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Why do some countries spend more for health? An assessment of sociopolitical determinants and international aid for government health expenditures
Abstract
A consensus exists that rising income levels and technological development are among key drivers of total health spending. Determinants of public sector health expenditure, by contrast, are less well understood. This study examines a complex relationship across government health expenditure (GHE), sociopolitical risks, and international aid, while taking into account the impacts of national income, debt and tax financing and aging populations on health spending. We apply a fixed-effects two-stage least squares regression method to a panel dataset comprising 120 countries for the years 1995 through 2010. Our results show that democratic accountability has a diminishing positive correlation with GHE, and that levels of GHE are higher when government is more stable. Corruption is associated with less GHE in developing countries, but with higher GHE in developed countries. We also find that development assistance for health (DAH) is fungible with domestically financed government health expenditure (DGHE). For an average country, a 1% increase in DAH to government is associated with a 0.03-0.04% decrease in DGHE. Furthermore, the degree of fungibility of DAH to government is higher in countries where corruption or ethnic tensions are widespread. However, DAH to non-governmental organizations is not fungible with DGHE.
... In this way, they strengthen the government's ability to define and implement health-promoting policies. The result is also consistent with previous research that voice and accountability enhance public health expenditures (Farag, et al., 2012;Liang & Mirelman, 2014) and improve health outcomes (Wigley & Akkoyunlu-Wigley, 2011. Voice and accountability is the fourth most relevant individual institutional dimensions that foster health outcome in SSA. ...
... governments are more willing to invest in health (Klomp and Haan, 2009;Liang & Mirelman, 2014). A stable government can place more emphasis on long-term social programs, such as health (Liang & Mirelman, 2014). ...
... governments are more willing to invest in health (Klomp and Haan, 2009;Liang & Mirelman, 2014). A stable government can place more emphasis on long-term social programs, such as health (Liang & Mirelman, 2014). Many public health programs require substantial financial support, while the benefits can only be seen in the long term. ...
This paper identifies the institutional dimensions that are the most relevant to the improvement of health capital in sub-Saharan Africa. To this end, institutional quality measures are integrated into a health production model. Using data from the World Bank, this model is estimated by the Two stage least squares (2SLS) method on a panel of 45 countries over the period 1996–2018. The results show that the most relevant institutional dimensions that foster health capital development in the region are by order: rule of law, control of corruption, government effectiveness, voice and accountability and political stability and absence of violence. The results suggest that fostering these institutional quality dimensions is critical to improving health capital development in Africa.
... Existing literature has studied health financing transitions to examine the determinants of an increase in per capita government health expenditure and the associated fall in the share of out-of-pocket payments (OOP) to total health expenditure (THE) (Fan and Savedoff 2014;Ke et al. 2011). While some studies have explored the crowding-out concept in the health financing transition, they have not estimated the effects of government health expenditure on out-of-pocket payments and external assistance on health and vice versa (Dieleman and Hanlon 2014;Liang and Mirelman 2014;Fosu 2008). Many studies have found that per capita income, fiscal improvement, and demographic changes are significant drivers of the rise in government health expenditure (Di Matteo 2005;Baltagi and Moscone 2010). ...
... Further, the result shows a crowding-out effect between GGHE and EXT in countries without legislation on UHC. Even though past literature has not directly measured the crowding-out effects of health expenditure, it has measured the displacement or replacement of GGHE during the external economic crisis (Dieleman and Hanlon 2014;Ke et al. 2011;Fosu 2008;Liang and Mirelman 2014). Liang and Mirelman (2014) argue that development assistance for health (DAH) is interchangeable with domestically funded government health expenditure, and their research shows a negative relationship in the sample of 120 countries. ...
... Even though past literature has not directly measured the crowding-out effects of health expenditure, it has measured the displacement or replacement of GGHE during the external economic crisis (Dieleman and Hanlon 2014;Ke et al. 2011;Fosu 2008;Liang and Mirelman 2014). Liang and Mirelman (2014) argue that development assistance for health (DAH) is interchangeable with domestically funded government health expenditure, and their research shows a negative relationship in the sample of 120 countries. Fosu (2008) found that external debt servicing arrangement for structural adjustment during an economic crisis reduces domestic government health expenditure in Sub-Saharan African countries. ...
Healthcare financing is crucial for sustainable development and has been gaining attention, particularly since the COVID-19 pandemic. Although ample studies have explored the determinants of healthcare spending, the current study examines the determinants of health financing transition in 124 low- and middle-income countries (LMICs) for 19 years, from 2000 to 2018. The study first estimates the elasticity of health expenditure (i.e., government, private, and external) to per capita income, fiscal spending, age dependency, control of corruption, and time; second, it investigates crowding-out/in effects between domestic and external health financing. As the sample countries are heterogeneous in terms of development and universal health coverage (UHC) reform, our study employs a panel regression model with cluster-robust fixed effects and a bootstrapping quantile regression with fixed effects model to capture unobserved heterogeneity and produce robust estimates across quantile distributions. The results show that an increase in per capita government health expenditure (GHE) and per capita external health expenditure from foreign donors can reduce the share of out-of-pocket health expenditure to total health expenditure (OOPHE), thereby improving the health status and well-being of the people. The study also finds crowding-out effects of per capita external health financing on GHE in LIMCs. Interestingly, the results show that the control of corruption increases the per capita GHE in low-income countries. Thus, in low-income countries, improving governance would improve efficiency in fund utilization and strengthen the health system. Further, our study concludes that those countries that have passed UHC legislation are moving faster toward health financing transition by increasing public spending on health care. Healthcare policy in developing countries should prioritize (i) the adoption and implementation of UHC reform, (ii) alternative revenue mobilization strategy for financing public health care.
... Our results are corroborated by previous literature that suggest five potential avenues in which corruption can affect MM. The first concerns public spending on healthcare [50,51]. Mauro finds evidence that corrupt politicians tend to spend more public resources on those sectors on which it is easier to levy larger bribes [50]. ...
... Similar results for developing countries have been found by Delavallade [52]. Whereas Liang and Mirelman, using a dataset covering 120 countriesincluding both high-income and developing countries-come up with mixed results [51]. The authors find that the correlation between corruption and healthcare spending is positive in high income countries, while it is negative for low middle income ones [51]. ...
... Whereas Liang and Mirelman, using a dataset covering 120 countriesincluding both high-income and developing countries-come up with mixed results [51]. The authors find that the correlation between corruption and healthcare spending is positive in high income countries, while it is negative for low middle income ones [51]. Second, corruption reduces government revenues, which, in turn, leads to lower publicly provided services [53]. ...
About 295,000 women died globally during and following pregnancy and childbirth in 2017. Two-thirds of these deaths occurred in Sub-Saharan Africa. By linking individual and regional data from 135 regions in 17 Sub-Saharan African countries over the period 2002–2018 this study explores how bribery affects maternal mortality in Sub-Saharan Africa. Our results show that the percentage of people who had first-hand experience in bribery is significantly and positively associated with pregnancy related deaths. We find that a 10 p.p. increase in the prevalence of bribery is associated with up to 41 [95% CI: 10–73] additional deaths for every 1,000 pregnancy-related deaths. However, the healthcare system quality appears to be an important moderator. To reduce maternal mortality, policy makers should not only increase investments in healthcare, they need also to implement measures to combat corruption.
... These have found determinants of overall health expenditure to include not only macroeconomic factors (eg, GDP per capita as the strongest determinant), [14][15][16][17][18] health financing arrangements, 19 20 and demographic and socioeconomic status, 21 22 but critically, political factors. [23][24][25][26][27][28] Reeves et al found the implementation of austerity measures in 27 European Union (EU) countries led to reduced health expenditure, but that the government's ideology had no impact. 23 Both democratic and authoritarian leadership have been shown to have a positive effect on government health expenditure (GHE). ...
... 27 Democratic accountability was found to have a diminishing positive correlation with GHE, however the levels of GHE were higher when the government was more stable. 28 Corruption is associated with lower GHE in LMICs, but with higher GHE in high-income countries. 28 Political will and good governance in health have been shown to be major drivers of effective health systems 30often achieved through strengthening PHC and improving service accessibility and equity, and particularly among women and children. ...
... 28 Corruption is associated with lower GHE in LMICs, but with higher GHE in high-income countries. 28 Political will and good governance in health have been shown to be major drivers of effective health systems 30often achieved through strengthening PHC and improving service accessibility and equity, and particularly among women and children. Particular governance arrangements and political structures have been associated with improved health outcomes, such as maternal, child and adult mortality and life expectancy, intermediated by the strength of the health system and the level of resources. ...
In 2018 global leaders renewed their political commitment to primary healthcare (PHC) ratifying the Declaration of Astana emphasising the importance of building a sustainable PHC system based on accessible and affordable delivery models strengthened by community empowerment. Yet, PHC often remains underfunded, of poor quality, unreliable and not accountable to users which further deprives PHC of funding. This paper analyses the determinants of PHC expenditure in 102 countries, and quantitatively tests the influence of a set of economic, social and political determinants of government expenditure on PHC. The analysis is focused on the determinants of PHC funding from government sources as the government is in a position to make decisions in relation to this expenditure as opposed to out-of-pocket spending which is not in their direct control. Multivariate regression analysis was done to determine statistically significant predictors.
Our analysis found that some economic factors—namely Gross Domestic Product (GDP) per capita, government commitment to health and tax revenue raising capacity—were strongly associated with per capita government spending on PHC. We also found that control of corruption was strongly associated with the level of total spending on PHC, while voice and accountability were positively associated with greater government commitment to PHC as measured by government spending on PHC as a share of total government health spending.
Our analysis takes a step towards understanding of the drivers of PHC expenditure beyond the level of national income. Some of these drivers may be beyond the remit of health policy decision makers and relate to broader governance arrangements and political forces in societies. Thus, efforts to prioritise PHC in the health agenda and increase PHC expenditure should recognise the constraints within the political landscapes and engage with a wide range of actors who influence decisions affecting the health sector.
... The income level of a country, as measured by GDP, is a key variable that is commonly applied by researchers in studies focusing on the determinants of PHE. Various studies, such as those by Fan and Savedof [9], Liang and Mirelman [17], and Sfakianakis et al. [18] confirm the positive relationship between PHE and GDP. Although researchers agree that growing incomes increase the demand for health care services and raise health spending, they differ over how much. ...
... This relationship appeared to be stronger in the short run, rather than in the long run. Using data covering 120 countries for the years 1995 and 2010, Liang and Mirelman, also found a positive relationship between government debt and PHE [17]. Studies focusing on countries with a lower level of GDP tend to identify a negative relationship between the debt level and PHE. ...
Background
Public health expenditure is one of the fastest-growing spending items in EU member states. As the population ages and wealth increases, governments allocate more resources to their health systems. In view of this, the aim of this study is to identify the key determinants of public health expenditure in the EU member states.
Methods
This study is based on macro-level EU panel data covering the period from 2000 to 2018. The association between explanatory variables and public health expenditure is analyzed by applying both static and dynamic econometric modeling.
