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Environmental influences on healthcare expenditures: an exploratory analysis from Ontario, Canada
  1. M Jerrett1,
  2. J Eyles1,
  3. C Dufournaud2,
  4. S Birch3
  1. 1School of Geography and Geology, Health Studies Program, and Institute of Environment and Health, McMaster University, Hamilton, Ontario, Canada
  2. 2Department of Geography, University of Waterloo, Canada
  3. 3Department of Clinical Epidemiology and Biostatistics and Centre for Health Economics and Policy Analysis, McMaster University
  1. Correspondence to:
 Professor M Jerrett, School of Geography and Geology, Health Studies Program, and Institute of Environment and Health, McMaster University, Hamilton, Ontario, Canada L8S 4L8;


Study objective: This paper explores the relation between healthcare expenditures (HCEs) and environmental variables in Ontario, Canada.

Design: The authors used a sequential two stage regression model to control for variables that may influence HCEs and for the possibility of endogenous relations. The analysis relies on cross sectional ecological data from the 49 counties of Ontario.

Main results: The results show that, after control for other variables that may influence health expenditures, both total toxic pollution output and per capita municipal environmental expenditures have significant associations with health expenditures. Counties with higher pollution output tend to have higher per capita HCEs, while those that spend more on defending environmental quality have lower expenditures on health care.

Conclusions: The implications of our findings are twofold. Firstly, sound investments in public health and environmental protection have external benefits in the form of reduced HCEs. Combined with the other benefits such as recreational values, investments in environmental protection probably yield net social benefits. Secondly, health policy that excludes consideration of environmental quality may eventually result in increased expenditures. These results suggest a need to broaden the cost containment debate to ensure environmental determinants of health receive attention as potential complements to conventional cost control policies.

  • healthcare expenditures
  • environment

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  • Funding: this research was funded by the McMaster Institute of Environment and Health and the Geographic Information Science Health and Environmental Analysis Laboratory, McMaster University.

  • Conflicts of interest: none.

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