Effects of health and social care spending constraints on mortality in England: a time trend analysis

Effects of health and social care spending constraints on mortality in England: a time trend analysis

ObjectiveSince 2010, England has experienced relative constraints in public expenditure on healthcare (PEH) and social care (PES). We sought to determine whether these constraints have affected mortality rates.MethodsWe collected data on health and social care resources and finances for England from...

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Bibliographic Details
Published in:BMJ open Vol. 7; no. 11; p. e017722
Main Authors: Watkins, Johnathan, Wulaningsih, Wahyu, Da Zhou, Charlie, Marshall, Dominic C, Sylianteng, Guia D C, Dela Rosa, Phyllis G, Miguel, Viveka A, Raine, Rosalind, King, Lawrence P, Maruthappu, Mahiben
Format: Journal Article
Language:English
Published: England BMJ Publishing Group LTD 01-11-2017
BMJ Publishing Group
Subjects:
Adolescent
Adult
Age
Aged
Aged, 80 and over
Budgets
Child
Child, Preschool
Delivery of Health Care - economics
Emergency medical care
England
Female
Forecasting
Funding
GDP
Government spending
Gross Domestic Product
Health care expenditures
Health care policy
Health Economics
Health Expenditures
Hospitals
Humans
Infant
Infant, Newborn
Internet
Life expectancy
Local government
Male
Middle Aged
Mortality
Mortality - trends
Population
Public health
Young Adult
England
United Kingdom > UK
United States > US
Wales
expenditure
life expectancy
spending
mortality
social care
time trend
PYLL
health care
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Summary:ObjectiveSince 2010, England has experienced relative constraints in public expenditure on healthcare (PEH) and social care (PES). We sought to determine whether these constraints have affected mortality rates.MethodsWe collected data on health and social care resources and finances for England from 2001 to 2014. Time trend analyses were conducted to compare the actual mortality rates in 2011–2014 with the counterfactual rates expected based on trends before spending constraints. Fixed-effects regression analyses were conducted using annual data on PES and PEH with mortality as the outcome, with further adjustments for macroeconomic factors and resources. Analyses were stratified by age group, place of death and lower-tier local authority (n=325). Mortality rates to 2020 were projected based on recent trends.ResultsSpending constraints between 2010 and 2014 were associated with an estimated 45 368 (95% CI 34 530 to 56 206) higher than expected number of deaths compared with pre-2010 trends. Deaths in those aged ≥60 and in care homes accounted for the majority. PES was more strongly linked with care home and home mortality than PEH, with each £10 per capita decline in real PES associated with an increase of 5.10 (3.65–6.54) (p<0.001) care home deaths per 100 000. These associations persisted in lag analyses and after adjustment for macroeconomic factors. Furthermore, we found that changes in real PES per capita may be linked to mortality mostly via changes in nurse numbers. Projections to 2020 based on 2009-2014 trend was cumulatively linked to an estimated 152 141 (95% CI 134 597 and 169 685) additional deaths.ConclusionsSpending constraints, especially PES, are associated with a substantial mortality gap. We suggest that spending should be targeted on improving care delivered in care homes and at home; and maintaining or increasing nurse numbers.
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ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2017-017722