Results
Although GDP and out-of-pocket health expenditure are identified as the key drivers of public health expenditure, there are other variables, such as health system characteristics, with a statistically significant association with expenditure. Other variables, such as election year and the level of public debt, result to exert only a modest influence on the level of public health expenditure. Results also indicate that the aging of the population, political ideologies of governments and citizens’ expectations, appear to be statistically insignificant.
Conclusion
Since increases in public health expenditure in EU member states are mainly triggered by GDP increases, it is expected that differences in PHE per capita across member states will persist and, consequently, making it more difficult to attain the health equity sustainable development goal. Thus, measures to reduce EU economic inequalities, will ultimately result in reducing disparities in public health expenditures across member states.
... It has long been argued that corruption affects the composition of public expenditure (Croix and Delavallade, 2007;Delavallade, 2006;Mauro, 1998). According to Liang and Mirelman (2014) the most corrupt countries allocate fewer public resources to the health Electronic copy available at: https://ssrn.com/abstract=4719753 sector, which provides less rent-seeking opportunities for officials and the government than other components of public expenditure (physical capital, housing, etc.). ...
... sector, which provides less rent-seeking opportunities for officials and the government than other components of public expenditure (physical capital, housing, etc.). This implies that controlling corruption facilitates the allocation of public expenditure to the health sector (Liang and Mirelman, 2014). ...
Using Afrobarometer data, we show that respondents living in sub-national regions in which corruption in the health sector is more common are more likely to report that they have had to go without medical care for themselves or their family regularly or lack access entirely. We also show that corruption in other aspects of the public administration is not significantly associated with access to health care, suggesting that when it comes to improving access to healthcare, fighting medical corruption is of primary importance. For those who have accessed medical care, the regional incidence of medical corruption predicts more difficulty in terms of obtaining the care that they needed. We conclude that medical corruption not only restricts access to medical care, but also degrades the quality of the service for those able to access the system.
... From a demographic perspective, the literature mainly shows the role of population aging (Murthy and Okunade, 2016). Regarding political factors, Liang and Mirelman (2014) and Datta (2019) show that accountability and democracy increase public health expenditure. Despite this growing interest in the political determinants of health spending, little attention has been paid to the role of women's political empowerment. ...
... We also use four main controls variables, namely (i) the natural logarithm of GDP per capita, (ii) trade openness, (iii) the share of the population over 65 years of age and, (iv) total natural resources rent. Consistent with the literature on the determinants of health expenditure, we expect a positive effect of GDP per capita, trade openness, and aging population on public health expenditure (Liang and Mirelman, 2014;Murthy and Okunade, 2016;Rana, 2020). According to the resources curse literature, we expect a negative effect of natural resources (Cockx and Francken, 2014). ...
This paper analyses the effect of women's political empowerment on public health expenditure in a sample of 48 African countries over the period 2000-2017. Using The Ordinary Least Squares (OLS), the two-step system Generalized Method of Moments (GMM), and the Sequential Linear Panel Dynamic Model (SELPDM), the results provide strong evidence of a positive effect of women's political empowerment on public health expenditure in Africa. This result is robust to additional control variables, to alternative measures of women's political empowerment, to alternative measure of health expenditure, to outliers, and to alternative data structure. Based on these findings, we encourage efforts to promote the African women's political empowerment and suggest an increase in the number of seats held by women in parliaments.
... Indeed, many developing countries depend on foreign aid and grants to improve delivery of social sector services (including health) and boost economic growth. However, such aid has the potential to reduce domestically generated government health spending [10,11]. ...
... Also, since the political aim of government officials is to retain power, an incumbent government may be opportunistic by altering fiscal policies by spending more on specific sectors of the economy to attract votes [26,27]. Further, since democracy reduces corruption, government health spending is expected to be higher in democracies than under dictatorships [10]. ...
Purpose: This paper examines the factors influencing government health spending in Ghana with a particular focus on IMF conditionalities.
Design/methodology/approach: We estimate four simultaneous equations using three-stage least squares (3SLS) estimator. The data used cover the period 1980 – 2014.
Findings: After controlling for some other factors affecting government health spending, the results show that democracy and foreign aid significantly increase public sector health funding. IMF programs with its associated conditionalities insignificantly reduce public health spending Ghana.
Originality/value: This study provides important evidence on the impact of IMF conditionalities on health sector funding in Ghana. The results will serve as guide to policymakers when negotiating for IMF credit so that such arrangements do not obstruct health sector funding.
... However, the impact of anti-corruption on health outcomes is controversial. On the one hand, the mitigation of corruption can improve health outcomes by increasing the efficient use of medical funds [18] and the effectiveness of public health policies [19]. On the other hand, perhaps because anti-corruption reduces the motivation of government officials to provide the society with an appropriate number of high-quality public goods [20], Hessami [21] and Liang and Mirelman [18] found a positive relationship between corruption and government health expenditure, which means that less corruption may lead to less government health expenditure and thus produce a negative impact on health outcomes. ...
... On the one hand, the mitigation of corruption can improve health outcomes by increasing the efficient use of medical funds [18] and the effectiveness of public health policies [19]. On the other hand, perhaps because anti-corruption reduces the motivation of government officials to provide the society with an appropriate number of high-quality public goods [20], Hessami [21] and Liang and Mirelman [18] found a positive relationship between corruption and government health expenditure, which means that less corruption may lead to less government health expenditure and thus produce a negative impact on health outcomes. As such, government efficiency may affect health outcomes by influencing anti-corruption, but the influence direction is not clear. ...
This paper uses the unbalanced panel data of 156 countries during the period of 2002 to 2018 to explore the possible impact of government efficiency on health outcomes. Firstly, we used the fixed-effect model to examine the relationship between government efficiency and health outcomes and found that the increase in government efficiency can significantly improve health outcomes. Then, a series of robustness checks were carried out, which confirmed the reliability of the above result. Thirdly, this paper conducted a heterogeneity analysis from the perspective of life cycle. Fourthly, this paper investigated the mechanisms of the impact of government efficiency on health outcomes from the perspectives of economic growth, health innovation, education and corruption control. Finally, this paper studied the moderating effects of the ruling party’s ideology and democracy on the relationship between government efficiency and health outcomes. The findings of this study provide some references for governments to improve health outcomes.
... Our empirical understanding of the full impacts of development lending, the ensuing debt stock and its servicing on health financing in borrower countries is, however, limited and conflicting. Three studies of countries in Africa (using data from 1975 to 1994) [12], Latin America (1985-2003) [13] and South and Southeast Asia (1980-2010) [14] have found a higher debt burden to be associated with less government health spending or less overall social spending, while a larger study of 120 LMICs found the opposite (1995-2010) [15]. Other research has identified constraining effects on government health spending of IMF loan conditionalities (e.g. ...
... [16,17]). The identified empirical studies [12][13][14][15][16][17] are all quantitative multi-country studies. We therefore have a limited understanding of which particular social, economic and political country characteristics and which lending arrangements constrain health spending or support it. ...
Debt burdens are growing steadily in Low- and Middle-Income Countries (LMICs), compounded by the COVID-19 economic recession, threatening to crowd out essential health spending. In 2019, 54 LMICs spent more on servicing their debt to foreign creditors than on financing their health services. While development loans may have positive effects on population health, the ensuing debt servicing requirements may have detrimental effects on health through constrained fiscal space for government health spending. However, the existing evidence is inadequate for an understanding of whether, and if so how and under what circumstances, debt may constrain government health spending. We call for more research on the impacts of debt on health financing and call on creditors and borrowers to carefully consider the potential impacts of lending on borrower countries’ ability to finance their health services.
... The stability of the political environment is a critical dimension of institutional quality that determines the interest of policy makers in improving health. In a context where the political environment is stable and certain, governments are more willing to invest in health (Klomp and Haan, 2013;Liang and Mirelman, 2014). Liang and Mirelman (2014) suggest that there is an intrinsic difference in the goals of stable and unstable governments. ...
... In a context where the political environment is stable and certain, governments are more willing to invest in health (Klomp and Haan, 2013;Liang and Mirelman, 2014). Liang and Mirelman (2014) suggest that there is an intrinsic difference in the goals of stable and unstable governments. For them, a stable government is able to place more emphasis on long-term social programs, such as health. ...
The objective of this research is to identify the institutional dimensions that are the most relevant to the improvement of health outcomes in sub-Saharan Africa. To this end, institutional quality measures are integrated into a health production model. This model is estimated by the Two-stage least squares method on a panel of 45 countries observed over the period 1996-2018. The data used are from the World Bank. The results show that the most relevant institutional dimensions that improve health outcomes in the region are by order: rule of law, control of corruption, government effectiveness, voice and accountability and political stability and absence of violence. For these reasons, African decision-makers who often have limited resources can focus on a few key components of these institutional qualities or their combinations to improve health outcomes in their countries.
... In the context of SSA, Lu et al. (2010) confirmed that aid exerts a positive impact on PHE when it channelled through private sector and adverse impact when it comes via government agencies. Similar conclusions have been obtained by Liang and Mirelman (2014) who employed a panel dataset comprising 120 developed and developing countries among them was SSA. Their results showed that the increases in aid inflows through government were associated with significant decreases in PHE. ...
... Moreover, the reported results show that aid presence in SSA exercises no fungible effect on PHE. This finding lends a great support to study of Liang and Mirelman (2014) which vindicated the absence of fungibility hypothesis in the region. However, this outcome opposes the evidence executed in the other contexts arguing that aid is fungible (Heller, 1975;Khan and Hoshino, 1992;Gbesemete and Gerdtham, 1992;Brautigam and Knack, 2004;Farag et al., 2009;Murthy and Okunade, 2009;Ke et al., 2011). ...
... In the context of SSA, Lu et al. (2010) confirmed that aid exerts a positive impact on PHE when it channelled through private sector and adverse impact when it comes via government agencies. Similar conclusions have been obtained by Liang and Mirelman (2014) who employed a panel dataset comprising 120 developed and developing countries among them was SSA. Their results showed that the increases in aid inflows through government were associated with significant decreases in PHE. ...
... Moreover, the reported results show that aid presence in SSA exercises no fungible effect on PHE. This finding lends a great support to study of Liang and Mirelman (2014) which vindicated the absence of fungibility hypothesis in the region. However, this outcome opposes the evidence executed in the other contexts arguing that aid is fungible (Heller, 1975;Khan and Hoshino, 1992;Gbesemete and Gerdtham, 1992;Brautigam and Knack, 2004;Farag et al., 2009;Murthy and Okunade, 2009;Ke et al., 2011). ...
Out of pocket health expenditure (OOPHE) represents a substantial share of health spending in Sub-Sahara Africa (SSA). OOPHE consumes a large proportion of the population’s incomes and, therefore, pushes them into sever poverty. In this paper, we examine whether and to what extent foreign aid and its interaction with the recipient country’s institutional quality reduce OOPHE. We apply fixed-effects instrumental variables (FE-IV) panel regressions for data set belongs to 45 SSA countries over the period 1995-2015. We find that aid does not robustly affect OOPHE. Neither does the effect of aid depend on institutional quality. Finally, we test whether aid affects public health expenditure (PHE), which is arguably the dominant transmission channel through which aid should affect OOPHE. We find that aid had no effect on PHE indicating the rejection of fungibility hypothesis.
