Yale study shows impact of social services spending on improving nations’ health

Funding social services might be more effective in improving the health of a nation’s population than spending money on health services, according to a study by the Yale Global Health Leadership Institute (GHLI) published in the July issue of BMJ Quality and Safety.

Many countries are increasingly confronting issues of rising health care costs with limited improvement in health outcomes, notes Elizabeth H. Bradley, faculty director of the GHLI and lead author on the paper.

The issue, she says, is particularly acute in the United States, which ranks highest among Organisation for Economic Co-operation and Development (OECD) countries in health care spending as a percentage of gross domestic product (GDP) while remaining among the lowest performers in several key health areas. In 2005, the U.S. spent 16% of GDP on health care compared with an average of 9% spent by other OECD countries, and in 2006, the United States ranked 25th in life expectancy, 29th in infant mortality and 24th in maternal mortality among the 30 OECD countries.

“Although health professionals have long recognized the importance of socio-economic, environmental and behavioral determinants of health, health care reforms have focused largely on spending for health services, with less attention focused on spending in potentially important social policy areas,” says Bradley.

To weigh the effectiveness of spending on heath services vs. social services, the GHLI used 2009 data from the OECD to examine five health outcomes measured over an 11-year period: life expectancy at birth, infant mortality, low birth weight, maternal mortality and potential years of life lost.

The Yale researchers found that, when adjusted for GDP per capita, health services expenditures — such as rehabilitative care, long-term care, laboratory tests, prevention and public health services, and health insurance — were only significantly associated with better health outcomes in two of five health areas.

On the other hand, social-services expenditures (also adjusted for GDP per capita) were significantly associated with better health outcomes in three of five indicators. For the purposes of this research, social spending included investments such as income supplements, housing, unemployment coverage, support services for older adults, disability and survivor benefits. The ratio of social to health expenditures was significantly associated with better outcomes in infant mortality, life expectancy and increased potential life years lost, and GDP per capita.

“Social spending is usually viewed outside of the realm of health care issues,” says Bradley. “These findings indicate that there may be a direct connection between social spending and health outcomes. More attention to broader domains of social policy may be helpful in accomplishing improvements in health envisioned by health care reformers.”

She adds, “The U.S. may want to review how money is being divided among social and health services and look more at long-term social spending as a way to achieve improvements in health outcomes.”