Journal of healthcare quality research · 2025
[Analysis of the relationship between public health expenditure and health outcomes in Spain (2002-2022)].
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Escandell Rico F M, Pérez Fernández L
Аннотация
OBJECTIVE: To analyze the relationship between public health expenditure and its possible association with health indicators, particularly life expectancy and infant mortality in Spain during the period 2002-2022.
METHOD: An ecological, longitudinal, and retrospective study that included the 17 autonomous communities, generating a panel of 340 observations (17 communities ×20years). Official data from the Public Health Expenditure Statistics and health indicators from the Ministry of Health were used. Time trends in public health expenditure, life expectancy, and infant mortality were analyzed, and correlation analysis, multiple regression, and hierarchical cluster analysis were applied to evaluate patterns and associations.
RESULTS: Public health expenditure per capita increased by 70.6% between 2002 and 2022, mainly concentrated in hospital services, while primary care showed limited growth, and public health only increased significantly after the COVID-19 pandemic. A positive, albeit weak, association was observed between total spending and life expectancy, and a negative correlation approaching significance between spending and infant mortality. Regional inequalities persisted, with regions such as Catalonia and Madrid presenting the highest spending levels and improved indicators, in contrast to regions such as Andalusia and the Valencian Community, which maintained lower and more unstable levels.
CONCLUSIONS: Increased public health spending in Spain is associated with improvements in key health indicators, but spending alone does not guarantee better outcomes. Efficiency improvements, strengthening of primary care, reduction of territorial inequalities, and results-oriented strategic planning are required to ensure the sustainability and effectiveness of the health system.
METHOD: An ecological, longitudinal, and retrospective study that included the 17 autonomous communities, generating a panel of 340 observations (17 communities ×20years). Official data from the Public Health Expenditure Statistics and health indicators from the Ministry of Health were used. Time trends in public health expenditure, life expectancy, and infant mortality were analyzed, and correlation analysis, multiple regression, and hierarchical cluster analysis were applied to evaluate patterns and associations.
RESULTS: Public health expenditure per capita increased by 70.6% between 2002 and 2022, mainly concentrated in hospital services, while primary care showed limited growth, and public health only increased significantly after the COVID-19 pandemic. A positive, albeit weak, association was observed between total spending and life expectancy, and a negative correlation approaching significance between spending and infant mortality. Regional inequalities persisted, with regions such as Catalonia and Madrid presenting the highest spending levels and improved indicators, in contrast to regions such as Andalusia and the Valencian Community, which maintained lower and more unstable levels.
CONCLUSIONS: Increased public health spending in Spain is associated with improvements in key health indicators, but spending alone does not guarantee better outcomes. Efficiency improvements, strengthening of primary care, reduction of territorial inequalities, and results-oriented strategic planning are required to ensure the sustainability and effectiveness of the health system.