... Finally, as regards the effect of political instability on public spending on healthcare, the only study to our knowledge that has looked into this issue is that by Liang and Mirelman (2014). ...
The aim of this paper is to examine the moderating effect of political instability on the relationship between fiscal capacity and public health expenditure. On the basis of panel data from six (06) countries of the West African Economic and Monetary Union, over the period 2000-2020, the method of double least squares with time and individual fixed effects was applied. It was established that fiscal capacity positively influenced public health expenditure. The coefficient for the interaction term was negative and significant, affirming the hypothesis that political instability distorts the positive impact of public health expenditure. It is necessary for various governments to further improve their mobilization of fiscal resources to move towards universal health coverage. To mitigate the adverse effects of political instability on public healthcare financing, there is a need for West African Economic and Monetary countries to improving the quality of governance. The implementation of economic policies aimed at reducing inequalities, creating jobs and providing equitable opportunities for all citizens helps to improve people's conditions, fighting corruption and promoting transparency and accountability. These economic policies are necessary for political stability, which facilitates the mobilisation of fiscal resources and consequently improves public health expenditure.
... Corruption limits the scope for public expenditure and investment in health care by retarding economic growth and development (Mauro, 1995 (1998) shows that corruption distorts the composition of public expenditure as some areas offer greater scope for bribery and embezzlement. While Maruo only found suggestive evidence that corruption reduces health expenditure, later work has availed of larger datasets to con rm that corruption reduces public expenditure on healthcare, at least in developing countries (Liang and Mirelman, 2014). Within health budgets, corruption can also have a distorting effect leading to a bias in favour of constructing expensive high-tech facilities at the expense of basic primary heath expenditure as the former offer greater scope for kickbacks, nepotism, and embezzlement (Vian, 2008a(Vian, , 2008b. ...
A large literature links corruption to reduced investment in health infrastructure, inefficiencies and distortions in health systems, and poor health outcomes. Corruption also leads to poor quality buildings and infrastructure, and increased death and destruction from natural disasters. The literature thus tells us that “corruption kills” but a gap exists in terms of our understanding of the effect of corruption on health inequality. Using country level panel data on inequality in the length of life from Jorda, Niño-Zarazúa, and Tejería-Martínez (2024) and the V-DEM indicator of political corruption, we show that increases in corruption lead to increases in health inequality. These results are robust to using GMM methods to allow for endogeneity. All components of the overall V-DEM political corruption index are harmful in terms of generating health inequality when entered in the model on their own, with corruption in the legal and public sectors emerging as significant when all are included. Health inequality for men and women is increased by corruption. Finally, we demonstrate that corruption leads to increased gaps in the length of life in middle and low incomes countries, but not in high income countries. Corruption is a particular threat to citizens of emerging and developing countries.
... (PIB). From 1995to 2009, Fan and Savedoff (2014, as well as (Liang & Mirelman, 2014), conducted in-depth assessments of the relationship between revenue mobilization and government spending on healthcare in 126 countries. Moreover, an in-depth study of 89 countries from 1995 to 2011 revealed a significant connection between government tax revenues and healthcare spending (Reeves et al., 2015). ...
Using environmental, economic, and demographic variables, this paper aims to reveal their effects on South Asian countries’ public health expenditures during the period 2002 to 2020. Using the short-run and long-run coefficients obtained from the panel autoregressive distributed lag (ARDL) model, this paper analyzes the effect that variables like CO2 emission, GDP per capita, life expectancy, and the proportion of elderly people on government health expenditure. The analysis shows that CO2 emissions correlate positively with GDP per capita with public health expenditures showing the burden on the health budgets due to environmental pollution and development. On the other hand, an increased elderly population is characterized by a negative relation with health spending probably due to changed healthy living lifestyles. Life expectancy has a positive relationship with healthcare expenditures and all other variables have shown insignificant effects on expenditures or else any other variable. The research stresses the post-COVID-19 need for regulating air pollution, distributing economic resources efficiently, and developing more sustainable healthcare policies in South Asia. The outcomes of these analyses should assist policymakers in strategically addressing the conflict between environmental protection and economic growth, as well as investment in public health.
... In the quantitative literature, some econometric studies have examined the relationship between external and domestic financing in the form of fungibility, i.e. whether the health budget increases by less than the amount injected as development assistance for the health sector due to an associated decrease in Government Health Expenditure as a Source (GHE-S), i.e. from domestic revenue (Lu et al. 2010, Dieleman et al. 2013, Liang and Mirelman 2014, Patenaude 2021, with most authors finding a fungibility effect. Other studies have examined the relationship between external health financing and out-of-pocket payments (OOPs), finding no effect or a crowding-in effect (Xu et al. 2011, Younsi et al. 2016, Ali et al. 2020. ...
Sustainable and equitably contributed domestic health financing is essential for improving health and making progress towards Universal Health Coverage (UHC) in Low- and Middle-Income Countries. In this study, we explore the pathways through which development partners influence the mix of domestic health financing sources in Senegal. We performed a qualitative case study comprised of 32 key stakeholder interviews and a purposive document review, supplemented by descriptive statistical analysis of World Health Organization and Organization for Economic Cooperation and Development data on health financing sources in Senegal. We developed a novel framework to analyse the different mechanisms and directions of development partner influence on domestic health financing contributions.
We identified development partner influence via four mechanisms: setting aims and standards, lobbying/negotiation, providing policy/technical advice, and providing external financing. Overall, development partners worked to increase tax-based government contributions and expand Community-Based Health Insurance (CBHI), which is seemingly equity enhancing. Fungibility and intrinsic equity issues related to CBHI may however limit equity gains. We encourage stakeholders in the health financing sphere to use our framework and analysis to unpack how development partners affect domestic health financing in other settings. This could help identify dynamics that do not optimally enhance equity and support progress towards UHC, to help achieve more coherent policy-making across all domains of development partner activities in support of UHC. Future research should investigate the role of international creditors, lending and loan conditionalities on domestic health financing in recipient countries, including equity implications.
... The absence of violence and a stable political environment are the most important indicators of institutional quality that affect the interest of policymakers in enhancing health. In a stable political environment with the absence of violence, governments will be more interested in allocating more of their budget and willing to invest in health (Liang and Mirelman 2014), which could, in turn, enhance health outcomes and economic growth. Moreover, the presence of violence could play a role in the spread of diseases (such as HIV/AIDS, malaria, etc.). ...
Institutional quality (InQ) plays an important role in shaping economic growth (ECG), influencing how economies develop and perform. The literature addresses the nexus between InQ and ECG and the link between health and ECG; findings are often contradictory, creating knowledge gaps. Importantly, research on the interplay between InQ, health, and ECG in Sub-Saharan African (SSA) countries is particularly limited. This study aims to address this gap by evaluating how health impacts ECG, with an emphasis on the mediating role of InQ in the health–growth nexus in SSA. This study examines these interplays across 35 SSA countries from 2012 to 2022. The life expectancy at birth (LEX) and real gross domestic product per capita (GDP) are used as proxies for health outcomes and ECG, respectively. The system generalised method of moments estimator is employed to analyse data. Results show that the LEX has a strong positive effect on economic growth in SSA countries. Furthermore, the InQ indicators (such as control of corruption, government effectiveness, rule of law and political stability, and absence of violence) are positively correlated with ECG. When the LEX interacts with InQ indicators, InQ is identified as a key channel through which LEX influences ECG. The findings confirm that InQ plays a crucial role in the health–growth nexus, with the positive impact of LEX on ECG being more pronounced in countries with higher levels of InQ, while the effect is weaker in countries with lower levels of InQ. The findings of this study have crucial policy implications, highlighting the intricate link among institutional quality, health outcomes, and economic growth. This study’s findings provide essential insights for policymakers to design focused strategies that improve InQ and health outcomes to achieve sustained ECG in SSA.
... The study also found that healthcare costs affected GDP forecasts (Mladenović et al. 2016). Government spending on healthcare in 126 countries between 1995 and 2009 may be mainly attributed to revenue mobilization (Fan and Savedoff 2014;Liang and Mirelman 2014). A similar study also found that CO2 emissions in the top 15 natural gas provider nations from 2000 to 2018 were analyzed, considering the economic complexity index, urbanization, technology, and natural gas supply (Shah et al. 2023). ...
Air pollution is a danger to economies throughout the European Union. Industry, population expansion, a building boom owing to housing and infrastructure development, increasing vehicle traffic, crowded streets, a lack of availability of clean fuel, and ineffective control programs are the primary causes. Toxic air is a double-edged sword for a country’s health since it affects just a tiny fraction of Europe’s population. The financial burden and healthcare expenses for people rise when health expenditures rise. The present research looks at how dangerous air levels, healthcare costs, and the expansion of the European Union’s economy are all connected. The findings are based on data collected over 29 years and account for the abovementioned variables. The results of the unit root test have the significant probability values of all variables: health expenditures (HE), gross domestic product (GDP), nitrous oxides (NOX), and carbon dioxides (CO2) emissions at both level and first difference. We used the Johansen, Kao, and Pedroni cointegration tests to test the null hypothesis of no cointegration to see that sample variables had a long-term association. The PMG-ARDL test was used to get these findings. The results confirmed the significant probability values of dependent variables in long- and short-run results that GDP has a positive and significant effect on health expenditure, while NOX and CO2 emissions have a negative and significant impact on (HE), in the European Union. To verify the results, we applied the robustness test, fully modified OLS (FMOLD), and dynamic OLS (DOLS); the robustness test results validated the PMG-ARDL test results. Environmental pollution (CO2, NOX) has a significant and negative impact on healthcare expenditures and a significant effect on GDP (HE) in the EU region. The findings of this research have implications for a wide range of parties, including those who would examine the link between factors in a study meant to improve air quality, distribute health resources, or develop strategies for economic development.
Graphical Abstract
... However, it appears that an increase in tax revenues, especially through income tax and VAT rates, has a negative effect on GDP. Liang and Mirelman (2014) document that government debt and per capita GDP have a positive and statistically significant impact on public health expenditure. The positive sign on government debt implies that debt financing provides financial leverage to increase public expenditure on health. ...
