Assessing the value of 40 years of local public expenditures on health

Jonathon P. Leider, Natalia Alfonso, Beth Resnick, Eoghan Brady, J. Mac McCullough, David Bishai

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


The US public and private sectors now spend more than $3 trillion on health each year.While critical studies have examined the relationship between public spending on health and health outcomes, relatively little is known about the impact of broader public-sector spending on health. Using county-level public finance data for the period 1972-2012, we estimated the impact of local public hospital spending and nonhospital health spending on all-cause mortality in the county. Overall, a 10 percent increase in nonhospital health spending was associated with a 0.006 percent decrease in all-cause mortality one year after the initial spending. This effect was larger and significant in counties with greater proportions of racial/ethnic minorities. Our results indicate that county nonhospital health spending has health benefits that can help reduce costs and improve health outcomes in localities across the nation, though greater focus on population-oriented services may be warranted.

Original languageEnglish (US)
Pages (from-to)560-569
Number of pages10
JournalHealth Affairs
Issue number4
StatePublished - Apr 1 2018

Bibliographical note

Funding Information:
This project was supported by the de Beaumont Foundation through a grant to Johns Hopkins University. Jonathon Leider was a consultant to the de Beaumont Foundation. The authors thank the rest of the project team, including Art Sensenig, Ian Colrick, Natalie Kish, Jennifer Le, and Nick Scilingo

Publisher Copyright:
© 2018 Project HOPE- The People-to-People Health Foundation, Inc.


Dive into the research topics of 'Assessing the value of 40 years of local public expenditures on health'. Together they form a unique fingerprint.

Cite this