Financial Inclusion and Its Impact on Health: Empirical Evidence From Asia

Abstract

Asian countries have shown remarkable progress in financial inclusion and have become the world's fastest-growing regions. However, the financial inclusion-human health nexus has not received much attention. This study contributes to the empirical literature by examining the effect of financial inclusion on population health using panel data from Asian countries from 2007 to 2019. Population health is measured by death rate and life expectancy at birth. Our study finding shows that digital financial inclusion increases life expectancy but decreases the death rate in Asia. At the same time, financial inclusion positively impacts life expectancy and has a negative impact on the death rate in Asia. Finding also suggests that Internet users, GDP, and FDI have improved population health by increasing life expectancy and decreasing the death rate. The results suggest some essential policy implications.

Full text

ORIGINAL RESEARCH
published: 01 July 2022
doi: 10.3389/fpubh.2022.948964
Frontiers in Public Health | www.frontiersin.org 1July 2022 | Volume 10 | Article 948964
Edited by:
Chi Wei Su,
Qingdao University, China
Reviewed by:
Meng Qin,
Central Party School of the
Communist Party of China, China
Muhammad Umar,
University of Central Punjab, Pakistan
*Correspondence:
Ran Tao
taotao0212@163.com
Specialty section:
This article was submitted to
Health Economics,
a section of the journal
Frontiers in Public Health
Received: 20 May 2022
Accepted: 06 June 2022
Published: 01 July 2022
Citation:
Xiao W and Tao R (2022) Financial
Inclusion and Its Impact on Health:
Empirical Evidence From Asia.
Front. Public Health 10:948964.
doi: 10.3389/fpubh.2022.948964
Financial Inclusion and Its Impact on
Health: Empirical Evidence From Asia
Wenling Xiao 1and Ran Tao2
*
1School of Economics, Shandong Women’s University, Jinan, China, 2Qingdao Municipal Center for Disease Control and
Prevention, Qingdao, China
Asian countries have shown remarkable progress in financial inclusion and have become
the world’s fastest-growing regions. However, the financial inclusion-human health nexus
has not received much attention. This study contributes to the empirical literature by
examining the effect of financial inclusion on population health using panel data from
Asian countries from 2007 to 2019. Population health is measured by death rate and life
expectancy at birth. Our study finding shows that digital financial inclusion increases life
expectancy but decreases the death rate in Asia. At the same time, financial inclusion
positively impacts life expectancy and has a negative impact on the death rate in Asia.
Finding also suggests that Internet users, GDP, and FDI have improved population health
by increasing life expectancy and decreasing the death rate. The results suggest some
essential policy implications.
Keywords: human health, financial inclusion, FDI, GDP, Asian
INTRODUCTION
Financial inclusion provides affordable, accessible, and beneficial products and financial services
to individuals and businesses responsibly and sustainably (1,2). Financial development denotes
improvement in the size, stability, and efficiency of the financial system. While financial inclusion
denotes those individuals and businesses are able to fulfill their requirements due to accessibility to
affordable financial services and products (3). Recently, efforts to promote financial inclusion have
enlarged. Financial inclusion is considered the fundamental tool that can be used to obtain social
and economic development, especially in vulnerable societies (4). World Bank (1) declared financial
inclusion as enabling most Sustainable Development Goals (SDGs). Access to finance simplifies
daily activities and planning for long-term goals and emergencies for families and businesses.
United Nations Capital Development Fund (UNCDF) implies that financial account holders
can access credit easily, enlarge and retain their businesses, invest in education and health, and
handle financial shocks that enhance livelihoods’ sustainability (5). Financial inclusion directly
influences the health of people (6). Due to the occurrence of highly unpredictable diseases, financial
inclusion can support individuals in bearing these treatment expenses through savings that lead to
better health outcomes (7,8). Furthermore, financial inclusion helps people afford better quality
health inputs, such as a nutritious diet, clean energy, and improved sanitation (9). Besides these,
financial inclusion reduces mental stress by providing financial stability that could end up in good
quality health outcomes (10,11). Various studies have explored the impact of financial inclusion on
social and economic indicators (12–14), and very few studies have explored the impact of financial
inclusion on human health (15,16). Literature discloses that high mortality is considered a measure
representing the bad quality of human health, and enlarged life expectancy is a measure of good
quality of human health.