This paper investigates the relationship between public health expenditure growth and macroeconomic determinants in 59 low-, low-middle-, and upper-middle-income countries from 2000 to 2019. The study is motivated by the need to understand how macroeconomic policies affect public health spending and the performance of health systems in these countries. To achieve this objective, the Arellano-Bover/Blundell-Bond system-GMM approach is applied on dynamic panel data by dividing the global panel into three sub-panels: full sample period, pre-global financial crisis period, and post-global financial crisis period. The results show that tax capacity and spending capacity exhibit positive impacts on public health expenditure in the full sample period and pre-global financial crisis period, respectively. Meanwhile, in the post-crisis period, public health expenditure is negatively influenced by the global financial crisis due to weak taxation capacity and high debt burden. We find that debt service burden has a positive impact on public health expenditure (% of GDP) in the full sample period and pre-global financial crisis period, respectively, while public health expenditure (% of GGE) is negatively affected by debt service burden in the post-crisis period. Furthermore, fiscal balance has a negative and significant impact on public health expenditure in all sample periods. Our analysis also shows that the rise of public health expenditures is significantly influenced by GDP per capita, population ageing, and development assistance for health. These findings have significant implications for policymakers seeking to improve health system financing and effectiveness in these countries, where governments should prioritize efforts to improve revenue and tax systems to allocate more funds towards health system financing performance.
... Conformément à la littérature sur les déterminants des dépenses de santé (Murthy et Okunade, 2009 ;Liang et Mirelman, 2014 ;Rana et al., 2021), nous considérons plusieurs variables de contrôle, dont le revenu, l'aide publique au développement, la part de la population âgée de plus de 65 ans et la proportion de sièges occupés par des femmes dans les Parlements. ...
Natural resources and health spending in Africa: Is the Extractive Industries Transparency Initiative breaking the curse?
It is regularly observed that resource-rich countries perform less well socio-economically and politically than their resource-poor counterparts: the so-called “resource curse.” Several studies have shown that the poor quality of institutions is a key factor behind this curse. With this in mind, this paper examines whether the Extractive Industries Transparency Initiative (EITI) mitigates the negative effect of natural resources on public health spending in a panel of 35 resource-rich African countries over the period 2003–2017. Using the generalized method of moments, the results indicate that natural resources reduce public health expenditure. Furthermore, the paper shows empirically that the EITI moderates the negative effect of natural resources. This result supports the idea that the EITI, far from being a panacea, is nevertheless an effective policy program.
... have examined the factors in the health sector. The following sets of studies are in-line with prevalent literature (16,21,25,28,34,37). The government's involvement in the health sector spending and investment, and also managing its funds for improvement in sustainable development, must be focused on for better public health. ...
In the current times, the global economies and international organizations declared that pollution is one of the prominent causes of declined human health. Still, most literature is biased toward economic sustainability and ignores such vital issues. The current study tends to identify the factors affecting public health in the Group of Seven economies except for Italy (G6). Specifically, this study aims to investigate the influence of household waste (HHW), bureaucratic quality (BQ), democratic accountability (DA), urbanization growth (URP), GDP per capita, and renewable energy use (EPR) on public health, throughout 1996-2020. This study uses advanced panel data approaches and finds the heterogeneity of slope coefficients, the dependence of cross-sections, and the persistence of cointegration between the variables. The asymmetric distribution of data leads to employing the novel method of moment quantile regression. The estimated results reveal that URP, GDPPC, and EPR significantly increase domestic general government health expenditures, improving public health. However, HHW and BQ adversely affect public health by reducing health expenditures. The robustness of the results is tested via utilizing the panel quantile regression. Based on the empirical findings, this study suggests policies regarding the improvement in public health expenditure, R&D investment, spending in renewable energy sector, and strengthening of the institutional quality.
... However, it appears that an increase in tax revenues, especially through income tax and VAT rates, has a negative effect on GDP. Liang and Mirelman (2014) document that government debt and per capita GDP have a positive and statistically significant impact on public health expenditure. The positive sign on government debt implies that debt financing provides financial leverage to increase public expenditure on health. ...
Purpose – Basel AML Index 2021: 10th Public Edition - Ranking money laundering and terrorist financing risks around the world - shows that the level of problems depends to a large extent on a particular region. The aim of the article is to investigate whether such a situation is related to the lack of legislative regulation in certain regions or to other factors.
Design/methodology/approach– Review of regional studies, discourse analysis
Findings – The legal framework for anti-money laundering (AML) and countering the financing of terrorism (CFT) has a unifying role in a global context. At the stage of implementing the new framework, the problem of uniformity is at the forefront: ensuring not only a uniform legislative framework but also uniform understanding and application. Although it may seem that laws and other regulatory enactments have a central, primary role, but in practical life (during the implementation of norms), this role is not really so important. Regulatory solutions are a good and necessary thing, but more important are the political will, the direction of the philosophical view of law and the values of society. In the field of combating terrorism and money laundering, the economic pragmatism of any single country should not prevail over global moral values. The legislative framework is only the first step in the fight against terrorism and money laundering.
Originality/value– This article discusses important relevant worldvide developments.
Keywords Anti-money laundering, countering the financing of terrorism
Paper type General review
... Pour cause, il existe d'autres déterminants de santé, notamment sociaux 25 La couverture des services de santé essentiels est définie comme la couverture moyenne des services essentiels basée sur des interventions dans les secteurs de la reproduction, la santé maternelle, la santé des nouveau-nés et des enfants, les maladies infectieuses, les maladies non transmissibles et capacité et l'accès des services, parmi la population en général et parmi les plus défavorisées (WHO, 2018). En Guinée, l'indice de couverture de santé universelle était chiffré à 35 en 2015 comparativement à 36 pour la Sierra Leone, 34 pour le Libéria et 41 pour le Sénégal (World Health Organization, 2018, p.37). 26 Certain.e.s chercheurs et chercheuses, dont Brouillet (2013); Liang & Mirelman (2014) ;Schieber, Fleisher, & Gottret (2006), s'interrogent sur les risques de dépendance face aux sources externes de financement de la santé. Dans certains cas, ils affirment que l'aide étrangère peut entraîner les pays bénéficiaires à réaffecter les ressources normalement attribuées à la santé, pour l'envoyer dans d'autres secteurs d'activités. ...
... The stability of the political environment is a critical dimension of institutional quality that determines the interest of policy makers in improving health. In a context where the political environment is stable and certain, governments are more willing to invest in health (Klomp and Haan, 2013;Liang and Mirelman, 2014). In addition, political instability caused by riots, civil war or strikes can disrupt a country's health system (Klomp and Haan, 2009). ...
Executive summary The objective of this article is to identify institutional quality dimensions that can improve the health of populations in Sub-Saharan Africa (SSA). Identifying the institutional quality that improves health is important because it can enable African policymakers who often have limited resources to focus on a few key components of this institutional quality to improve health in their countries. Health variables used in this research are life expectancy at birth, under-five mortality rate and maternal mortality ratio. In the context of achieving the United Nations Sustainable Development Goals (SDGs), the African Union (AU) Agenda 2063 and national development plans, the governments of African countries have made improving the health of their populations a priority economic policy objective. For example, in SDGs, the peoples of the United Nations aspire to good health and well-being. Goal 3 aims to enable all people to live in good health and to promote the well-being of all people at all ages (United Nations, 2015). Through Agenda 2063, the peoples of Africa aspire to a high standard of living and quality of life, good health and well-being by 2063 (African Union Commission, 2015). However, the achievement of these goals and aspirations requires the implementation of adequate health policies. It requires knowledge and understanding of the mechanisms that explain the formation of health capital. Analysing to identify these mechanisms, examining them to understand them and explaining them through the lens of institutional quality is the main concern of this article. In this work, we hypothesize that better quality of economic and political institutions improves the health of populations in SSA and that some institutional dimensions are more relevant than others. The institutional quality is integrated into Grossman's (2000) health production function and adapted for the context. This function is estimated using the World Bank's World Development Indicators (WDI) and Worldwide Governance Indicators (WGI) on a sample of 45 countries in SSA. 2SLS estimation techniques are used to take into account endogeneity problems related to institutional quality, health and other variables and also measurement errors in these variables. Very few studies have attempted to analyse the role of institutional quality on health outcomes in SSA. In most cases, the existing body of work focuses on developing countries in general. 3 Those who studied the role of institutional quality have often limited themselves to a single dimension of these institutions. Our study aims to use several dimensions of institutional quality. The aim is to investigate whether some of these dimensions are more relevant than others in explaining health outcomes in SSA. This study contributes to the literature by (i) using six institutional quality indicators to analyse the role of institutional quality on health outcomes; (ii) adopting a specification based on a theoretical model and an estimation method that takes into account the endogeneity issues associated mainly with institutional quality and health outcomes (iv) covering a sample of 45 sub-Saharan African countries observed over a relatively long period from 1996 to 2018. Our robust results show that institutional quality that foster health outcomes in SSA are in order rule of law, control of corruption, government effectiveness, voice and accountability, and political stability and absence of violence. In order to improve health in SSA, decision-makers should, for example, in the area of child health, focus on prevention through vaccination and improved nutrition. For children who are already sick, they should put in place policies that promote the accurate identification of children's illnesses, ensure appropriate and combined treatment for all major illnesses, strengthen counselling for caregivers and speed up the referral process for seriously ill children. They should also improve the case management skills of healthcare workers and adequately expand healthcare facilities. Indeed, at the time of birth, a child's chances of survival are likely to increase significantly if it is delivered in the presence of a skilled attendant and in a health facility. Providing free child health care so that all African children can benefit from interventions or treatment in case of illness can save many lives. Skilled care during pregnancy, childbirth and the postpartum period can make the difference between a mother's life and death. For example, a severe haemorrhage in the third stage of labour can kill a healthy woman in two hours without care. An oxytocin injection given immediately after delivery is very effective in reducing the risk of haemorrhage. Women should receive care from trained health professionals such as doctors, nurses and midwives. They must be able to access health facilities geographically, which means that public officials must build health facilities wherever they are needed. Means of transport such as ambulances 4 must be accessible. Similarly, medicines or emergency products such as blood for rapid blood transfusion must be available. Post-partum care is also of crucial importance. It enables medical personnel to ensure that the mother and child are well and, if not, to detect and treat any postpartum problems at an early stage. It also enables medical professionals to promote healthy health behaviours such as breastfeeding and good nutrition, provide hygiene and immunization recommendations, and offer family planning and other reproductive health services. Quality maternal health care before, during and after childbirth should also be free of charge in all countries of the region. The publication of report cards on the performance of local health facilities can also be important. Indeed, it can spur communities to press for reform of health service delivery and thus force governments to be more effective. It can also persuade health workers to be regularly available to their patients. In terms of political stability and violence, these governments can reduce economic and social inequalities that cause uncertainty and political instability and generally lead to particularly damaging effects on the health of populations. Other factors explaining the formation of health capital imply that public officials should also increase access to electricity and the level of development of their countries in order to improve health status. Universal access to primary education can also improve the health status of populations. Rural populations should not be left out of the picture. To this end, inequalities in access to health care between rural and urban areas must be reduced or even eliminated. The level and efficiency of current health expenditure should also be increased.
... With regard to the GDP per capita variable, we find that its coefficient is positive and significant at the 1% level, meaning that countries with higher per capita income are better able to allocate a significant share of wealth to health expenditure. This result corroborates that of Liang & Mirelman (2014), who found that rising income levels is among the key drivers of total spending on health. In column (3) we control for democracy and, once again, the effect of females in parliament on public health expenditure remained qualitatively and quantitatively the same. ...
