Trends in health workforce and spending growth in four countries, 2000-2023: a longitudinal analysis

To assess how 21st-century healthcare spending grew in four high-income countries, to examine the extent to which healthcare workforce growth is associated with spending growth and to compare how the composition of the healthcare workforce has changed over time and across countries. We hypothesised that (1) healthcare spending growth patterns in the USA, the UK, Australia and Canada would be similar after the Great Recession; (2) healthcare workforce growth would be positively correlated with healthcare spending growth across countries and (3) growth in the healthcare workforce would be driven by non-physician and non-nursing workers across all countries.

Retrospective, descriptive cross-national longitudinal analysis.

National-level data from four high-income countries (Australia, Canada, the UK, the USA) using 2023 Economic Co-operation and Development Health Statistics and the WHO's National Health Workforce Accounts Data Portal.

Australia, Canada, the UK, the USA.

None.

Primary outcomes were healthcare spending growth as a per cent of gross domestic product and per capita, and healthcare workers as a per cent of total civilian employment and per capita. Secondary outcomes included growth and composition of practising physicians, nursing personnel and 'other' healthcare workers.

Healthcare employment and healthcare spending grew in all four countries over the study period. Healthcare employment accounted for over 90% of the variance in health spending over time in the USA, Canada and Australia and over 80% in the UK. Spearman correlation coefficients between employment and spending levels were 0.94 for Australia, 0.92 for Canada and 0.90 for both the UK and USA. While the USA led in healthcare spending growth prior to the Great Recession, its post-recession spending growth rate was similar to peer countries. Physicians and nurses collectively comprised less than one-third of total healthcare employment, with 'other' healthcare workers constituting the majority and a fast-growing component.

Results were consistent with all three hypotheses. Healthcare workforce growth was strongly correlated with spending growth within each country, reinforcing the centrality of labour force dynamics to healthcare spending trends.