Health care spending is a large – and ever increasing - portion of government budgets. Improving its efficiency has therefore become critically important. In the first-ever study to estimate health spending efficiency by gender across 27 industrialized nations, researchers discovered significant disparities within countries, with stronger gains in life expectancy for men than for women in nearly every nation.
"We were surprised to find a large gender gap in spending efficiency throughout the industrialized countries of the world. The average life expectancy of women rose from 75.5 to 79.8 between 1991 and 2007, while that of men rose from 72.5 to 77.1. The improvement for men had a much stronger association with health expenditures. In Canada, for example, a $100 increase in health expenditures was associated with a 1.26-month increase in life expectancy for women, compared to a 2.56-month increase for men," said Douglas Barthold, lead author and doctoral candidate in the Department of Economics at McGill University.
In the United States, a $100 increase in spending was associated with a 0.04 month increase in life expectancy for women, compared to a 0.70 month increase for men. Men fared better in the most efficient countries, like Germany, Switzerland, and Italy, as well as in the least efficient countries, like the USA, Sweden, and Poland. Canada's overall efficiency ranked 8th out of 27 countries. The United States ranked 22nd.
"Out of the 27 industrialized nations we studied, the United States ranks 25th when it comes to reducing women's deaths. The country's efficiency of investments in reducing men's deaths is only slightly better – ranking 18 out of 27," said Dr. Jody Heymann, senior author and Dean of the UCLA Fielding School of Public Health.
The researchers examined the relationship between internationally comparable measures of health expenditures, and gender specific life expectancy, while accounting for differences in social expenditures, economic development, and health behaviors. The analysis used country-level data from 27 Organization for Economic Cooperation and Development (OECD) countries during the period 1991 to 2007.
"While there are large differences in the efficiency of health spending across countries, men have experienced greater life expectancy gains than women per health dollar spent within nearly every country," said Barthold. The exact causes of the gender gap are unknown, thus highlighting the need for additional research on the topic. The study is coauthored by Prof. Arijit Nandi and José Mauricio Mendoza Rodríguez of McGill. The findings are published online in the First Look section of the American Journal of Public Health.
The study was part of the Healthier Societies Initiative at McGill University's Institute for Health and Social Policy. The Healthier Societies Initiative is a research program funded by Arnold and Blema Steinberg, which informs the public on health care issues related to increasing costs, health quality and access in Canada and other leading economies. A new website, http://www.healthiersocieties.org, aims to improve health system understanding for the public and policy makers by offering user-friendly interactive visual tools, and allowing comparisons of policies and trends across provinces and nations.
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