... Since the second policy score is related to the size of the country but not to malaria or GDP, this score explains novel components of the small country bias. The quality of institutions is adversely affected by corruption, thus reducing corruption improves the institutional quality and often translates into more efficient healthcare systems [23]. Corruption is negatively correlated with public spending on education and health, and even with total health expenditure per capita [24]. ...
Background
Foreign aid continues to play an essential role in health sector development in low-resource countries, particularly in terms of providing a vital portion of their health expenditures. However, the relationship between foreign aid allocation and malaria policy formulation and/or implementation among state aid recipients remains unknown.
Methods
Publicly available data were collected with the country as observational unit to set up the conceptual framework. The quality and strength of relationships between socioeconomic, environmental and institutional parameters were estimated by Pearson and polychoric correlations. A correlation matrix was explored by factor analysis.
Results
The first policy index captured policy variation related to malaria burden and development assistance. Funding per capita from all international agencies was correlated with malaria burden, whereas governmental funding for national malaria programmes per capita was not. The second policy index captured variation beyond malaria endemicity and country size. Variation was found to be related to international country risk instruments and funding from the United States Agency for International Development President’s Malaria Initiative.
Conclusions
Not all agencies involved in malaria policy allocate assistance in alignment with the gross domestic product and malaria burden. While the country size does not negatively impact malaria burden, it does account for greater development assistance per capita from selected international agencies. Novel policy indexes describe complex relationships between malaria policy, international foreign aid and socioeconomic parameters. Small countries have distinct environmental and sociopolitical properties.
... 6 Less work has been completed to estimate income elasticities for total and government health spending in developing countries but similar challenges regarding functional form, relying on fixed effect models and to a lesser extent dynamic panel models will yield different estimates. 7,8,9,10,11 Only one study has modeled out of pocket health spending (Xu et al 2011). ...
... The quality of institutions and total health expenditure are influenced by corruption. Weakening corruption is fundamental to improving the efficiency of health care systems [29]. Corruption is correlated with public spending on education and health and even with total health expenditure per capita [22]. ...
Background
Foreign aid has been shown to be favourably biased towards small countries. This study investigated whether country size bias also occurs in national malaria policy and development assistance from international agencies.
Methods
Data from publicly available sources were collected with countries as observational units. The exploratory data analysis was based on the conceptual framework with socio-economic, environmental and institutional parameters. The strength of relationships was estimated by the Pearson and polychoric correlation coefficients. The correlation matrix was explored by factor analysis.
Results
Malaria burden is strongly correlated with GDP per capita, total health expenditure per capita, HDI; moderately with latitude, weakly with elevation, urban population share, per capita funding from the Global Fund, PMI USAID, UK government and UNICEF. Small country status is strongly correlated with population size, land area, island status; moderately with development assistance received per capita, weakly with funding per capita from Global Fund, government NMP and PMI USAID. Policy score 1, a variable derived from our factor analysis and related to malaria endemicity, is significantly strongly correlated with the malaria burden, moderately with HDI, GDP per capita, total health expenditure per capita, PMI USAID funding; weakly with island status, urban population share, latitude, coastal population share, total government expenditure and trade openness, Global Fund funding, World Bank funding, UK government funding, and UNICEF funding per capita. Policy score 2, which captures variation not related to malaria endemicity, is significantly weakly related to the ICRG index, PMI USAID funding per capita and small country status.
Conclusions
The results suggest that malaria burden and economic development are bidirectionally related. Economic development can contribute to a reduction in the malaria burden. Country size does not negatively impact malaria burden, but it does account for greater development assistance per capita from selected international agencies. National malaria policy is associated with parameters related to public governance and is modified in small countries. Small country bias is present in the distribution of socio-economic resources and the allocation of foreign aid. Small countries are characterized by distinct environmental and socio-political properties.
... Despite fears about democratic institutions causing problems for public health in the early stages of the COVID-19 pandemic, the existing literature on this issue provides evidence for the facts that democratic nations have healthier populations (Besley and Kudamatsu, 2006;Cutler et al., 2006;Hall and Jones, 2007), a longer life expectancy (Baum and Lake, 2003;Mackenbach et al., 2013), and they invest more in health care (Liang and Mirelman, 2014). This is even more transparent when one investigates the relationship between democracy and the HIV pandemic, which is well studied. ...
Standard-Nutzungsbedingungen: Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden. Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen. Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Abstract More democratic countries are often expected to fail at providing a fast, strong, and effective response when facing a crisis such as COVID-19. This could result in higher infections and more negative health effects, but hard evidence to prove this claim is missing for the new disease. Studying the association with five different democracy measures, this study shows that while the infection rates of the disease do indeed appear to be higher for more democratic countries so far, their observed case fatality rates are lower. There is also a negative association between case fatality rates and government attempts to censor media. However, such censorship relates positively to the infection rate.
... Despite fears about democratic institutions causing problems for public health in the early stages of the COVID-19 pandemic, the existing literature on this issue provides evidence for the facts that democratic nations have healthier populations (Besley and Kudamatsu, 2006;Cutler et al., 2006;Hall and Jones, 2007), a longer life expectancy (Baum and Lake, 2003;Mackenbach et al., 2013), and they invest more in health care (Liang and Mirelman, 2014). This is even more transparent when one investigates the relationship between democracy and the HIV pandemic, which is well studied. ...
More democratic countries are often expected to fail at providing a fast, strong, and effective response when facing a crisis such as COVID-19. This could result in higher infections and more negative health effects, but hard evidence to prove this claim is missing for the new disease. Studying the association with five different democracy measures, this study shows that while the infection rates of the disease do indeed appear to be higher for more democratic countries so far, their observed case fatality rates are lower. There is also a negative association between case fatality rates and government attempts to censor media. However, such censorship relates positively to the infection rate.
... On the other hand, government spending on health may increase total expenditure in the health sector, thus driving longterm prepayment levels in the opposite direction (16). The increased government expenditure on health can also be used to build hospitals, train doctors and nurses, and produce innovative drugs, thus promoting the overall development of the health sector and boosting the market (17,18). Compared with necessary medical services, high-tech equipment and services offered by well-educated employees are more expensive, while price regulation and control of premium healthcare packages are not always easy, particularly in a private-dominated system (19). ...
Background:
Health prepayment, a key indicator under the Sustainable Development Goals monitoring framework, is strongly associated with household financial protection; however, the impact of government health budget on the level of prepayment has rarely been discussed.
Aims:
To address the following research questions. (1) Does a higher government health budget translate into higher prepayment rates in the healthcare financing system? (2) What are the effects of government health budget on public prepayment and private prepaid plans? (3) What are the heterogeneities between groups of countries with different income levels and public health prepayment systems?
Methods:
Analysis of panel co-integration, impulse response function, and variance decomposition were conducted in 34 Organisation for Economic Co-operation and Development (OECD) members for the period 1995-2016.
Results:
Government health budget has a long-running equilibrium relationship with the level of public and total prepayment. However, a stable relationship could not be confirmed with private prepaid plans. Moreover, government health budget played a significant positive role in explaining the fluctuations in the total and public prepayments over a long time, that is, 51 and 37 periods, respectively. Considering differences between groups of countries, the impacts are greater for those with higher income levels and more public-dominated health-financing systems.
Conclusions:
Government health budget has a long-time relationship with the levels of both total prepaid expenditure and public prepayment. By contrast, it does not systematically crowd out private prepaid plans.
... An EA regime can use more government health expenditure when the EA is a high-income country. Furthermore, a country can decrease the government health expenditure when they can substitute it with international aid (Liang and Mirelman, 2014). GDP per capita data is from Table 2 presents primary empirical findings. ...
p>Previous studies on the public health expenditure focus on the presence of multiparty elections in electoral autocracies (EAs). Most of elections in EAs often are unfair because those are for the victory of dictators. Multiparty elections per se do not capture the impact of characteristics during elections such as the electoral competitiveness in EAs. Some EAs pay health expenditure less than others even though electoral competitiveness is high. I analyze the effect of electoral competitiveness on the government health expenditure with the balanced panel data of 20 EAs from 2001 to 2017. There are two rival arguments on how electoral competitiveness affect the expenditure according to previous studies; (a) a high level of electoral competitiveness stands for a difficulty of dictatorial winning in elections. Autocrats, hence, gather various demands including health issues from voters, and can increase the government health expenditure; (b) Autocrats pursue the victory in elections. Pork and personal benefits to voters rather than programmed policies are helpful for the victory. Therefore, there is no incentive for autocrats to provide government health policy to voters when the level of electoral competitiveness is high. Empirical findings demonstrate that electoral competitiveness in EAs lead the decrease of government health expenditure. This paper concludes that electoral competitiveness does not increase the public health expenditure; the higher level of competitiveness in autocracies does not mean that voters can exert their power to autocrats to realize policies.</p
The factors influencing donor countries’ overall contributions to developmental assistance for health (DAH) are little known, despite the importance of DAH in improving health conditions in low- and middle-income countries. This study examines how political elite polarization in legislative branches affects DAH commitments and disbursements from country-members of the OECD’s Development Assistance Committee. From a world-society perspective, political polarization may decouple DAH contributions from global health funding norms and values. I test the impact of polarization on DAH commitments and disbursements using two-way fixed-effects regression analyses on multiple data sets and a new index of right–left elite polarization. I find that polarization is negatively associated with DAH disbursements but shows no significant relationship with DAH commitments. This suggests that elite polarization in donor countries impedes legislative efficiency, potentially increasing DAH disbursement volatility, and (more broadly) that political dynamics in donor countries can significantly impact the stability of global health financing. These findings have important implications for understanding the challenges in sustaining consistent DAH funding, especially from Development Assistance Committee members.
We investigate the heterogeneous effect of various types of corruption on human capital accumulation in a sample of 88 developing countries from 2000 to 2018. Quantiles via moments regression is used for our empirical investigation. We find that corruption exerts an adverse effect on human capital accumulation. Moreover, the harmful effect of corruption on human capital accumulation is higher in countries with low stock of human capital and lower in countries with high stock of human capital. In addition, both public sector corruption and regime corruption are detrimental to human capital accumulation, although public sector corruption is the most detrimental. Furthermore, corruption disproportionately affects female human capital compared to male human capital. These results imply that anti‐corruption strategies should be taken into account in the formulation and implementation of policies to improve human capital in developing countries.
This article analyses the effect of women's political empowerment on child undernourishment for a sample of 87 developing countries over the period 2001–2021. We provide evidence through various empirical approaches that women's political empowerment reduces undernourishment. Examination of transmission channels indicates that women's political empowerment improves nutrition through its effects on public health spending, public education spending and governance. This result remains robust when we: (i) decompose the women's political empowerment index; (ii) control for income level, natural resource dependency, civil and political liberties, and religious predominance; and (iii) control for endogeneity using methods with external instrumental variables, namely two-stage least squares (2SLS) and Lewbel's ordinary least squares method. This article contributes to the literature by demonstrating the fundamental role of women’s political empowerment in achieving sustainable development goals, in particular improving the food and nutritional status of children.
