International data suggest that total spending on health and social programs is more closely associated with health outcomes than health care spending alone. To better understand the relationship between health outcomes and spending on health care and social programs, Canadian researchers conducted a retrospective, longitudinal study of spending in nine Canadian provinces during a 31-year period. They calculated the ratio of provincial government spending on social services to health care spending in each province and year. The effects on three measures of health outcomes-potentially avoidable mortality, infant mortality, and life expectancy at birth-were then determined.

Average per capita spending on health, in thousands of dollars, was about three times higher (2.90) than spending on social services (0.93). A one-cent increase in social spending per dollar spent on health was associated with a 0.1% decrease in potentially avoidable mortality and a 0.01% increase in life expectancy. Increased health care spending did not have similar associations.

These findings suggest that spending on health care may not be as effective as social spending in terms of improving health. Social spending, the researchers note, changes the risk distribution for the entire population, whereas health care spending only applies to those who present with disease. Redirecting resources from health care to social services may be an efficient way to improve health outcomes, they conclude.-KR

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