Xiao and Tao Financial Inclusion and Its Impact on Health
As far as the theoretical aspect of financial inclusion is
concerned, literature provides two theories regarding financial
inclusion: the vulnerable group theory and the public goods
theory of financial inclusion (17). The vulnerable group theory
implies that financial inclusion should consider a vulnerable
population of society, including the poor, younger, older, and
women (6). In contrast, the public goods theory claims that
financial inclusion should be accessible to the whole society and
no one should be left excluded (18). However, the theory of
capability implies that financial inclusion enlarges the freedom
of people in making choices for essential necessities such as good
quality healthcare, education, clean water, and sanitation facilities
that improve the health outcomes of people (19).
As long as the empirical aspect of the nexus between financial
inclusion and health is concerned, Claessens and Feijen (20)
found that credit to the private sector is positively linked with
human health. In the case of South Africa, Sarma & Pais (21)
found a strong association between financial development and
life expectancy. Their study measures financial development by
domestic credit as a percent of GDP, M3 as a percent of GDP,
and domestic credit to the private sector as a percent of GDP
(22). In the case of OECD economies, Gunakar (23) found that
financial development enhances health outcomes by increasing
the extent of life expectancy and reducing the rate of infant
mortality. Financial development in this study is measured by
liquid liabilities as a percent of GDP, credit to the private sector
as a percent of GDP, and market capitalization as a percent of
GDP (24). In the case of African economies, Chireshe (25) found
that financial development increases life expectancy and reduces
the child mortality rate. Gyasi et al. (15) explored the impact
of financial inclusion on adult health in the case of Ghana. It is
reported that financial inclusion is positively related to the health
outcomes of adults (26). However, despite much effort, we cannot
find any study exploring the impact of financial inclusion on
human health in the case of Asian economies (27). This study
provides us answer to the following question: Does financial
inclusion lead to better health outcomes? To our knowledge, this
is the first study of its kind that determines the nexus between
financial inclusion and health outcomes (18).
Given this lacuna of existing literature, our study investigates
the impact of financial inclusion on public health in the case of
selected Asian economies. The sample of the study is selected
based on data availability (28). Our study will make contributions
to the existing literature in the following manners. Firstly, to
the best of the authors’ knowledge, this study is the first one
exploring the nexus between financial inclusion and public health
in the case of the Asian region. Secondly, the study will use 2
SLS and GMM approaches to explore this nexus from 2007 to
2019 (29). Thirdly, this is the first-ever study in the Asian region
covering proxy health measures such as life expectancy and death
rate. Lastly, most previous studies measure financial development
through domestic credit to the private sector as a percent of GDP
(26). However, our study measures financial inclusion using two
proxy measures, namely ATMs and debit cards. This study tries to
deal with the endogeneity issues and perform sensitivity analysis
to check the robustness of the outcomes. The findings of the study
will support policymakers in designing such policies that ease the
involvement of individuals in financial activities to protect their
health outcomes.
MODEL AND METHODS
In recent years, financial inclusion has been supposed as a
dynamic tool for attaining human development in advanced
and developing countries (30). Financial inclusion also improves
macroeconomic stability and inclusive economic growth (2).
Our study is based on the vulnerable group theory (17).
Theoretical developments have argued that financial inclusion
improves human development. As such, we employ the following
economic model that follows (31):
Healthit =η0+η1FIit +η2Internetit +η3HEit
+η4GDPit +η5FDIit +λi+εit (1)
where is the population health (Healthit) that depend on financial
inclusion (FI), internet users (Internet), health expenditure
(HE), GDP growth (GDP), and foreign direct investment (FDI).
Where λirefers to unobserved individual-country and εit is
the error term. However, i(t) represents the country (year), and
the remaining ηs are coefficients of the concerned explanatory
variables. Financial inclusion can significantly improve human
health outcomes. Thus, we expect an estimate of d to be positive.
Following the research work of Immurana et al. (32), the
control variables included in the health model include internet
users, health expenditure, GDP growth, and FDI. The remaining
explanatory variables have a favorable impact on population
health; thus, estimates of η2,η3,η4, and η5are expected to be
positive. We estimate model (1) using the two-stage least squares
(2 SLS) technique. This method is best suited because it can
easily address the problem of endogeneity. The main sources
of endogeneity are measurement errors, omitted variable bias,
and reverse causality. These issues arise for different reasons;
however, they can overcome the problem using instrumental
variables. For estimation, this study employs the 2 SLS estimators
to estimate the baseline outcomes. In our model, financial
inclusion is a potential endogenous variable. The augmented
panel model is:
Healthit =η0+η1Healthit−1+η1FIit +η2Internetit
+η3HEit +η4GDPit +η5FDIit +λi+εit (2)
while Healthit−1is the first lag of health outcomes in equation
(2), which is a dynamic term in the panel model. We estimate
model (2) using the Blundell & Bond (33) system GMM
technique. The system GMM approach has been used in
many previous empirical health-related studies (32). Following
Immurana et al. (31,34), we use the dynamic panel-data
model (2). This econometric specification is widely used in
the empirical finance literature to examine the nexus between
financial inclusion and human development. This approach
is suitable as the number of countries (N=18) is more
than the number of years (T=13), as in our study. Few
diagnostics tests, such as the serial correlation test and the
Sargan test statistic—are also used to demonstrate the validity
of estimates.
