Effect of provincial spending on social services and health care on health outcomes in Canada: an observational longitudinal study

Abstract

Background: Escalating health care spending is a concern in Western countries, given the lack of evidence of a direct connection between spending and improvements in health. We aimed to determine the association between spending on health care and social programs and health outcomes in Canada.

Methods: We used retrospective data from Canadian provincial expenditure reports, for the period 1981 to 2011, to model the effects of social and health spending (as a ratio, social/health) on potentially avoidable mortality, infant mortality and life expectancy. We used linear regressions, accounting for provincial fixed effects and time, and controlling for confounding variables at the provincial level.

Results: A 1-cent increase in social spending per dollar spent on health was associated with a 0.1% (95% confidence interval [CI] 0.04% to 0.16%) decrease in potentially avoidable mortality and a 0.01% (95% CI 0.01% to 0.02%) increase in life expectancy. The ratio had a statistically nonsignificant relationship with infant mortality (p = 0.2).

Interpretation: Population-level health outcomes could benefit from a reallocation of government dollars from health to social spending, even if total government spending were left unchanged. This result is consistent with other findings from Canada and the United States.

Figure 1:

Real spending per capita (thousands of dollars), by province (outliers noted). Light green lines = individual provinces, dark green line = national average. Note: NB = New Brunswick, NL = Newfoundland and Labrador.

Figure 2:

Trends over time, at national and provincial levels, of 3 population health variables: potentially avoidable mortality, infant mortality and life expectancy at birth. One outlier is noted. Light green lines = individual provinces, dark green line = national average. Note: NL = Newfoundland and Labrador.