Changes in government spending on healthcare and population mortality in the European union, 1995-2010: a cross-sectional ecological study.
OBJECTIVE
Economic measures such as unemployment and gross domestic product are correlated with changes in health outcomes. We aimed to examine the effects of changes in government healthcare spending, an increasingly important measure given constrained government budgets in several European Union countries.


METHODS
Multivariate regression analysis was used to assess the effect of changes in healthcare spending as a proportion of total government expenditure, government healthcare spending as a proportion of gross domestic product and government healthcare spending measured in purchasing power parity per capita, on five mortality indicators. Additional variables were controlled for to ensure robustness of data. One to five year lag analyses were conducted.


METHODS
European Union countries 1995-2010.


METHODS
Neonatal mortality, postneonatal mortality, one to five years of age mortality, under five years of age mortality, adult male mortality, adult female mortality.


RESULTS
A 1% decrease in government healthcare spending was associated with significant increase in all mortality metrics: neonatal mortality (coefficient -0.1217, p = 0.0001), postneonatal mortality (coefficient -0.0499, p = 0.0018), one to five years of age mortality (coefficient -0.0185, p = 0.0002), under five years of age mortality (coefficient -0.1897, p = 0.0003), adult male mortality (coefficient -2.5398, p = 0.0000) and adult female mortality (coefficient -1.4492, p = 0.0000). One per cent decrease in healthcare spending, measured as a proportion of gross domestic product and in purchasing power parity, was both associated with significant increases (p < 0.05) in all metrics. Five years after the 1% decrease in healthcare spending, significant increases (p < 0.05) continued to be observed in all mortality metrics.


CONCLUSIONS
Decreased government healthcare spending is associated with increased population mortality in the short and long term. Policy interventions implemented in response to the financial crisis may be associated with worsening population health.
Homerton College, Cambridge University, Cambridge CB2 8PH, UK MRC Unit for Longitudinal Health and Ageing, University College London, London WC1B 5JU, UK sb930@cam.ac.uk.
Sanjay
S
Budhdeo
Institute for Mathematical & Molecular Biomedicine, King's College London, London SE1 1UL, UK.
Johnathan
J
Watkins
Harvard School of Public Health, Harvard University, MA 02115, USA.
Rifat
R
Atun
The Economist, London SW1A 1HG, UK Faculty of History, University of Oxford, Oxford, OX1 2RL, UK.
Callum
C
Williams
Special Envoy for Financing to the Director General of the World Health Organization (WHO), Geneva 27, Switzerland Department of Public Health, University of Bern, Bern, CH 3011, Switzerland.
Thomas
T
Zeltner
Imperial College School of Medicine, London SW7 2AZ, UK.
Mahiben
M
Maruthappu
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics* / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005060:Europe / Q000453:epidemiology; D005062:European Union; D005260:Female; D005380:Financing, Government / Q000191:economics* / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D044382:Population Groups / Q000706:statistics & numerical data*; D055815:Young Adult
European Union; austerity; healthcare spending; mortality