OECD國家健康與社會支出與健康結果之關係：資源配置之分析

Abstract

研究背景：隨著人口高齡化、慢性病盛行及疾病負擔型態轉變，健康照護資源如何有效配置以改善群體健康已成為重要政策議題。過去研究多聚焦於健康支出與健康結果之關係，但近年研究逐漸指出，社會支出亦可能透過改善所得安全、就業、住宅及其他健康社會決定因素影響健康。此外，影響健康結果的因素不僅包括支出總量，不同支出配置方式亦可能產生差異。然而，現有研究對於健康支出、社會支出及社會支出功能別與多面向健康結果之關係，仍缺乏綜合探討，因此，本研究以經濟合作暨發展組織(Organisation for Economic Co-operation and Development, OECD)國家為對象，探討社會資源配置與群體健康結果之關係。

研究目的：本研究旨在探討OECD國家中，健康支出、社會支出及社會支出功能別與健康結果之關係。

研究方法：本研究資料來源包括全球疾病負擔研究(Global Burden of Disease Study 2023, GBD 2023)、OECD、世界銀行(World Bank)及世界衛生組織(World Health Organization, WHO)等國際資料庫，使用36個OECD國家2000至2019年資料。主要自變項包括健康支出占國內生產毛額(Gross Domestic Product, GDP)比例、社會支出占GDP比例，以及七項社會支出功能別占比。依變項包括死亡率、失能調整生命年(Disability-Adjusted Life Years, DALY)、潛在生命損失年(Years of Life Lost, YLL)、失能損失健康生命年(Years Lived with Disability, YLD)、出生時平均餘命及出生時健康餘命。統計分析採用固定效果模型，並控制年齡十歲分層、社會人口指數(Socio-Demographic Index, SDI)、失業率、女性人口比例、吸菸、高風險飲酒、懸浮微粒污染(Particulate Matter Pollution)風險暴露值及線性時間趨勢。

研究結果：研究結果顯示，總健康支出占 GDP 比例與死亡率呈顯著負相關（β = -0.94, p < 0.001），並與 YLD 呈顯著正相關（β = 0.19, p = 0.007）；其餘健康結果則未達統計顯著。總社會支出占 GDP 比例僅與 YLD 呈顯著負相關（β = -0.08，p = 0.047），與死亡率、DALY、YLL、出生時平均餘命及健康餘命之關係均未達統計顯著。在社會支出功能別方面，遺族支出占比與六項健康結果均呈顯著有利關係；此外，高齡支出、家庭支出、積極勞動市場政策支出、失業支出及住宅支出占比亦大多與較佳健康結果相關。失能與疾病相關支出占比則與較低死亡率、較低DALY及較低YLL相關，並與較高平均餘命及較高健康餘命相關，但同時與較高 YLD 相關（β = 0.08，p = 0.015）。

研究結論：健康支出、社會支出及社會支出功能配置與健康結果之關係並不相同。健康支出與死亡率改善有關，而社會支出則僅與 YLD 下降相關；相較之下，不同社會支出功能別與健康結果之關係較為一致且明顯。因此，影響群體健康的不僅是健康與社會支出規模，也包括社會支出之配置方式，除持續投入健康照護資源外，亦應重視社會投資與資源配置策略，以提升群體健康與健康餘命。

Background and Objective: Population aging and the growing burden of chronic diseases have increased interest in how public resource allocation relates to population health. This study examined the associations of health expenditure, social expenditure, and social expenditure categories with health outcomes in Organization for Economic Co-operation and Development (OECD) countries.

Methods: Data from 36 OECD countries between 2000 and 2019 were obtained from the Global Burden of Disease Study 2023 (GBD 2023), OECD, the World Bank, and the World Health Organization (WHO) databases. Fixed-effects models were used to analyze the relationships between public spending and health outcomes, including mortality, disability-adjusted life years (DALY), years of life lost (YLL), years lived with disability (YLD), life expectancy, and healthy life expectancy.

Results: The study included 36 OECD countries and 720 observations. Higher health expenditure was associated with lower mortality and higher YLD, while social expenditure was significantly associated only with lower YLD. Compared with overall expenditure levels, social expenditure categories exhibited more consistent associations with health outcomes. Survivors expenditure showed favorable associations across all six health indicators. In addition, old-age, family, active labor market policy, unemployment expenditures and housing expenditure were generally associated with better health outcomes. Incapacity- and illness-related expenditure was associated with lower mortality, DALY, and YLL, as well as higher life expectancy and healthy life expectancy, but was also associated with higher YLD.

Conclusions: The findings suggest that population health may be influenced not only by the overall level of health and social spending but also by how social resources are allocated across policy domains. Social expenditure categories demonstrated more consistent associations with health outcomes than total social expenditure, highlighting the potential importance of spending composition in promoting population health.