School of Public Health, University of Adelaide, Level 9, Adelaide Health and Medical Sciences Building, The University of Adelaide, 5005, Australia.
School of Public Health, University of Adelaide, Level 9, Adelaide Health and Medical Sciences Building, The University of Adelaide, 5005, Australia.
Health Policy. 2018 Aug;122(8):892-899. doi: 10.1016/j.healthpol.2018.04.011. Epub 2018 Apr 27.
There is limited empirical evidence of the nature of any relationship between health spending and health outcomes in Australia. We address this by estimating the elasticity of health outcomes with respect to public healthcare spending using an instrumental variable (IV) approach to account for endogeneity of healthcare spending to health outcomes. Results suggest that, based on the conditional mean, a 1% increase in public health spending was associated with a 2.2% (p < 0.05) reduction in the number of standardised Years of Life Lost (YLL). Sensitivity analyses and robustness checks supported this conclusion. Further exploration using IV quantile regression indicated that marginal returns on public health spending were significantly greater for areas with poorer health outcomes compared to areas with better health outcomes. On average, marginal increases in public health spending reduce YLL, but areas with poorer health outcomes have the greatest potential to benefit from the same marginal increase in public health spending compared to areas with better health outcomes. Understanding the relationship between health spending and outcomes and how this differs according to baseline health outcomes can help meet dual policy objectives to improve the productivity of the healthcare system and reduce inequity.
在澳大利亚，健康支出与健康结果之间关系的性质的实证证据有限。我们通过使用工具变量（IV）方法估计健康结果对公共医疗保健支出的弹性来解决这个问题，以解决医疗保健支出对健康结果的内生性问题。结果表明，基于条件均值，公共卫生支出增加 1%与标准寿命损失（YLL）数量减少 2.2%（p<0.05）相关。敏感性分析和稳健性检验支持了这一结论。使用 IV 分位数回归的进一步探索表明，与健康状况较好的地区相比，公共卫生支出的边际回报在健康状况较差的地区更为显著。平均而言，公共卫生支出的边际增加减少了 YLL，但与健康状况较好的地区相比，健康状况较差的地区从公共卫生支出的相同边际增加中获益的潜力最大。了解健康支出与结果之间的关系，以及这种关系如何根据基线健康结果而有所不同，可以帮助实现提高医疗保健系统生产力和减少不平等的双重政策目标。