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Xiao and Tao Financial Inclusion and Its Impact on Health
TABLE 1 | Descriptive statistics and definitions.
Variable Mean Std. dev. Definitions Sources
LE 72.4 44.7 Life expectancy at birth, total (years) World bank
DR 6.57 1.95 Death rate, crude (per 1,000 people) World bank
ATMs 53.0 39.4 ATMs per 100,000 adults IMF
Debit 30.7 24.0 Debit card (% age 15+) IMF
Internet 36.7 27.4 Individuals using the Internet (% of the population) World bank
HE 4.33 1.38 Current health expenditure (% of GDP) World bank
GDP 5.38 2.85 GDP growth (annual %) World bank
FDI 4.46 3.99 Foreign direct investment, net inflows (% of GDP) World bank
TABLE 2 | List of countries.
1 Bangladesh 7 Indonesia 13 Korea, Rep.
2 India 8 Malaysia 14 Russian Federation
3 Pakistan 9 Philippines 15 Kazakhstan
4 Sri Lanka 10 Singapore 16 Kyrgyz Republic
5 China 11 Thailand 17 Tajikistan
6 Mongolia 12 Vietnam 18 Uzbekistan
DATA
Table 1 displays the details of descriptive statistics of variables,
definitions and symbols of variables, and sources of data series.
The list of selected Asian countries is reported in Table 2. Asian
Health in this study is measured by two indicators such as
life expectancy and death rate. Two indicators also measure
financial inclusion: ATMs per 1,000 adults and debit cards (%
age 15+). Previous studies have used the same variables for
financial inclusion (2,35). The role of internet use, health
expenditures, foreign direct investment, and GDP growth have
been added as control variables. Internet use is measured as
internet users in the percentage of the population. Health
expenditures are measured as a percentage of GDP. GDP
growth is taken in annual percentage. Net inflows determine
FDI as a percent of GDP. The data for financial inclusion
indicators have been taken from IMF, while the data for
the remaining variables have been collected from the World
Bank. Table 2 shows that the mean (standard deviation) for
life expectancy is 72.4 (44.7), the death rate is 6.57 (1.95),
ATMs is 53.0 (39.4), a debit card is 30.7 (24.0), the internet
user is 36.7 (27.4), health expenditure is 4.33 (1.38), GDP
growth is 5.38 (2.85), and FDI is 4.46 (3.99). While Table 3
shows that the correlation matrix and findings is free from
multicollinearity problem.
RESULTS AND DISCUSSION
Table 4 reports the results of 2 SLS and GMM estimates
for life expectancy models. It is found that ATMs and
life expectancy are significantly and positively associated in
both 2 SLS and GMM models. It reveals that a 1 percent
upsurge in the number of ATMs improves life expectancy
by 0.134 percent in the 2 SLS model and 0.051 percent
in the GMM model. The findings further reveal that debit
card and life expectancy are also significantly and positively
associated in both 2 SLS and GMM models. It implies that
a 1 percent upsurge in the number of credit cards improves
life expectancy by 0.091 percent in the 2 SLS model and
0.024 percent in the GMM model. Hence, it is confirmed that
both financial inclusion indicators contribute significantly to
enhancing population health in selected 18 Asian economies.
This finding is supported by Immurana (32), who noted that
financial inclusion enhances health in Africa. This finding
infers that digital financial inclusion easy financial services,
enabling people to acquire health-related goods and services.
This means that financial services boost human health. This
finding is also backed by Ofosu-Mensah Ababio et al. (34),
who reported that financial inclusion is an effective tool for
achieving socio-economic development by reducing poverty and
income inequality. The findings validate the study of Churchill
et al. (36) that shows that financial inclusion has a strong
poverty-reducing effect, improving population health. Another
possible reason is that financial inclusion improves human health
via income channels. Financial inclusion prompts the human
development process in Asian economies. Findings infer that a
well-performing digital financial system is an important factor in
human development.