This study uses data from 1986 to 2021 and the auto-regressive distributed lag model to explore India’s fiscal policy determinants of government health spending. The results find two structural breaks in time: (i) 2002 for state government health spending (SGHS) and (ii) 2014 for central government health spending. The results also show that central revenue transfers to states have a positive and statistically significant effect on SGHS in the long run. The results imply that a 1% rise in central revenue transfers to states leads to a 0.399% increase in SGHS. Further, state government public debt exhibits a negative and statistically significant relationship with SGHS, implying that a 1% rise in public debt leads to a 0.119% fall in SGHS in the long run. Fiscal management (i.e., revenue mobilization and debt sustainability) is essential to prepare a long-term strategy for health-care financing.
This study investigates the impact of corruption control and government health expenditure on health outcomes in West Africa, examining both direct effects and interactive influences. Utilizing data from 11 countries and employing the random effects technique, the study assesses life expectancy, infant mortality, and under-5 mortality as health indicators. The findings reveal that corruption control enhances life expectancy and reduces infant and under-5 mortality. Government health expenditure shows mixed effects, negatively affecting life expectancy and positively influencing infant and under-5 mortality. The interactive impact of corruption control and health expenditure on health outcomes is insignificant. The study recommends that policymakers in West Africa prioritize comprehensive anti-corruption measures to enhance life expectancy and mitigate infant and under-5 mortality. Thus, strengthening transparency and governance frameworks is crucial for achieving Sustainable Development Goal (SDG) 3.
Bu çalışma kapsamında gelişmekte olan bir ülke olarak, Türkiye ekonomisinde özel- kamu sağlık harcamaları arasındaki ilişki ve özel sağlık harcamalarının gelir ve nüfus değişkeniyle ilişkisi ARDL sınır testi yaklaşımıyla incelenecektir. Sağlık piyasasında dışlama etkisini inceleyen çalışma oldukça sınırlı sayıdadır. Çalışma 1980-2021 arası dönemi incelemektedir. İlgili dönemler Türkiye ekonomisinde ekonomik-politik krizlerin yaşandığı, ekonomide dönüşümlerin yaşandığı bir dönem olmuştur. Bu bağlamda çalışmanın literatüre katkı sunması beklenmektedir. Çalışma giriş bölümünden sonra literatür taraması bölümüyle devam edecektir. Veri seti ve metodoloji bölümünde analizde kullanılan değişkenler ve ekonometrik yöntemler tanıtılacaktır. Çalışma bulgular ve sonuç bölümüyle tamamlanacaktır.
Russia’s fear of Ukraine becoming a member of the European Union and the North Atlantic Treaty Organization catalyzed the current conflict in Ukraine. The invasion also alarmed other countries, such as Finland and Sweden, who have themselves considered a formal partnership with NATO. Russia’s actions to date have created massive instability and political tensions that uniquely influence the health and socio-political life of civilians in Ukraine and the entire region. The direct and indirect threats of war “gone regional,” “global”, or “nuclear” have energized these countries and their historical alliances to reassess their own socio-political, environmental, and healthcare consequences. All countries of the region have clear histories of
forced occupation and decades of threats resulting from World War II and its aftermath. The purpose of this rapid communication is 2-fold. First, it discusses the socio-political and healthcare consequences of the ongoing Ukrainian conflict in Finland, Russia, Sweden, Poland, and Ukraine. Second, it clarifies the most essential elements of the Hybrid War which cause uniquely distinctive violations of humanitarian laws, treaties, and conventions.
India's emerging economy is dealing with severe air pollution. The main reasons for this include industrial activity, population growth, a construction boom due to housing and infrastructure development, increased vehicular traffic, congested streets, poorly maintained vehicles, limited access to clean fuel, and a lack of effective control programmes. Poor health conditions brought on by the toxic air are a double-edged sword for a nation. Increased spending on health raises the financial burden on individuals and increases individual healthcare costs. The current study investigates the association between hazardous air, health spending, and India's growing economy's GDP. The results are based on a 44-year-long dataset that includes all three factors listed above. The results are based on the ARDL bounds test and Granger causality. The nexus between all three variables is not identical in the short and long term. Granger causality has mixed evidence since it has demonstrated both one-way and two-way causation flowing between variables. The study's finding has consequences for various stakeholders who might analyse the association created between variables of a study done to enhance air quality, allocate health budgets, and design action plans for economic growth.
This study examines the effect of democracy on public health by using panel data of 188 countries over the period 1972–2019. We use various regression methods, such as pooled ordinary least squares, fixed effects, dynamic generalized method of moments (GMM), a split-sample method, and a quadratic model to address econometric issues. The pooled regression supports the positive effect on health, but it does not exist in low-income countries, which can be explained by the threshold effect. The fixed effects regression confirms the positive impact on infant mortality but not on life expectancy, which illustrates the historical and cumulative effect of democracy on life expectancy. The non-linear regression finds a U-shaped relationship between democracy and infant mortality, which is consistent with the fixed effects regression result of the positive effect on mortality in the low-income group. The dynamic GMM regression shows the expected strong relationship between previous health and current health status. Overall, the regression analysis supports the positive effect of democracy on public health.
Does electoral competition affect expenditures on the provision of public goods in electoral autocracies? Previous studies firmly agree that multiparty elections are critical to autocratic survival. Accordingly, studies argue that multiparty elections lead to an increase in health expenditure in electoral autocracies. In addition to the literature, less explored is the effect of electoral competition on the expenditure. If oppositions can run elections with a higher level of electoral competition and threaten the dictator's winning over elections, would autocrats provide more public goods to citizens? This paper raises a pessimistic view on this question and argues that the impact of electoral competition does not affect government health expenditure. Empirical findings with 291 cases of 70 electoral autocracies from 2000 to 2018 and an illustrative case study of Armenia demonstrate that autocrats are less likely to provide health and education expenditures to citizens even though they face higher competition during elections.
Motivation
The relationship between aid flows and recipients' spending on health is an important component of the ongoing attempt to measure and improve aid effectiveness.
Purpose
This article aims to reveal complex interactions occurring between donors, who use surveillance and monitoring to ensure that their aid is effective, and recipients who are pursuing individual political survival in conjunction with national development.
Methods and approach
This study applies a fixed‐effects model to a dataset of 111 aid recipients from 2000–2018.
Findings
This study finds that the impact of democracy, government effectiveness, and political stability on public health spending declines as more aid is introduced.
Policy implications
The findings suggest that aid could lead to reductions in health expenditure when the donor community’s surveillance focuses more on risky or untrustworthy recipients and indirectly creates incentives for good recipients to divert funding away from the health sector.
In this article, we empirically analyze the impact of central and subnational government spending on human development in a sample of 57 developed and developing countries over the period 2000–18. Specifically, we focus on the effects of health and education public expenditure on the Human Development Index (HDI) and its dimensions (life expectancy, education, and income). Applying data panel analysis, our empirical evidence shows the importance of central and subnational government health expenditure positively impacting on HDI and each of its components, while in the case of the education expenditure, this positive effect is only confirmed on the educational dimension of HDI. Our study shows how governments can stimulate human development, improving the well‐being of citizens, by allocating more resources to healthcare through the different administrative levels.
COVID-19 pandemic has become one of the crucial public health problems around the world however, this is not the first pandemic in human society. A similar pandemic has occurred in human history several times but the only difference in comparison to an earlier pandemic is that the transmissible rate of this virus is quite faster. Because of this, it gave no time to people, health authorities, and the government to respond properly. Due to which COVID-19 succeed to crush the health systems, economic structures, social relationships as well as individual willpower to fight against it. In between, due to COVID-19, new social relationships and behavior emerged whereas some vanished as they remained less or no use for that society. This paper discusses the relationship between three variables; COVID-19 spread (cases), democracy, and population. IBM SPSS version 25 is used to test the statistical relationship between research variables. The study also found a weak correlation between the testing variables.
This paper examines the factors affecting the changes in the public health expenditure in the Philippines, from 2001 to 2015, namely income (Gross Domestic Product per capita growth rate), elderly population (population 65 and above as a percentage of the total population), and urban population (urban population growth rate). Using multivariate Ordinary Least Squares regression, the results show that elderly population and urban population are significant parameters of public health expenditure, with the overall model being highly significant and shows no evidence of multicollinearity, serial correlation, and heteroscedasticity. Moreover, it also finds out that public health in the Philippines is more of a necessity than a luxury good. Keywords: Public health expenditure, Gross Domestic Product per capita growth rate, population 65 and above, urban population growth rate.
Policy-makers face pressures to improve lives and safeguard public finances sustainably. In this analysis, we estimate the economic importance of the health-care sector in 19 European national economies.
We use input–output tables for the year 2010 and sectoral data to estimate a set of multipliers: simple, total, truncated, type I and type II multipliers for output, income, value-added, employment and import multiplier.
The analysis reveals similarities in the economic importance of the health-care sector for the national economies of the observed countries. Results suggest prevailing positive effects on national economies (value-added, employment and household income) when spending on health-care sector products and services increases, especially in comparison to the effects of increases in spending in other sectors. The importance of the health-care sector is connected to countries’ levels of development; the benefits are especially promising in countries with lower levels of gross domestic product (GDP) per capita, where changes in the health-care sector have a larger impact on employment in the national economy than similar changes in more developed countries. The health-care sector therefore can play an important role as an instrument of economic policy.
Özet
Amaç: Dünya genelinde de, ülkeler özelinde de sağlık harcamaları artmaya devam etmektedir. Bu sistematik derleme çalışmasının amacı; sağlık harcamalarının önemli belirleyicilerinden biri olan gelir ile sağlık harcaması ilişkisini, OECD ülkeleri açısından gelir esnekliği bulguları üzerinden değerlendirmektir. Bu çerçevede ilk olarak, OECD üyesi ülkelerin sağlık harcaması düzeyleri ve yıllara göre gerçekleşen değişimler incelenmiştir. Sonrasında sağlık harcamaları ve gelir esnekliği ilişkisi tanımlanmıştır. Yöntem:Çalışmanın devamında amaç doğrultusunda 2008-2018 yılları arasında yayımlanmış olan ve belirli ölçütler ile seçilmiş 16 adet bilimsel çalışma, sağlık harcamaları ve gelir arasındaki ilişki açısından sistematik bir şekilde derlenmiş ve yayınlardaki gelir esnekliği bulguları gruplandırılarak karşılaştırılabilir hale getirilmiştir. Bulgular:Gruplar arasında gözlemlenebilir farklılıklar olmakla birlikte, sağlık harcamalarının gelir esnekliği değerlerinin çoğunlukla 0 (sıfır) ile 1 (bir) değerleri arasında ve“ihtiyaç” olarak sınıflandırılan grup içerisinde yer aldığı belirlenmiştir. Sonuç:Bu sonuç, sağlık hizmetleri için yapılan harcamaların yıllara göre artış göstermesine rağmen hala yeterli seviyeye ulaşamadığını göstermektedir. Bu açıdan, sağlık harcamalarının önümüzdeki yıllarda da artmaya devam etmesi beklenmektedir.
