): Are Economic Crises Age and Gender Neutral? Evidence from European Union Mortality Data. Economic Analysis and Policy 60: 69–77.
Ferreira, E. – Monteiro, J. – Manso, J. (2019): “Death by Economic Crisis”: Suicide and Self-Inflicted Injury in the European Union (EU15) during the Worst of Times. Society and Economy 41 (1): 145–164.
Folland, S. – Goodman, A. – Stano, M. (2013): The Economics of Health and Health Care. Upper Saddle River, New Jersey: Pearson Education Inc.
Ford, E. – Ajani, U. – Croft, J. – Critchley, J. – Labarthe, D. – Kottke, T. – Giles, W. – Capewell, S. (2007): Explaining the Decrease in U.S. Deaths from Coronary Disease, 1980-2000. The New England Journal of Medicine 356: 2388–2398.
Gallet, C. – Doucouliagos, H. (2017): The Impact of Health Care Spending on Health Outcomes: A Meta-Regression Analysis. Social Science & Medicine 179: 9–17.
Gupta, S. – Verhoeven, M. – Tiongson, E. (2003): Public Spending on Health Care and the Poor. Health Economics 12 (8): 685–696.
Hadley, J. (1982): More Medical Care, Better Health. Washington, D.C.: Urban Institute Press.
Ionides, E. – Wang, Z. – Tapia-Granados, J. (2013): Macroeconomic Effects of Mortality Revealed by Panel Analysis with Nonlinear Trends. Annals of Applied Statistics 7 (3): 1362–1385.
Jaba, E. – Balan, C. – Robu, I. (2014): The Relationship between Life Expectancy at Birth and Health Expenditures Estimated by a Cross-Country and Time-Series Analysis. Procedia Econonics and Finance 15: 108–114.
Jones, C. (2002): Why have Health Expenditures as a Share of GDP Risen So Much? NBER Working Paper No. 9325.
Kravdal, O. (2001): The Impact of Marital Status on Cancer. Social Science and Medicine 52: 357–368.
Kristjuhan, U. – Taidre, E. (2012): The Last Recession Was Good for Life Expectancy. Rejuvenation Research 15: 134–135.
Levin, A. – Lin, C. – Chu, C. (2002): Unit Root Tests in Panel Data: Asymptotic and Finite Sample Properties. Journal of Econometrics 108: 1–24.
Mackenbach, J. (1996): The Contribution of Medical Care to Mortality Decline: McKeown Revisited. Journal of Clinical Epidemiology 49 (11): 1207–1213.
MacKeown, T. (1976): The Role of Medicine: Dream, Mirage, Or Nemesis. London: Nuffield Provincial Hospitals Trust.
Marmot, M. (2000): A Social View of Health and Disease. In: Heller, T. – Muston, R. – Sidell, M. – Lloyd, C. (eds): Working for Health. London: Sage Publications.
Marmot, M. – Wilkinson, R. (2006): Social Determinants of Health. Oxford: Oxford University Press.
Marmot, M. – Friel, S. – Bell, R. – Howeling, A. – Taylor, S. (2008): Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Lancet 372: 1661–1669.
McGuire, J. (2005): Basic Health Care Provision and Under-5 Mortality: A Cross-National Study of Developing Countries. World Development 34 (3): 405–425.
Minoiu, C. – Andrés, A. (2008): The Effect of Public Spending on Suicide: Evidence from US State Data. The Journal of Socio-Economics 237–261.
OECD (2018): OECD.Stat. https://stats.oecd.org/Index.aspx?DataSetCode=SOCX_AGG, accessed 05/01/2018.
Or, Z. (2000): Determinants of Health Outcomes in Industrialized Countries: A Pooled, Cross-Country, Time-Series Analysis. OECD Economic Studies 30: 53–77.
Palloni, A. – Yonker, J. (2012): Health in the U.S. at Young Ages: Preliminary Findings. OCDE Working Paper 2012–04.
Potts, J. – Schwartz, W. (2004): The Impact of the Revolution in Biomedical Research in Life Expectancy by 2050. In: Aaron, H. J. – Schwartz, W. B. (eds): Coping with Methuselah: The Impact of Molecular Biology on Medicine and Society. Washington D. C.: Brookings Institution Press, pp. 16–25.
Ruhm, C. (2000): Are Recessions Good for Your Health? Quarterly Journal of Economics 115: 617–650.
Ruhm, C. (2015): Recessions, Healthy No More? Journal Health Economics 42: 17–28.
Santerre, R. – Neum, S. (2010): Health Economics: Theories, Insights, and Industry Studies. Mason: South-Western Cengage Learning.
Schnittker, J. – Karandinos, G. (2010): Methusela's Medicine: Pharmaceutical Innovation and Mortality in the United States, 1960-2000. Social Science and Medicine 70: 961–968.
Szreter, S. (2000): The McKeown Thesis. Journal of Health Services Research and Policy 5 (2): 119–121.
Wang, L. (2002): Health Outcomes in Low-Income Countries and Policy Implications: Empirical Findings from Demographic and Health Surveys. World Bank Working paper No. 2831.
White, H. (1980): A Heteroscedasticity-Consistent Covariance Matrix Estimator and a Direct Test for Heteroscedasticity. Econometrica 48: 817–838.
World Bank (2018): World Development Indicators. https://data.worldbank.org/indicator, accessed06/01/2018.
World Health Organization (2018a): WHO Mortality Database. http://apps.who.int/healthinfo/statistics/mortality/whodpms/, accessed 06/01/2018.
World Health Organization (2018b): Health for All Database. https://gateway.euro.who.int/en/datasets/european-health-for-all-database/, accessed 06/01/2018.