The impact of internet use on life expectancy is found
to be significant and positive on life expectancy in all
four models, displaying that the use of the internet tends
to improve human health in the sample of selected Asian
economies. This result is in line with Majeed & Khan (37),
who found that internet development improves population
health by increasing financial and health literacy, spreading
health information, and health care services. This finding is
also supported by Mushtaq & Bruneau (38), who noted that
the composite impact of internet development and financial
inclusion is an important factor for human development. The
findings display that the nexus between health expenditures
and life expectancy is significantly positive only in one model,
confirming that current health expenditures are capable to
improve health outcomes in Asian economies. The GDP and
life expectancy association is found significantly positive in
both GMM models, showing that an upsurge in GDP improves
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Xiao and Tao Financial Inclusion and Its Impact on Health
TABLE 3 | Matrix of correlations.
LE DR ATMs Debit Internet HE GDP FDI
LE 1
DR −0.334 1.000
ATMs 0.554 0.203 1.000
Debit 0.596 0.063 0.641 1.000
Internet 0.697 0.031 0.693 0.683 1.000
HE 0.209 0.052 0.296 0.115 0.254 1.000
GDP −0.163 0.253 −0.370 −0.194 −0.282 −0.068 1.000
FDI 0.194 0.118 −0.080 0.268 0.153 0.006 0.222 1.000
TABLE 4 | Financial inclusion and life expectancy (2 SLS & GMM).
2 SLS 2 SLS GMM GMM
Coef. z-stat Coef. z-stat Coef. z-stat Coef. z-stat
L.LE 0.901** 2.060 0.970*** 4.930
ATMs 0.134*** 4.070 0.051**** 5.330
Debit 0.091*** 8.150 0.024** 2.210
Internet 0.059* 1.920 0.020*** 2.950 0.021** 2.160 0.030*** 4.650
HE 0.008 0.020 0.302 1.560 0.017** 2.030 0.010 1.180
GDP 0.059 1.020 0.029 1.030 0.012*** 4.580 0.013*** 4.800
FDI 0.045* 1.820 0.036*** 2.740 0.015*** 4.280 0.013*** 2.970
Cons 6.970*** 6.660 7.226 9.210 3.089*** 6.720 2.522*** 8.290
Observations 234 234 216 216
Countries 18 18 18 18
AR (1) 0.301 0.102
AR (2) 0.210 0.087
Sargan-test 0.254 0.345
***Significant at 1%; **Significant at 5%; *Significant at 10%.
TABLE 5 | Financial inclusion and death rate (2 SLS & GMM).
2 SLS 2 SLS GMM GMM
Coef. z-stat Coef. z-stat Coef. z-stat Coef. z-stat
L.DR 0.952*** 9.292 0.953*** 8.122
ATMs −0.008** 2.200 −0.007*** 3.160
Debit −0.005 1.130 −0.002*** 3.460
Internet −0.004 0.640 −0.009*** 3.020 −0.005 0.320 −0.007** 2.130
HE −0.200*** 2.850 −0.218*** 2.630 −0.019** 2.370 −0.017** 2.050
GDP −0.012 0.546 −0.014 0.150 −0.015** 1.980 −0.016*** 2.450
FDI −0.008 1.430 −0.013** 2.370 −0.005** 2.340 −0.004*** 3.370
Cons −6.252*** 21.62 −6.058*** 17.91 −6.872 1.590 −0.793 0.180
Observations 234 234 216 216
Countries 18 18 18 18
AR (1) 0.422 0.321
AR (2) 0.210 0.321
Sargan-test 0.345 0.412
***Significant at 1%; **Significant at 5%.
public health in Asian economies. Ordinarily, economic progress
is found to improve human health by increasing positive
externalities. For instance, Woodward et al. (39) found economic
development to boost human health. The impact of FDI on
life expectancy is found to be significantly positive in all
four models confirming that FDI plays a prominent role in
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Xiao and Tao Financial Inclusion and Its Impact on Health
improving people’s health in Asian economies. Thus, it is
confirmed that financial inclusion, internet use, GDP, and
FDI are significant indicators of human health in the case of
Asian economies. Both GMM models are correctly specified, as
confirmed by a statistically insignificant coefficient estimate of
the Sargan test.
