Is there a statistical relationship between economic crises and changes in government health expenditure growth? an analysis of twenty-four European countries.
OBJECTIVE
To identify whether, by what means, and the extent to which historically, government health care expenditure growth in Europe has changed following economic crises.


METHODS
Organization for Economic Cooperation and Development Health Data 2011.


METHODS
Cross-country fixed effects multiple regression analysis is used to determine whether statutory health care expenditure growth in the year after economic crises differs from that which would otherwise be predicted by general economic trends. Better understanding of the mechanisms involved is achieved by distinguishing between policy responses which lead to cost-shifting and all others.


RESULTS
In the year after an economic downturn, public health care expenditure grows more slowly than would have been expected given the longer term economic climate. Cost-shifting and other policy responses are both associated with these slowdowns. However, while changes in tax-derived expenditure are associated with both cost-shifting and other policy responses following a crisis, changes in expenditure derived from social insurance have been associated only with changes in cost-shifting.


CONCLUSIONS
Disproportionate cuts to the health sector, as well as reliance on cost-shifting to slow growth in health care expenditure, serve as a warning in terms of potentially negative effects on equity, efficiency, and quality of health services and, potentially, health outcomes following economic crises.
European Observatory on Health Systems and Policies & LSE Health, London School of Economics and Political Science, Houghton Street, London, UK. j.d.cylus@lse.ac.uk
Jonathan
J
Cylus
Philipa
P
Mladovsky
Martin
M
McKee
D017047:Cost Sharing / Q000706:statistics & numerical data; D004467:Economics / Q000706:statistics & numerical data*; D005060:Europe; D059066:Gross Domestic Product / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D018803:Models, Economic; D009313:National Health Programs / Q000458:organization & administration* / Q000706:statistics & numerical data*; D012044:Regression Analysis