Does health care spending improve health outcomes? Evidence from English programme budgeting data
- 1 July 2008
- journal article
- Published by Elsevier BV in Journal of Health Economics
- Vol. 27 (4), 826-842
- https://doi.org/10.1016/j.jhealeco.2007.12.002
Abstract
Empirical evidence has hitherto been inconclusive about the strength of the link between health care spending and health outcomes. This paper uses programme budgeting data prepared by 295 English Primary Care Trusts to model the link for two specific programmes of care: cancer and circulatory diseases. A theoretical model is developed in which decision-makers must allocate a fixed budget across programmes of care so as to maximize social welfare, in the light of a health production function for each programme. This yields an expenditure equation and a health outcomes equation for each programme. These are estimated for the two programmes of care using instrumental variables methods. All the equations prove to be well specified. They suggest that the cost of a life year saved in cancer is about 13,100 pounds, and in circulation about 8000 pounds. These results challenge the widely held view that health care has little marginal impact on health. From a policy perspective, they can help set priorities by informing resource allocation across programmes of care. They can also help health technology agencies decide whether their cost-effectiveness thresholds for accepting new technologies are set at the right level.Keywords
This publication has 13 references indexed in Scilit:
- The relationship between health care expenditure and health outcomesThe European Journal of Health Economics, 2006
- Capitation Funding in the Public SectorJournal of the Royal Statistical Society Series A: Statistics in Society, 2001
- The anomaly that finally went away?Journal of Epidemiology and Community Health, 2001
- An explanation of the persistent doctor-mortality associationJournal of Epidemiology and Community Health, 2001
- Health care spending as determinants of health outcomesHealth Economics, 1999
- Diagnostics for IV RegressionsOxford Bulletin of Economics and Statistics, 1999
- Testing Identifiability and Specification in Instrumental Variable ModelsEconometric Theory, 1993
- International cross-section analysis of the determination of mortalitySocial Science & Medicine, 1987
- Health service 'input' and mortality 'output' in developed countries.Journal of Epidemiology and Community Health, 1978
- The Estimation of Economic Relationships using Instrumental VariablesEconometrica, 1958