Changes in government health spending and short-term mortality in four European countries in the twenty-first century

The recent slowdown in mortality decline in high-income countries is often attributed to declines in health spending. The objective was to characterize the association between government health spending and short-term mortality risk in UK, Italy, Spain, and Greece. A panel data (time-series cross-sectional) design using annual data from all residents in those countries during 2002–2019 was applied. 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 one thousand US dollars increase in health spending per capita. 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 (Italy, Spain and Greece). 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: 6.1%). In the UK, the association appears inverse throughout 2002–2019. The main findings held when we introduced cumulative lagged values ​​of health spending. The health spending-mortality association shifted from inverse to direct between 2002–2010 and 2011–2019 in the Italy-Spain-Greece group, so the decline in health spending does not adequately explain the slowdown in mortality decline during 2011–2019 in these countries.