Health spending and outcomes
This web workshop will explore the relationship between health spending and health outcomes, bringing together empirical evidence from a diverse range of country contexts. Presentations will examine whether increased public investment in health translates into measurable improvements in population health, drawing on case studies from Brazil, Indonesia, the United Kingdom, the United States, and South Africa, alongside a systematic review of existing research. The session will provide participants with a deeper understanding of the key methods and theoretical approaches used to evaluate the impact of health expenditure. It will conclude with dedicated time for questions, answers, and open discussion, offering an opportunity for critical reflection and exchange.
Presentations:
- The effect of public health expenditure on health and health care use: a systematic review
This systematic review and meta-regression analysis synthesizes the international literature on the effect of public health expenditure on health and care. Findings highlight the importance of strong governance, sustainable financing, and investment in prevention and workforce, while revealing key gaps in evidence from low- and middle- income countries and in understanding financing mechanisms.
Presenter: Eliana ChavarrÃa-Pino is a postdoctoral researcher at the Ludwig Maximilian University of Munich. Her work focuses on the evaluation of health policies and programmes in low- and middle-income countries, with a particular emphasis on health financing and the health workforce.
This study examines how different types of NHS spending vary in their ability to generate health gains, measured in cost per quality-adjusted life year (QALY). Using 2016 data and two-stage least squares, the authors estimate that locally commissioned services deliver a QALY for around £8,000, while results for primary care and specialised services are more uncertain. Accounting for this variation slightly increases the overall estimated cost per QALY across the NHS. The findings suggest that directing additional investment toward primary care and locally commissioned services may yield the greatest health benefits.
Presenter: James Lomas is a senior lecturer at the Department of Economics and Related Studies at the University of York. His research is focused on applied microeconometric analysis that answers the empirical questions posed in the context of economic evaluation and cost-effectiveness analysis.Â
- Assessing the Efficiency of Public Health Resourcing in South Africa: A District-Level Analysis Using Data Envelopment Analysis
This study evaluates how efficiently public health funds are used across 48 districts in South Africa amid tight fiscal constraints. Using stochastic frontier analysis, it finds wide variation in efficiency (7%–87%), with significant potential to improve health outcomes without increasing spending. Results highlight that primary health care spending is most effective when supported by sufficient hospital capacity, while hospital spending shows more consistent benefits. The study identifies district performance patterns to guide better resource allocation and peer learning in constrained health systems.
Presenter: Fouché Venter is Executive Director of the Economic Research Southern Africa. He has managed numerous public policy-related economic research projects in South Africa and other African countries, with a deep interest in collecting, analysing and disseminating the evidence needed to design good public policies.
This presentation discusses how government health spending shapes health outcomes by exploring unique top-down variation generated by Brazil’s 29th Constitutional Amendment, which mandated minimum thresholds for municipal health spending. It describes how sharp changes in health spending resulting from the Constitutional Amendment affect downstream outcomes, documenting increases in available resources and access to health at various margins, with resulting declines in infant mortality and all cause mortality. Secondly, it discusses the production function of public healthcare, documenting non-linearities and input complementarities. A number of key margins of spending effectiveness and constraints to larger gains from health spending are highlighted, including frictions between bureaucratic capacity and political incentives.
Presenter: Damian Clarke is a researcher and Associate Professor of Economics at The University of Exeter, and The University of Chile. His research focuses on maternal and child health, and family fertility decisions. In particular, his papers examine the impact of public programs on maternal mortality and morbidity, early life health outcomes for children, and the determinants of parental investment in children.
- Does increasing overall health expenditure reduce inequality in under-5 mortality rates between provinces in Indonesia?
This study analyses whether increased public health spending in Indonesia (2004–2012) reduced inequalities in under-five mortality across socioeconomic groups. Using dynamic panel System-GMM and instrumental variables, it finds that higher spending actually widened inequality, as wealthier households benefited more from mortality reductions than poorer ones. The study finds no significant difference in impact between provinces with high and low baseline mortality. Overall, the results suggest that simply increasing health spending is insufficient to reduce inequalities unless funds are better targeted toward disadvantaged populations and high-need areas.
Presenter: Ivan Ochoa-Moreno is a Research Fellow in Global Health at the University of York. His research focuses on impact evaluation of health policies, universalisation of healthcare and lifelong impact of early-life health and development.
This study extends prior work on the value of healthcare spending by examining health-adjusted life expectancy (HALE) and lifetime costs across all ages and diseases. Using global burden and expenditure data, it estimates that healthcare improvements from 1996 to 2016 increased HALE by about 1.3 years at a cost of roughly $182,000 per HALE gained. Results vary widely by disease, with substantial gains for conditions like HIV/AIDS and heart disease, but negative effects for drug use disorders. The findings highlight the importance of evaluating healthcare value across the full life course and by specific causes.
Presenter: Marcia Weaver, PhD, is a Research Professor of Health Metrics Sciences at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington where she leads the cost-effectiveness research team. She specialises in meta-regression analysis of published cost-effectiveness estimates and has published 103 peer-reviewed articles.Â