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J Health Econ. 2008 Jul;27(4):826-842. doi: 10.1016/j.jhealeco.2007.12.002. Epub 2007 Dec 25.

Does health care spending improve health outcomes? Evidence from English programme budgeting data.

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Department of Economics, University of York, UK.
Centre for Health Economics, University of York, Heslington, York YO10 5DD, UK.


Empirical evidence has hitherto been inconclusive about the strength of the link between health care spending and health outcomes. This paper uses programme budgeting data prepared by 295 English Primary Care Trusts to model the link for two specific programmes of care: cancer and circulatory diseases. A theoretical model is developed in which decision-makers must allocate a fixed budget across programmes of care so as to maximize social welfare, in the light of a health production function for each programme. This yields an expenditure equation and a health outcomes equation for each programme. These are estimated for the two programmes of care using instrumental variables methods. All the equations prove to be well specified. They suggest that the cost of a life year saved in cancer is about 13,100 pounds, and in circulation about 8000 pounds. These results challenge the widely held view that health care has little marginal impact on health. From a policy perspective, they can help set priorities by informing resource allocation across programmes of care. They can also help health technology agencies decide whether their cost-effectiveness thresholds for accepting new technologies are set at the right level.

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