Is There a Statistical Relationship between Economic Crises and Changes in Government Health Expenditure Growth? An Analysis of Twenty-Four European Countries
Article first published online: 7 JUN 2012
© Health Research and Educational Trust
Health Services Research
Volume 47, Issue 6, pages 2204–2224, December 2012
How to Cite
Cylus, J., Mladovsky, P. and McKee, M. (2012), Is There a Statistical Relationship between Economic Crises and Changes in Government Health Expenditure Growth? An Analysis of Twenty-Four European Countries. Health Services Research, 47: 2204–2224. doi: 10.1111/j.1475-6773.2012.01428.x
- Issue published online: 12 NOV 2012
- Article first published online: 7 JUN 2012
- Health economics;
- health care financing/insurance/premiums;
- comparative health systems/international health;
- health care organizations and systems
To identify whether, by what means, and the extent to which historically, government health care expenditure growth in Europe has changed following economic crises.
Organization for Economic Cooperation and Development Health Data 2011.
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.
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.
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.