DOES HEALTH EXPENDITURE BUILD TRUST? EVIDENCE FROM OECD COUNTRIES, 2010-2022
Author(s)
Shatarupa Dey, PhD;
University of Utah, Graduate Student, Salt Lake City, UT, USA
University of Utah, Graduate Student, Salt Lake City, UT, USA
OBJECTIVES: This study analyses the relationship between national health expenditure and public trust in government across OECD countries from 2010 to 2022.
METHODS: This study used a longitudinal panel dataset of 37 OECD countries from 2010 to 2022. Costa Rica was excluded from the analysis due to its 2021 OECD membership, which left insufficient data for the years preceding it. Health expenditure data were drawn from OECD sources and merged with annual measures of political trust. Analyses included pooled ordinary least squares models to identify cross-sectional associations and fixed-effects models to assess within-country changes over time.
RESULTS: The pooled OLS model reveals that people in richer, high-spending countries generally exhibit higher levels of political trust—consistent with theories linking state capacity and welfarism to increased legitimacy and confidence. However, the US is a notable outlier in this regard, spending heavily but showing only moderate trust. In this case, factors such as party polarization, institutional performance, and historical context may shape citizens’ confidence. The subsequent analysis, which relied on fixed-effects models, showed that a within-country increase in spending does not necessarily lead to higher trust—confirming the theory of countercyclical investments and suggesting that reactive/short-term spending alone may not lead to increased political trust. Trust increased in 2020, consistent with a pandemic-related “rally-around-the-flag” effect, while in 2021 and 2022 the association between health expenditure and trust was negative, with the strongest negative association observed in 2022.
CONCLUSIONS: Increased national health expenditure is generally associated with greater political trust across countries; however, increases in spending within countries do not automatically generate higher trust. These findings suggest that high resource allocation and spending alone may not be sufficient to build trust; consistent, effective government performance over time leads to greater confidence.
METHODS: This study used a longitudinal panel dataset of 37 OECD countries from 2010 to 2022. Costa Rica was excluded from the analysis due to its 2021 OECD membership, which left insufficient data for the years preceding it. Health expenditure data were drawn from OECD sources and merged with annual measures of political trust. Analyses included pooled ordinary least squares models to identify cross-sectional associations and fixed-effects models to assess within-country changes over time.
RESULTS: The pooled OLS model reveals that people in richer, high-spending countries generally exhibit higher levels of political trust—consistent with theories linking state capacity and welfarism to increased legitimacy and confidence. However, the US is a notable outlier in this regard, spending heavily but showing only moderate trust. In this case, factors such as party polarization, institutional performance, and historical context may shape citizens’ confidence. The subsequent analysis, which relied on fixed-effects models, showed that a within-country increase in spending does not necessarily lead to higher trust—confirming the theory of countercyclical investments and suggesting that reactive/short-term spending alone may not lead to increased political trust. Trust increased in 2020, consistent with a pandemic-related “rally-around-the-flag” effect, while in 2021 and 2022 the association between health expenditure and trust was negative, with the strongest negative association observed in 2022.
CONCLUSIONS: Increased national health expenditure is generally associated with greater political trust across countries; however, increases in spending within countries do not automatically generate higher trust. These findings suggest that high resource allocation and spending alone may not be sufficient to build trust; consistent, effective government performance over time leads to greater confidence.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HPR65
Topic
Health Policy & Regulatory
Topic Subcategory
Public Spending & National Health Expenditures
Disease
No Additional Disease & Conditions/Specialized Treatment Areas