OECD working paper로 발간된(2014년) 건강, 긴축, 경제위기의 상관관계를 다룬 보고서입니다. 경제위기와 긴축정책, 건강outcome을 다룬 기존 논문을 리뷰하고 있으며, OECD국가들의 최근 의료비 경향을 살펴보면서, OECD통계가 실업과 의료간의 관계를 드러내는지도 살펴보고자 합니다. 관련연구와 각국의 health reform 내용들이 부록으로 담겨져 있으니 참고하시기 바랍니다.

인용하실때는 아래와 같이 인용하세요.

van Gool, K. and M. Pearson (2014), “Health, Austerity and Economic Crisis: Assessing the Short-term Impact in OECD countries”, OECD Health Working Papers, No. 76, OECD publishing.

http://dx.doi.org/10.1787/5jxx71lt1zg6-en

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OECD Health Working Papers No. 76

Health, Austerity and Economic Crisis

ASSESSING THE SHORT-TERM IMPACT IN OECD COUNTRIES

Kees van Gool, Mark Pearson

SUMMARY
The economic crisis that started in 2008 has had a profound impact on the lives of citizens. Millions of people lost their job, saw their life-savings disappear and experienced prolonged financial hardship. The economic crisis has also led a number of OECD governments to introduce austerity measures to reduce public deficits. The health sector, like many other social welfare programmes, has witnessed extensive spending cuts and has also been the subject of substantial reforms. The combined effects of economic crisis, austerity and reforms have led many OECD health systems into unchartered territory.

This paper looks at the impact of economic crisis on health and health care. It summarises findings from the published literature on the effects of economic crisis that took place over the past few decades and also describes recent health policy reforms, focusing on those countries where the economic crisis has hit hardest. Finally, this paper analyses the empirical relationship between unemployment and health care use, quality and health outcomes, using data from OECD Health Statistics. In doing so, it investigates whether the effects of unemployment on health outcomes have been extenuated by austerity measures.
Results show that economic downturns are associated with adverse outcomes for some, but certainly not all, health indicators. During times of economic crises, mental health deteriorates and the prevalence of communicable diseases appears to rise, but at the same time there are fewer deaths from transport accidents. There is less consistent evidence on the relationship between economic conditions and overall health outcomes such as mortality and health care quality. However, this paper finds that a higher rate of
unemployment is strongly linked to lower health care use, which may have longer term consequences that are not yet evident in the available data. Recent health care austerity measures are associated with a decline in hospital admissions in OECD countries, but not in pharmaceutical consumption. This provides some evidence that falls in pharmaceutical expenditure can primarily be explained by efforts to negotiate lower prices and encourage use of cheaper bioequivalent generics.
While many of the health reforms undertaken since the start of the economic crisis can make a positive long-term contribution to the health system’s productivity and efficiency, there may also be negative impacts. The short-term effects examined in this paper suggest that austerity measures have had
mixed success in protecting patients from reduced health care access, but there remains an important need to actively monitor the wider long-term health impact of the economic crisis.

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TABLE OF CONTENTS
ACKNOWLDEGEMENTS ……………………………………………………3
SUMMARY ………………………………………………………………………..4
RÉSUMÉ……………………………………………………………………………5
1. DO ECONOMIC DOWNTURNS LEAD TO WORSE HEALTH OUTCOMES?……….7
Economic crises can affect health outcomes through multiple channels……………………………………………..7
Studies show mixed results on the relationship between economic crises and health outcomes……………..9
There is clear evidence that economic downturns lead to lower health care use………………………………..13
However, the effect of economic recessions on health care supply are not well understood ………………..14
Few studies have examined the effect of policy in mitigating the recessionary impact on health – with surprising results………………………………………..15

2. THE GLOBAL FINANCIAL CRISIS HAS LED GOVERNMENTS TO IMPLEMENT STRICT
AUSTERITY MEASURES AND HEALTH SYSTEM REFORMS……………………………………………………16
Health care spending stagnates across the OECD, with substantial falls in some countries………………..16
Countries have used a variety of policy instruments to cut health care expenditure and restructure the health system…………………………………..18
3. WHAT CAN OECD HEALTH STATISTICS REVEAL ABOUT THE LINKS BETWEEN UNEMPLOYMENT AND HEALTH AND HEALTH CARE? …………………………24
4. WHAT HAS BEEN THE SHORT-TERM INFLUENCE OF AUSTERITY AND UNEMPLOYMENT ON HEALTH INDICATORS? ……………………………27
5. POLICY AND RESEARCH IMPLICATIONS………………………………….28
6. CONCLUSION ……………………………………………………………………….31
REFERENCES………………………………………………………………………..32

ANNEX A ……………………………………………………………………………37
ANNEX B ………………………………………………………………………………..44
ANNEX C …………………………………………………………………………………47

ANNEX D …………………………………………………………………………………49
Tables
Table 1. Summary of previous empirical literature on the health effects economic downturns published between 1990 and 2013…………………………………………………..10
Table 2. Relationship between an increase in unemployment and health indicators………………………26
Table 3. Evidence of differences between……………………………………………………………………………….27
Table C1. Categories for high and modest cuts to health expenditure growth…………………………………48
Table D1. Estimated relationships between unemployment and health indicators ………………………….49
Table D2. Testing for differences in the role of unemployment: regression results …………………………51
Figures
Figure 1. Health expenditure falls most in countries hit hard by the recession and with high pre-crisis health expenditure growth………………………………..17
Figure 2. Growth in health expenditure during economic crisis……………..18