UK life expectancy and healthcare spend vs OECD. NHS success story?

UK life expectancy expanded - in line with the OECD average (more or less, there was a little catch up) until recently where (like in a few countries) it seems to be flattening. This is a blunt but well understood measure of a population’s health.

A similar type of trend can be seen in childhood mortality. Although experts can gripe with the data, the overall trend is likely robust. There is also some catch up from OECD average from a poorer start.

This is a good achievement by the UK given what the UK has spent on healthcare since the 1970s.

My general observation here is that the UK has underspend / invested less in healthcare but has managed to obtain an average to above average results.

The under spend as % GDP has been 2 to 4 percent points lower than OECD peers on average. This has been going on since the 1970s. (The World bank data is from 2000, sourced from WHO)

There are many factors that combine to impact life expectnacy and health. Correlation is not causation.

However, I think there is enough data and evidence to suggest that given the amount the UK has invested in health (and social care and education) that if the UK wants to continue the positive trends in health, it will likely have to spend more or at current levels of spend the health out comes will - in my view - likely to continue to tail off.

In this sense, the UK’s NHS has been a unique system that has enabled outsized gains in health outcomes for the amount of spend over the last 50 years.

OECD data.

OECD data.

I can’t make a nice graph widget, but I can show how this % spend on GDP goes back to the 1970s. so this is arguably about 50 years of under spend, at even the lower end of 2% of GDP that’s somewhere in the region of £500bn to £1,000 bn (yes 1 £trillion) in culmulative under spend compared to what would have been spent on the OECD average %.

(Now whether it would have been well spent or what else the UK spent the money on is another debate - maybe the OECD over spent given its outcomes… but given the UK is uniquely low (though Italy is close in some years and has slightly worse outcomes broadly) .

You can see how Germany is approx matching the UK since 1970 on life expectancy and trend (OK it did slowly gain beofre mathcing), but was spending much more of GDP to achieve that.

Impact Investing papers on return, healthcare over 200 years

Two short papers for ESG/IMpact and one for healthcare specialists

 Impact funds earn 4.7% lower IRRs compared to traditional VC funds (Barber et al, 2015, update 2018)

“We document that investors derive nonpecuniary utility from investing in dual-objective venture/growth equity funds, thus sacrificing financial returns. In reduced form, impact funds earn 4.7% lower IRRs compared to traditional VC funds. Likewise, random utility/willingness-to-pay (WTP) models of investment choice indicate investors accept 3.4% lower IRRs for impact funds. We rule out alternative interpretations of risk, liquidity, and naiveté. Development organizations, banks, public pensions, Europeans, and UNPRI signatories have high WTP; endowments and private pensions have none. ..”

But also see -

“…Over the past two years the organizations we work for—the Rise Fund, a $2 billion impact-investing fund managed by TPG Growth, and the Bridgespan Group, a global socialimpact advisory firm—have attempted to bring the rigor of financial performance measurement to the assessment of social and environmental impact. Through trial and error, and in collaboration with experts who have been working for years in the field, the partnership between Rise and Bridgespan has produced a methodology to estimate—before any money is committed—the financial value of the social and environmental good that is likely to result from each dollar invested. Thus social-impact investors, whether corporations or institutions, can evaluate the projected return on an opportunity. We call our new metric the impact multiple of money (IMM)….” Note, TPG are actively promoting their fund - serious investors, but expect them to be arguing this case.

One confounding problem on IRR, returns is that the idea of the risk taken to achieve those returns is difficult to assess - one could argue practially impossible - and thus risk-adjusted comparisons which would better will never be known and thus this question not ever fully answered.


Two Hundred Years of Health and Medical Care: The Importance of Medical Care for Life Expectancy Gains (Catillon, 2018)

H/T Tyler Cowen, is a long reaching look at how medical care has impacted life expectancy (or not) over 200 years of data in the state of Mass, US.

“Using two hundred years of national and Massachusetts data on medical care and health, we examine how central medical care is to life expectancy gains. While common theories about medical care cost growth stress growing demand, our analysis highlights the importance of supply side factors, including the major public investments in research, workforce training and hospital construction that fueled a surge in spending over the 1955-1975 span. There is a stronger case that personal medicine affected health in the second half of the twentieth century than in the preceding 150 years. Finally, we consider whether medical care productivity decreases over time, and find that spending increased faster than life expectancy, although the ratio stabilized in the past two decades. “