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Health Aff (Millwood). 2015 Apr;34(4):562-70. doi: 10.1377/hlthaff.2014.0634.

Cancer mortality reductions were greatest among countries where cancer care spending rose the most, 1995-2007.

Author information

Warren Stevens is a senior research economist at Precision Health Economics in San Francisco, California.
Tomas J. Philipson ( is the Daniel Levin Professor of Public Policy at the Irving B. Harris Graduate School of Public Policy, University of Chicago, in Illinois.
Zeba M. Khan is vice president of corporate responsibility at Celgene Corporation, in Summit, New Jersey.
Joanna P. MacEwan is a research economist at Precision Health Economics in San Francisco.
Mark T. Linthicum is a research scientist and associate director of health services research at Precision Health Economics in Los Angeles, California.
Dana P. Goldman is the Leonard D. Schaeffer Chair and director of the Schaeffer Center for Health Policy and Economics at the University of Southern California, in Los Angeles.


Health care spending and health outcomes vary markedly across countries, but the association between spending and outcomes remains unclear. This inevitably raises questions as to whether continuing growth in spending is justified, especially relative to the rising cost of cancer care. We compared cancer care across sixteen countries over time, examining changes in cancer spending and two measures of cancer mortality (amenable and excess mortality). We found that compared to low-spending health systems, high-spending systems had consistently lower cancer mortality in the period 1995-2007. Similarly, we found that the countries that increased spending the most had a 17 percent decrease in amenable mortality, compared to 8 percent in the countries with the lowest growth in cancer spending. For excess mortality, the corresponding decreases were 13 percent and 9 percent. Additionally, the rate of decrease for the countries with the highest spending growth was faster than the all-country trend. These findings are consistent with the existence of a link between higher cancer spending and lower cancer mortality. However, further work is needed to investigate the mechanisms that underlie this correlation.


Cost of Health Care; Developed World < International/global health studies; Health Economics; Health Spending; International/global health studies

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