Département de gestion, d'évaluation et de politique de santé, École de santé publique, Université de Montréal, Montréal, QC, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Can J Public Health. 2023 Aug;114(4):584-592. doi: 10.17269/s41997-023-00751-y. Epub 2023 Mar 29.
Public health systems have been centre stage during the COVID-19 pandemic, but governments invest relatively little in public health as compared to curative care. Previous research has shown that public health expenditures are under pressure during recessions and could be politically determined, but very few studies analyze quantitatively their determinants. This study investigates the political and fiscal determinants of public health and curative care expenditures.
After constructing a dataset building on disaggregated health expenditures in the Canadian provinces from 1975 to 2018, we use error correction models to study the short-run and long-run influence of fiscal and political determinants on public health expenditures and on curative expenditures. Fiscal determinants include measures of public debt charges and federal transfers. Political determinants include government partisanship and election cycles. We also explore whether curative expenditures crowd out public health expenditures.
We find no difference between left and right governments in curative care expenditures but show that left governments spend more on public health if we control for past spending decisions in favour of curative care. Fiscal austerity reduces both public health and curative expenditures, and provincial governments use additional intergovernmental transfers to increase their curative care budgets. A growth in the proportion of curative care relative to total health budgets is associated with a decline in public health expenditures.
Even though they have low political salience, public health expenditures remain driven by partisanship and electoral concerns. Despite their widely acknowledged importance, public health programs develop in the shadow of curative care priorities.
在 COVID-19 大流行期间，公共卫生系统成为关注焦点，但与治疗护理相比，政府对公共卫生的投资相对较少。先前的研究表明，公共卫生支出在经济衰退期间面临压力，并且可能受到政治因素的影响，但很少有研究从定量角度分析其决定因素。本研究调查了公共卫生和治疗支出的政治和财政决定因素。
在构建了一个基于 1975 年至 2018 年加拿大各省卫生支出细分的数据集之后，我们使用误差修正模型研究了财政和政治决定因素对公共卫生支出和治疗支出的短期和长期影响。财政决定因素包括公共债务利息支出和联邦转移支付的衡量指标。政治决定因素包括政府党派和选举周期。我们还探讨了治疗支出是否会排挤公共卫生支出。
我们发现，在治疗护理支出方面，左、右翼政府之间没有差异，但如果我们控制过去偏向治疗护理的支出决策，就会发现左翼政府在公共卫生方面的支出更多。财政紧缩减少了公共卫生和治疗支出，省政府利用额外的政府间转移来增加治疗护理预算。治疗护理在总卫生预算中所占比例的增加与公共卫生支出的减少相关。
尽管公共卫生支出的政治关注度较低，但它们仍然受到党派和选举关注的驱动。尽管公共卫生计划被广泛认为很重要，但它们在治疗护理优先事项的阴影下发展。
