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The political economy of austerity and healthcare: Cross-national analysis of expenditure changes in 27 European nations 1995–2011

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  • Reeves, Aaron
  • McKee, Martin
  • Basu, Sanjay
  • Stuckler, David

Abstract

Why have patterns of healthcare spending varied during the Great Recession? Using cross-national, harmonised data for 27 EU countries from 1995 to 2011, we evaluated political, economic, and health system determinants of recent changes to healthcare expenditure. Data from EuroStat, the IMF, and World Bank (2013 editions) were evaluated using multivariate random- and fixed-effects models, correcting for pre-existing time-trends. Reductions in government health expenditure were not significantly associated with magnitude of economic recessions (annual change in GDP, p=0.31, or cumulative decline, p=0.40 or debt crises (measured by public debt as a percentage of GDP, p=0.38 or per capita, p=0.83)). Nor did ideology of governing parties have an effect. In contrast, each $100 reduction in tax revenue was associated with a $2.72 drop in health spending (95% CI: $1.03–4.41). IMF borrowers were significantly more likely to reduce healthcare budgets than non-IMF borrowers (OR=3.88, 95% CI: 1.95 –7.74), even after correcting for potential confounding by indication. Exposure to lending from international financial institutions, tax revenue falls, and decisions to implement cuts correlate more closely than underlying economic conditions or orientation of political parties with healthcare expenditure change in EU member states.

Suggested Citation

  • Reeves, Aaron & McKee, Martin & Basu, Sanjay & Stuckler, David, 2014. "The political economy of austerity and healthcare: Cross-national analysis of expenditure changes in 27 European nations 1995–2011," Health Policy, Elsevier, vol. 115(1), pages 1-8.
    • Handle: RePEc:eee:hepoli:v:115:y:2014:i:1:p:1-8
    DOI: 10.1016/j.healthpol.2013.11.008
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    as
    1. Burgard, Sarah A. & Brand, Jennie E. & House, James S., 2009. "Perceived job insecurity and worker health in the United States," Social Science & Medicine, Elsevier, vol. 69(5), pages 777-785, September.
    2. Dreher, Axel & Sturm, Jan-Egbert & Vreeland, James Raymond, 2009. "Development aid and international politics: Does membership on the UN Security Council influence World Bank decisions?," Journal of Development Economics, Elsevier, vol. 88(1), pages 1-18, January.
    3. Carmen M. Reinhart & Kenneth S. Rogoff, 2010. "Growth in a Time of Debt," American Economic Review, American Economic Association, vol. 100(2), pages 573-578, May.
    4. Griliches, Zvi & Hausman, Jerry A., 1986. "Errors in variables in panel data," Journal of Econometrics, Elsevier, vol. 31(1), pages 93-118, February.
    5. Jacob S. Hacker & Paul Pierson, 2010. "Winner-Take-All Politics: Public Policy, Political Organization, and the Precipitous Rise of Top Incomes in the United States," Politics & Society, , vol. 38(2), pages 152-204, June.
    6. James Vreeland, 2006. "IMF program compliance: Aggregate index versus policy specific research strategies," The Review of International Organizations, Springer, vol. 1(4), pages 359-378, December.
    7. David Stuckler & Lawrence P King & Sanjay Basu, 2008. "International Monetary Fund Programs and Tuberculosis Outcomes in Post-Communist Countries," PLOS Medicine, Public Library of Science, vol. 5(7), pages 1-12, July.
    8. Mr. Andrea Pescatori & Mr. Daniel Leigh & Mr. Jaime Guajardo & Mr. Pete Devries, 2011. "A New Action-Based Dataset of Fiscal Consolidation," IMF Working Papers 2011/128, International Monetary Fund.
    9. Przeworski, Adam & Vreeland, James Raymond, 2000. "The effect of IMF programs on economic growth," Journal of Development Economics, Elsevier, vol. 62(2), pages 385-421, August.
    10. Conor Keegan & Steve Thomas & Charles Normand & Conceição Portela, 2013. "Measuring recession severity and its impact on healthcare expenditure," International Journal of Health Economics and Management, Springer, vol. 13(2), pages 139-155, June.
    11. Kim, Il-Ho & Muntaner, Carles & Khang, Young-Ho & Paek, Domyung & Cho, Sung-Il, 2006. "The relationship between nonstandard working and mental health in a representative sample of the South Korean population," Social Science & Medicine, Elsevier, vol. 63(3), pages 566-574, August.
    12. Antonio Spilimbergo & Martin Schindler & Steven A. Symansky, 2009. "Fiscal Multipliers," IMF Staff Position Notes 2009/11, International Monetary Fund.
    13. Fergusson, David M. & John Horwood, L. & Woodward, Lianne J., 2001. "Unemployment and psychosocial adjustment in young adults: causation or selection?," Social Science & Medicine, Elsevier, vol. 53(3), pages 305-320, August.
    14. Griliches, Zvi, 1974. "Errors in Variables and Other Unobservables," Econometrica, Econometric Society, vol. 42(6), pages 971-998, November.
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