期刊
AMERICAN JOURNAL OF EPIDEMIOLOGY
卷 191, 期 3, 页码 386-396出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kwab179
关键词
health-care resources; health service utilization; health spending; mortality; out-of-pocket spending
资金
- Japan Society for the Promotion of Science [20J00394]
- Murata Science Foundation
- Grants-in-Aid for Scientific Research [20J00394] Funding Source: KAKEN
Cross-national studies have found limited evidence of benefits in the linkage between health-care spending and population health. This study suggests that variation in health spending is not associated with decreased mortality rates and has a weak association with increased health-care resources and service utilization. In contrast, gross domestic product per capita is significantly associated with increased health resources, higher service utilization, and lower mortality rates.
Cross-national studies of the linkage of health-care spending with population health have found surprisingly limited evidence of benefits. In this study, we investigated associations between national health spending and key health resources (numbers of hospital beds, physicians, and nurses) and utilization of cost-effective health services (antenatal care, attendance of trained staff at childbirth, and measles vaccination), sometimes in ways that curtail the benefits of that expenditure. Using annual panel data from 1990-2014 covering 140 countries, we show that variation in health spending as a share of gross domestic product is not associated with decreased mortality rates. It is also very weakly associated with increased health-care resources and health service utilization (elasticity smaller than 0.08), with the association being close to 0 in low-income countries. In addition, countries with a higher share of out-of-pocket spending have a significantly lower level of health resources and service utilization. These findings, rather than the ineffectiveness of health care, could explain the lack of impact of health spending. In contrast, gross domestic product per capita is significantly associated with increased health resources, a higher rate of service utilization, and lower mortality rates, suggesting that income is an important determinant of public health.
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