How Business Cycles Affect the Healthcare Sector: A Cross-country Investigation

Kathleen Cleeren, Lien Lamey, Jan Hinrich Meyer, Ko De Ruyter

Research output: Indexed journal article Articlepeer-review

17 Citations (Scopus)


The long-term relationship between the general economy and healthcare expenditures has been extensively researched, to explain differences in healthcare spending between countries, but the midterm (i.e., business cycle) perspective has been overlooked. This study explores business cycle sensitivity in both public and private parts of the healthcare sector across 32 countries. Responses to the business cycle vary notably, both across spending sources and across countries. Whereas in some countries, consumers and/or governments cut back, in others, private and/or public healthcare buyers tend to spend more. We also assess long-term consequences of business cycle sensitivity and show that public cost cutting during economic downturns deflates the mortality rates, whereas private cut backs increase the long-term growth in total healthcare expenditures. Finally, multiple factors help explain variability in cyclical sensitivity. Private cost cuts during economic downturns are smaller in countries with a predominantly publicly funded healthcare system and more preventive public activities. Public cut backs during contractions are smaller in countries that rely more on tax-based resources rather than social health insurances.

Original languageEnglish
Pages (from-to)787-800
Number of pages14
JournalHealth Economics (United Kingdom)
Issue number7
Publication statusPublished - 1 Jul 2016
Externally publishedYes


  • business cycle
  • healthcare expenditures
  • healthcare systems
  • mortality


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