Anahtar Kelimeler: sağlık ekonomisi, sağlık harcamaları, gelir esnekliği, OECD ülkeleri
JEL Kodu: I10, N30, H51
Anecdotal evidence relates corruption with high levels of military spending. This paper tests empirically whether such a relationship exists. The empirical analysis is based on data from four different sources for up to 120 countries during 1985–1998. The association between military spending and corruption is investigated by using cross-section and panel regression techniques. The results suggest that corruption is associated with higher military spending as a share of both GDP and total government spending, as well as with arms procurement in relation to GDP and total government spending. The results can be interpreted as evidence that defense spending may be used as a component of an indicator of the quality of governance.
This study presents an empirical investigation of differences in health care expenditure between the 26 federal entities of Switzerland in the 1990s. So far, demand and supply-related factors have dominated the debate, while political determinants have largely been neglected. Here, they will be assessed together with the usual indicators on the basis of a cross-sectional analysis of both public and private health care spending. It will be shown that no approach represents the whole truth, but each one a grain of it. Demand for health care is clearly a function of socio-economic factors. On the supply side, it is mainly the number of practitioners and the overall level of provision that drive costs. Finally, from the political factors, general state interventionism is decisive – though only so far as public spending is concerned.
This paper empirically examines the impact of corruption on the structure of government spending by sector. Using the three-stage
least squares method on 64 countries between 1996 and 2001, we show that public corruption distorts the structure of public
spending by reducing the portion of social expenditure (education, health and social protection) and increasing the part dedicated
to public services and order, fuel and energy, culture, and defense. However, civil and political rights seem to be a stronger
determinant of expense on defense than corruption. Our results are robust to instrumentation by the latitude of the country.
This paper examines the relationship between foreign aid and growth in real GDP per capita as it emerges from simple augmentations of popular cross-country growth specifications. It is shown that aid in all likelihood increases the growth rate, and this result is not conditional on ‘good’ policy. There are, however, decreasing returns to aid, and the estimated effectiveness of aid is highly sensitive to the choice of estimator and the set of control variables. When investment and human capital are controlled for, no positive effect of aid is found. Yet, aid continues to impact on growth via investment. We conclude by stressing the need for more theoretical work before this kind of cross-country regression is used for policy purposes.
We present a model that links heterogeneity of preferences across ethnic groups in a city to the amount and type of public
goods the city supplies. We test the implications of the model with three related data sets: U. S. cities, U. S. metropolitan
areas, and U. S. urban counties. Results show that the shares of spending on productive public goods—education, roads, sewers
and trash pickup—in U. S. cities (metro areas/urban counties) are inversely related to the city's (metro area's/county's)
ethnic fragmentation, even after controlling for other socioeconomic and demographic determinants. We conclude that ethnic
conflict is an important determinant of local public finances.
Explaining cross-country differences in growth rates requires not only an understanding of the link between growth and public policies, but also an understanding of why countries choose different public policies. This paper shows that ethnic diversity helps explain cross-country differences in public policies and other economic indicators. In the case of Sub-Saharan Africa, economic growth is associated with low schooling, political instability, underdeveloped financial systems, distorted foreign exchange markets, high government deficits, and insufficient infrastructure. Africa's high ethnic fragmentation explains a significant part of most of these characteristics. Copyright 1997, the President and Fellows of Harvard College and the Massachusetts Institute of Technology.
Explaining cross-country differences in growth rates requires not only an understanding of the link between growth and public
policies, but also an understanding of why countries choose different public policies. This paper shows that ethnic diversity
helps explain cross-country differences in public policies and other economic indicators. In the case of Sub-Saharan Africa,
economic growth is associated with low schooling, political instability, underdeveloped financial systems, distorted foreign
exchange markets, high government deficits, and insufficient infrastructure. Africa's high ethnic fragmentation explains a
significant part of most of these characteristics.
How does the management and resolution of the current crisis compare with the response of the Nordic countries in the early 1990s, widely regarded as exemplary? We argue that, while intervention has been prompter, the measures taken so far remain less comprehensive and in-depth. In particular, the cleansing of balance sheets has proceeded more slowly, and less attention has been paid to reducing excess capacity and avoiding competitive distortions. In general, policymakers have given higher priority to sustaining aggregate demand in the short term than to encouraging adjustment in the financial sector and containing moral hazard. We argue that three factors largely explain this outcome: the more international nature of the crisis; the complexity of the instruments involved; and, hardly appreciated so far, the effect of accounting practices on the dynamics of the events, reflecting in particular the prominent role of fair value accounting (and mark to market losses) in relation to amortised cost accounting for loan books. There is a risk that the policies followed so far may delay the establishment of the basis for a sustainably profitable and less risk-prone financial sector.
This article explores the relationship between cabinet instability and political performance in parliamentary democracies. I develop two theoretical arguments about how cabinet instability should affect government effectiveness, and I use these to define several measures of instability. The first argument suggests that instability in the partisan composition of cabinets should make it difficult for governments to adopt and implement new policy programs. The second argument suggests that instability in the partisan control of portfolios within the government (portfolio volatility) should make it difficult for cabinet ministers to obtain relevant information during policy formulation and implementation. I test both arguments by examining the short- and long-run effect of the instability variables on success at health care cost containment. The analysis indicates that short-run increases in portfolio volatility present problems for government decision makers, but in the long run, unstable systems are able to address the problems that instability poses.
This paper examines the relation between political corruption and the composition of public spending. A rent-seeking model is used to describe political rent creation through the composition of public spending. Political corruption is indicated by empirical results for 29 OECD countries for the period 1996-2009: allocation of public spending to expenditure categories characterized by high-technology goods supplied by non-competitive industries varies positively with the Corruption Perceptions Index (CPI) provided by Transparency International. Previous literature on corruption in government has focused on low-income countries. The results of this study suggest that political corruption is also an issue in OECD countries.
Health care systems need organizational direction, physical plants, and fiscal resources to deliver services to their constituents. This article addresses how or whether these needs are being met in low- and middle-income countries. Over the past 10 years, debates on global health have paid increasing attention to the importance of health care systems, which encompass the institutions, organizations, and resources (physical, financial, and human) assembled to deliver health care services that meet population needs. It has become especially important to emphasize health care systems in low- and middle-income countries because of the substantial external funding provided for disease-specific programs, especially for drugs and medical supplies, and the relative underfunding of the broader health care infrastructures in these countries.(1) A functioning health care system is fundamental to the achievement of universal coverage for health ...
In this paper we examine whether partisan influence on social expenditure in the OECD has decreased over the past three decades. We analyze whether a reduced partisan influence is due to more trade openness, larger budget deficits or the creation of new supranational institutions. Our empirical approach distinguishes between the effects on the long-run growth of social expenditures and its short-run adjustment to violations of the long-run equilibrium linking social spending with macroeconomic and demographic trends. We find that partisan motives, indeed, play an important role in the explanation of short-run dynamics in social spending. Left-wing parties are found to spend significantly more than their right-wing counterparts and parties spend more before elections. However, the partisan influence has
changed over time. While ideology has lost some of its influence, the electoral cycle has become more important to explain changes in social expenditure. This result should be addressed to a general institutional change that took place in the early 1990s and continued over that decade. While changes in trade openness, indebtedness and budget deficits have not changed the partisan influence on social spending, they are particularly important to explain the short-run dynamics of social spending.
In this article, we examined if partisan ideology and electoral motives influence public healthcare expenditure (HCE) in countries of the Organization for Economic Cooperation and Development. We distinguished between the effects on the growth of the expenditures and its adjustment to violations of a long-run equilibrium linking HCE with macroeconomic and demographic trends. Regarding the influence of partisan ideology, we found that if governments are sufficiently long in power, right-wing governments spend less on public health than their left-wing counterparts. Furthermore, if a right-wing party governs without coalition partners, it responds more strongly to deviations from the long-run HCE equilibrium than left-wing governments. With regard to electoral motives, we found that health expenditure increases in years of elections. Independent of their partisan ideology, single-party (minority) governments induce higher (lower) growth of public HCE. Each of these political factors by its own may increase (decrease) HCE growth by approximately one percentage point. Given an average annual growth of HCE of approximately 4.1%, political factors turn out to be important determinants of trends in public HCE. Copyright © 2013 John Wiley & Sons, Ltd.
A sample of 67 nations is used in a cross-sectional regression analysis to study the statistical correlation of political liberty with size and internal allocation of public budget (central government). Among functional categories of expenditures the budget shares of health and social security are positively related to the level of political liberty while the opposite is true for the defense budget. Social expenditures are also positively associated with this variable.The regression are repeated for economic classifications of public expenditures. The regression results show that capital expenditures and current expenditures on goods and services are negatively associated with political liberty. The relative size of government expenditure (as a percentage of GDP) also varies systematically with the index of political liberty but the relation is nonlinear.
This paper asks whether predatory behavior by corrupt politicians distorts the composition of government expenditure. Corruption is found to reduce government spending on education in a cross section of countries.
This paper tests several leading hypotheses on determinants of government expenditure. The purpose is to avoid omitted variables bias by testing the prominent theories in a comprehensive specification, to identify persistent puzzles for the current set of theories, and to explore those puzzles in greater depth by looking at the composition of government expenditure and the level of government at which it takes place as well as its magnitude. Using Government Financial Statistics data from the IMF covering over 100 countries from 1970–2000, I look at cross-sectional and inter-temporal variation in government expenditure and both individual categories of expenditure (such as defense, education, health care) and different levels of government (central, and local). Among other results, I find a new explanation for Wagner's Law, widespread evidence that preference heterogeneity leads to decentralization rather than outright decreases in expenditures, that a great deal of the expenditure associated with increased trade openness is not in categories that explicitly insure for risk, and evidence that both political access and income inequality affect the extent of social insurance.
This paper presents a set of indicators to assess health care system performance. It also presents new comparative data on health care policies and institutions for OECD countries. This set of indicators allows the empirical characterisation of health care systems and the identification of groups of countries sharing similar health institutions. It also helps to uncover strengths and weaknesses of each country’s health care system and assessing the scope for improving value-for-money. The empirical analysis suggests that there is room in all countries surveyed to improve the effectiveness of health care spending; there is no health care system that performs systematically better in delivering cost-effective health care – big-bang reforms are therefore not warranted; increasing the coherence of policy settings, by adopting best policy practices within a similar system and borrowing the most appropriate elements from other systems will likely be more practical and effective to raise health care spending efficiency.