Table 5 reports the results of 2 SLS and GMM estimates
for death rate models. It is reported that ATMs and death
rates are significantly and negatively associated in both 2 SLS
and GMM models. It implies that a 1 percent upsurge in
ATMs users reduces the death rate by 0.008 percent in the
2 SLS model and 0.007 percent in the GMM model. The
findings display that debit card and death rate are associated
significantly and negatively in the GMM model only, while
the association is found statistically insignificant in the case
of the 2 SLS model. It displays that a 1 percent rise in the
number of credit cards reduces the death rate by 0.002 percent
in the GMM model. Thus, the findings of both 2 SLS and
GMM models confirmed that both determinants of financial
inclusion, ATMs and credit card, play a significant role in
improving population health in Asian economies. The nexus
between internet use and the death rate is found significant and
negative in the case of two models, revealing that internet use
plays a prominent role in improving human health in selected
Asian economies. The nexus between health expenditures and
the death rate is found significant and negative in all four models,
displaying that current health expenditures play a fundamental
role in improving population health in Asian economies. The
nexus between GDP and death rate is significantly negative
in the case of both GMM models, displaying that increase
in GDP significantly improves public health in selected Asian
economies. The association between FDI and death rate is
significantly negative in the case of three models, inferring
that FDI plays a key role in the improvement of population
health in the case of Asian economies. Similar to the life
expectancy model, financial inclusion, internet use, GDP, and
FDI are significant determinants of human health in the sample
of selected 18 Asian economies. The statistically insignificant
coefficient estimate of the Sargan test confirms that both GMM
models are correctly specified.
CONCLUSION AND IMPLICATIONS
In this study, an effort is made to explore the nexus between
financial inclusion and population health in the case of selected
Asian economies over the time span of 1995–2020. Financial
inclusion is measured through ATMs and debit cards in this
study, while health is measured through death rate and life
expectancy. For estimation purposes, the 2 SLS and GMM
methods have been used. The obtained results are as follows.
Both ATMs and credit cards positively affect population health,
revealing that financial inclusion enhances population health in
Asian economies. Other control variables such as GDP, current
health expenditures, FDI, and internet use positively influence
human health as described in most cases.
Thus, the study put forward some important policy
implications for policymakers, stakeholders, and governments
of Asian economies. It is suggested that the enlargement of
financial inclusion should be the responsibility of governments,
stakeholders, potential customers, service providers, financial
supervisors, financial regulators, and development agencies. The
promotion of financial inclusion should be embarked by the
whole banking sector to further improves human health. New
savings or deposit methods through branchless avenues and
technological methods must be encouraged to support customers
in accessing and depositing money. The governments should
start initiatives that provide financial education and training to
individuals about using branchless and digital avenues. Another
suggestion is that there should be strong collaborations and
linkages among financial service providers, financial regulations,
and governments. The restrictions on inflows of FDI should be
relaxed. Governments should establish strong regulatory and law
enforcement organizations. Remote and backward areas should
be modernized by establishing improved physical infrastructures
such as telecommunication, electricity, and paved roads that
provide mental peace to people, thus improving their health and
livelihood. The stakeholders and governments should struggle to
guarantee financial inclusion services to individuals from both
supply and demand sides to enhance the health and wellbeing of
people in Asian economies.
Besides these implications, the study also faces some
limitations that must be considered in future studies. For
instance, the study has used only two indicators to measure
human health; however, there are several other health indicators
that must be considered in future research, such as mental
health, other chronic diseases, and maternal health. Our study
is limited to the Asian region and adopts a linear method
of estimation to explore the nexus between financial inclusion
and human health. However, future studies can adopt non-
linear methods of estimation to get more interesting results.
Furthermore, future studies can also replicate these analyses for
other regions and economies.
DATA AVAILABILITY STATEMENT
Publicly available datasets were analyzed in this study. This data
can be found here: https://data.worldbank.org/.
AUTHOR CONTRIBUTIONS
WX: conceptualization, software, data curation, and
writing—original draft preparation. RT: methodology and
writing—reviewing and editing. WX and RT: visualization
and investigation. Both authors contributed to the article and
approved the submitted version.
FUNDING
This study was supported by High-level Talent Introduction
Research Project of Shandong Women’s University (Grant No.
2021RCYJ03) and Cultivation Fund for High-level Scientific
Research Projects of Shandong Women’s University (Grant
No. 2021GSPSJ05).
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Xiao and Tao Financial Inclusion and Its Impact on Health
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Frontiers in Public Health | www.frontiersin.org 6July 2022 | Volume 10 | Article 948964