BMJ Qual Saf doi:10.1136/bmjqs.2010.048363
  • Original research

Health and social services expenditures: associations with health outcomes

  1. Brian Elbel3
  1. 1Yale School of Public Health, Division of Health Policy and Administration, and Global Health Leadership Institute, New Haven, Connecticut, USA
  2. 2Yale School of Medicine, Division of Cardiology, New Haven, Connecticut, USA
  3. 3New York University School of Medicine, Division of General Internal Medicine; New York University Wagner Graduate School of Public Service, New York, USA
  1. Correspondence to Dr Elizabeth H Bradley, Yale School of Public Health, Division of Health Policy and Administration, 60 College Street, New Haven, CT 06520, USA; elizabeth.bradley{at}
  • Accepted 25 February 2011
  • Published Online First 29 March 2011


Objective To examine variations in health service expenditures and social services expenditures across Organisation for Economic Co-operation and Development (OECD) countries and assess their association with five population-level health outcomes.

Design A pooled, cross-sectional analysis using data from the 2009 release of the OECD Health Data 2009 Statistics and Indicators and OECD Social Expenditure Database.

Setting OECD countries (n=30) from 1995 to 2005.

Main outcomes Life expectancy at birth, infant mortality, low birth weight, maternal mortality and potential years of life lost.

Results Health services expenditures adjusted for gross domestic product (GDP) per capita were significantly associated with better health outcomes in only two of five health indicators; social services expenditures adjusted for GDP were significantly associated with better health outcomes in three of five indicators. The ratio of social expenditures to health expenditures was significantly associated with better outcomes in infant mortality, life expectancy and increased potential life years lost, after adjusting for the level of health expenditures and GDP.

Conclusion Attention to broader domains of social policy may be helpful in accomplishing improvements in health envisioned by advocates of healthcare reform.


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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