Changes in government health spending and short-term mortality in four European countries in the 21st century

Background The recent slowdown in mortality decline in high-income countries is often attributed to decreasing in health spending. Objective To characterize the association between government health spending and short-term mortality risk in UK, Italy, Spain, and Greece. Methods Cross-sectional time-series design using annual data from all residents in those countries during 2002–2019. The exposure was the government health spending in thousands of constant dollars per capita and the main outcome was the age-standardized mortality rate. We examined time trends in exposure and outcome. Then, we applied linear regression models (country-fixed-effects -FE- and first-differences -FD-), adjusting for year, country, heatwave, coldwave, influenza, income per capita, and government social spending to estimate the percent change (PC) in mortality rate per unit increase in health spending. Results Mortality rates declined and health spending increased sharply during 2002–2010 in all four countries. Subsequently, mortality slowed its decline, while health spending either slowed its rise (UK) or decreased (other countries). Regression models show a significant association (p < 0.05) between health spending and mortality in the Italy-Spain-Greece group: inverse in 2002–2010 (PC-FE: -7.4%, PC-FD: -9.5%) and direct during 2010–2019 (PC-FE: 7.4%, PC-FD: 6.0%), while in the UK, the association probably was inverse throughout the period 2002–2019. Main results remain introducing cumulative lagged values ​​of health spending. Conclusion The health spending-mortality association went from inverse to direct between 2002–2010 and 2011–2019 in the Italy-Spain-Greece group, so the decline in health spending could not adequately explain the slowdown in mortality decline during 2011–2019 in these countries.