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Does the health system model shape prevention? Evidence from 22 OECD countries (2004-2023)
Pietro Marraffa1, Lorenzo Marega1, Gianfranco Politano2
1Department of Sciences of Public Health and Paediatrics, University of Turin, Turin, Italy.
Frontiers in Public Health
|July 2, 2026
Summary
Preventive care spending increased in most European countries between 2004-2023, but health system structure showed limited impact. Contextual factors likely drive budgetary prioritization of preventive health services.
Area of Science:
- Health Economics
- Public Health Policy
- Comparative Health Systems Analysis
Background:
- Global trends of population aging, rising healthcare costs, and public health challenges necessitate efficient resource allocation.
- Understanding the budgetary prioritization of preventive care within diverse European health systems is crucial for optimizing health outcomes and sustainability.
Purpose of the Study:
- To analyze trends in the share of total health expenditure allocated to preventive care in 22 European countries from 2004 to 2023.
- To examine the association between different health system structures (regulation, financing, provision) and the relative budgetary prioritization of preventive care, using Böhm's latest classification.
Main Methods:
- Time-trend analysis of secondary data from 22 European OECD countries (2004-2023).
- Hierarchical semi-log polynomial mixed-effects regression analysis.
- Inclusion of annual country-level preventive care expenditure share and Böhm's health system dimensions as explanatory variables.
Main Results:
- Most countries showed an increase in the preventive care expenditure share (0.2%–3.7% CAGR), while seven experienced a decrease (-0.2%–-6.3% CAGR).
- Financing and provision dimensions of health systems did not significantly influence the trend of preventive care expenditure share.
- Societal regulation was associated with a more pronounced curvilinear trend in preventive care expenditure share compared to statal regulation (b = 0.0035).
Conclusions:
- Limited evidence suggests health system type, as classified by Böhm, is strongly associated with the relative budgetary prioritization of preventive care.
- Contextual factors such as political priorities, public health strategies, and external shocks may play a more significant role in shaping preventive care expenditure.
- Further research is needed to explore the influence of these contextual factors on preventive care investment across European health systems.
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