Priority setting at the macro level. Health care in relation to other fields of social policy

Abstract

Definition of the problem Public health care consumes a large and growing fraction of fiscal resources devoted to social security in socio-economically advanced countries without necessarily improving population health or social welfare in general. Arguments Using various performance indicators, the article assesses the efficacy of public health spending in light of its opportunity costs, i.e., the budget constraints it imposes on other fields of social policy, in a cross-country comparison. The study confirms the findings of earlier research, namely that public health care exceeding a basic level of provision for the entire population yields remarkably little benefit, and that countries spending more than others do not necessarily achieve better health outcomes. Indeed, countries allocating a greater share of public resources to education fare better in several dimensions of social welfare, including aggregate health. Conclusion Under conditions of fiscal austerity, a policy shift that places greater emphasis on public education should be seriously considered, if necessary, at the cost of public health. © 2010 Springer-Verlag.