Systèmes de santé : efficacité et institutions
Ce document présente un ensemble d’indicateurs afin d’évaluer la performance des systèmes de santé. Il présente aussi de nouvelles données comparatives sur les politiques et les institutions dans le domaine de la santé pour les différents pays de l’OCDE. Cet ensemble d’indicateurs permet de caractériser empiriquement les systèmes de santé en identifiant des groupes de pays ayant des politiques et institutions comparables. Il permet aussi de mettre en valeur les forces et les faiblesses du système de santé de chaque pays et de déterminer les gains potentiels d’efficacité. L’analyse empirique montre que dans chacun des pays étudiés l’efficacité des dépenses de santé peut être améliorée; qu’il n’existe pas de système qui, pour un coût donné, produit systématiquement des meilleurs résultats – des réformes radicales en faveur d’un système de santé ne s
This paper empirically evaluates whether government ideology and electoral motives influenced the growth of public health expenditures in 18 OECD countries over the 1971-2004 period. The results suggest that incumbents behaved opportunistically and increased the growth of public health expenditures in election years. Government ideology did not have an influence. These findings indicate (1) the importance of public health in policy debates before elections and (2) the political pressure towards re-organizing public health policy platforms especially in times of demographic change.
Background:
Government spending on health from domestic sources is an important indicator of a government's commitment to the health of its people, and is essential for the sustainability of health programmes. We aimed to systematically analyse all data sources available for government spending on health in developing countries; describe trends in public financing of health; and test the extent to which they were related to changes in gross domestic product (GDP), government size, HIV prevalence, debt relief, and development assistance for health (DAH) to governmental and non-governmental sectors.
Methods:
We did a systematic analysis of all data sources available for government expenditures on health as agent (GHE-A) in developing countries, including government reports and databases from WHO and the International Monetary Fund (IMF). GHE-A consists of domestically and externally financed public health expenditures. We assessed the quality of these sources and used multiple imputation to generate a complete sequence of GHE-A. With these data and those for DAH to governments, we estimated government spending on health from domestic sources. We used panel-regression methods to estimate the association between government domestic spending on health and GDP, government size, HIV prevalence, debt relief, and DAH disbursed to governmental and non-governmental sectors. We tested the robustness of our conclusions using various models and subsets of countries.
Findings:
In all developing countries, public financing of health in constant US1 of DAH to government, government health expenditures from domestic resources were reduced by 1.14 (p=0). However, DAH to the non-governmental sector had a positive and significant effect on domestic government health spending. Both results were robust to multiple specifications and subset analyses. Other factors, such as debt relief, had no detectable effect on domestic government health spending.
Interpretation:
To address the negative effect of DAH on domestic government health spending, we recommend strong standardised monitoring of government health expenditures and government spending in other health-related sectors; establishment of collaborative targets to maintain or increase the share of government expenditures going to health; investment in the capacity of developing countries to effectively receive and use DAH; careful assessment of the risks and benefits of expanded DAH to non-governmental sectors; and investigation of the use of global price subsidies or product transfers as mechanisms for DAH.
Funding:
Bill & Melinda Gates Foundation.
A broad consensus holds that increased medical capability-technology-is the primary driver of health spending growth. However, technology does not expand independently of historical context; it is fueled by rising incomes and more generous insurance coverage. We estimate that medical technology explains 27-48 percent of health spending growth since 1960-a smaller percentage than earlier estimates. Income (gross domestic product, or GDP) growth plays a critical role, primarily through the actions of governments and employers on behalf of pools of consumers. The contribution of insurance is likely to differ, with less of a push from increasing generosity of coverage and more of a push from changes in provider payment.
The notable increases in funding from various donors for health over the past several years have made examining the effectiveness of aid all the more important. We examine the extent to which donor funding for health substitutes for--rather than complements--health financing by recipient governments. We find evidence of a strong substitution effect. The proportionate decrease in government spending associated with an increase in donor funding is largest in low-income countries. The results suggest that aid needs to be structured in a way that better aligns donors' and recipient governments' incentives, using innovative approaches such as performance-based aid financing.
This paper presents two propositions about corruption. First, the structure of government institutions and of the political
process are very important determinants of the level of corruption. In particular, weak governments that do not control their
agencies experience very high corruption levels. Second, the illegality of corruption and the need for secrecy make it much
more distortionary and costly than its sister activity, taxation. These results may explain why, in some less developed countries,
corruption is so high and so costly to development.
If a donor gives aid for a project that the recipient government would have undertaken anyway, the aid finances expenditures other than the intended project. The notion that aid in this sense may be"fungible"has recently received empirical support. The authors look at why aid isfungible or nonfungible, and the extent to which it is fungible in Sub-Saharan Africa. Their results suggest that aid may be partially fungible in Africa and suggests some reasons. They find relatively little evidence that aid leads to greater tax relief in Africa. Every dollar of aid leads to a 90-cent increase in government spending. The implications of this result are by no means clear. If the marginal cost of taxation is exceptionally high - which it might be in African countries - using aid for tax relief may be the best use of foreign resources. Aid's effect on the composition of current and capital spending? They increase equally. Even if all aid were intended to finance capital spending, the reallocation to current spending might not necessarily be harmful. The fungible of loans to specific sectors generally mirrors patterns found in a broader sample of countries. Aid to energy, transport, and communication sectors increase public spending in those sectors somewhat but by no means one for one. (By contrast, in the worldwide sample, aid to transport and communications was almost fully nonfungible). Aid to the education sector - which had no discernible effect on education spending in the global sample - had an almost one-for-one effect on education spending in Africa. Even in these partially fungible sectors, governments spend more out of aid resources than they do out of their own resources, at the margin. Governments do not spend all sectoral aid in that sector - nor do they treat such aid as merely budgetary support. The more donors to a country, the more likely aids is to be fungible. If the number of donors represents a proxy for monitoring costs, it is not surprising that most aid is partly fungible.
This paper is an empirical examination of the determinants of aggregate health care expenditure. The paper presents a systematic analysis of relationships across 19 OECD countries, showing the effects of aggregate income, institutional and socio-demographic factors on health care expenditure. The results indicate that institutional factors of the health systems, in addition to per capita Gross Domestic Product (GDP), contribute significantly to the explanation of the health care expenditure variation between countries; for example the way physicians in outpatient care are paid, and the mixture of public/private funding and inpatient/outpatient care.
Previous studies of international differences in health spending have been restricted to the use of relatively small samples of cross-sectional data. Our objective here is to re-examine the results of previous work using a sample of 560 pooled time-series and cross-section observations. Results confirm the importance of GDP as a determinant of health spending, with an estimated income elasticity at or around unity, but also suggest that OECD countries should not be regarded as a single, homogeneous group. The importance of some non-income variables is also confirmed, although the direct effect of these factors appears to be small.
This paper assesses the effectiveness of foreign aid in reducing poverty through its impact on human development indicators. We use a dataset of both bilateral aid and NGO aid flows. Our results show that NGO aid reduces infant mortality and does so more effectively than official bilateral aid. The impact on illiteracy is less significant. We also test whether foreign aid reduces government efforts in achieving developmental goals and find mixed evidence of a substitution effect.
The paper investigates empirically the impact of ethnic heterogeneity on the amount of public spending on health and education and the quality, or technical efficiency of spending. While it finds partial evidence for the claim that more heterogeneous societies spend less on public goods, it suggests that heterogeneity significantly affects the efficiency of public expenditure outcomes in terms of social indicators. The results suggest that the impact of heterogeneity on public expenditure outcomes is not just a public choice problem, but also an issue of technical efficiency
We try to demonstrate how economists may engage in research on comparative politics, relating the size and composition of government spending to the political system. A Downsian model of electoral competition and forward-looking voting indicates that majoritarian - as opposed to proportional - elections increase competition between parties by focusing it into some key marginal districts. This leads to less public goods, less rents for politicians, more redistribution and larger government. A model of legislative bargaining and backward-looking voting indicates that presidential - as opposed to parliamentary - regimes increase competition between both politicians and voters. This leads to less public goods, less rents for politicians, less redistribution, and smaller government. We confront these predictions with cross-country data from around 1990, controlling for economic and social determinants of government spending. We find strong and robust support for the prediction that the size of government is smaller under presidential regimes, and weaker support for the prediction that majoritarian elections are associated with less public goods. (C) 1999 Elsevier Science B.V. All rights reserved. JEL classification: D7; E6; H1; H4.
In this paper we start with a discussion of some of the different denotations of the problem of corruption. We then consider the ways in which the damaging consequences of corruption operate in a developing economy, while not ignoring its possible redeeming features in some cases. We pursue the question of why corruption is perceptibly so different in different societies and also persistent. Finally, we examine the feasible policy issues that arise in this context.
The recent boom in cross-country growth analysis has renewed the empirical interest in political sources of economic growth. A large number of studies have tested political variables in growth regressions and a very heterogeneous set of variables has been proposed to measure economically relevant differences in the political systems of countries. This paper distinguishes five categories of relevant political variables: democracy, government stability, political violence, policy volatility, and subjective perception of politics. For each of these categories, the specification, testing method, and results of the most relevant studies are presented and are critically discussed. The paper concludes that measures of democracy are least successful and measures of policy volatility and subjective perception of politics most successful as explanatory variables in cross-country growth regressions. Copyright 1997 by Blackwell Publishers Ltd
This paper investigates the impact of international migration on technical efficiency, resource allocation and income from agricultural production of family farming in Albania. The results suggest that migration is used by rural households as a pathway out of agriculture: migration is negatively associated with both labour and non-labour input allocation in agriculture, while no significant differences can be detected in terms of farm technical efficiency or agricultural income. Whether the rapid demographic changes in rural areas triggered by massive migration, possibly combined with propitious land and rural development policies, will ultimately produce the conditions for a more viable, high-return agriculture attracting larger investments remains to be seen.
Health care systems: Efficiency and insitutions. OECD Economics Department Working Paper No
- I Joumard
- C Andre
- C Nicq
Joumard, I., Andre, C., & Nicq, C. (2010). Health care systems: Efficiency and insitutions. OECD Economics Department Working Paper No.769.
Aid and growth regressions Specification tests in econometrics
- H Hansen
- F Tarp
Hansen, H., Tarp, F., 2001. Aid and growth regressions. J. Dev. Econ. 64, 547e570.
Hausman, J.A., 1978. Specification tests in econometrics. Econometrica 46,
1251e1271.
International Country Risk Guide Methodology. The Political Risk Services Group
PRS, 2012. International Country Risk Guide Methodology. The Political Risk Services Group, New York.
Financing Global Health 2012: the End of the Golden Age? IHME
IHME, 2012. Financing Global Health 2012: the End of the Golden Age? IHME,
Seattle, Washington.
The Determinants of Health Expenditure: a Country-Level Panel Data Analysis. The Results for Development Institute (R4D) Working Paper
- K Xu
- P Saksena
- A Holly
Xu, K., Saksena, P., Holly, A., 2011. The Determinants of Health Expenditure: a
Country-Level Panel Data Analysis. The Results for Development Institute (R4D)
Working Paper.
Health Financing Revisited: A Practitioner's Guide
- P Gottret
- G Schieber
Gottret, P., Schieber, G., 2006. Health Financing Revisited: A Practitioner's Guide.
World Bank, Washington, D.C. (Chapter 1).
Value for Money in Health Spending
- Oecd
OECD, 2010. Value for Money in Health Spending. OECD Publishing, Paris (Chapter 1).