DISAGGREGATING HEALTH SPENDING AND LIFE EXPECTANCY: THE CASE OF NIGERIA

This article aims to detect empirically, the nexus dynamic interrelationships between health expenditure, totally and disaggregated, economic growth, fertility rate, life expectancy and CO2 emissions in six middle-income MENA countries, namely, (Algeria, Egypt, Jordan, Lebanon, Morocco, and Tunisia), during 2000 to 2019. We employ an advanced econometric technique, Dynamic Panel Data system analysis, which allows estimating time rarely variant variables. Article results show a significant and robust positive association between health expenditure and economic growth, in one hand, and negative associations between economic growth and all which of, fertility rate, life expectancy and CO2 emissions, on the other hand. Moreover, a negative nexus between fertility rate and life expectancy has been detected. Public, private and external health expenditure affect economic growth positively and significantly, meanwhile affect fertility rate negatively, except health public expenditure, which seems to encourage fertility rate. This indicates that disaggregated health expenditure matters for examination. Furthermore, negative impact of CO2 emissions on growth and life expectancy can crowd out health expenditure positive impacts on both growth and life expectancy. A series of recommendations have been introduced such as increasing health share in public spending, and for more effective government health expenditure and control pollution and CO2 emissions. Furthermore, health spending, policies and system has to function as well to mitigate impacts of high fertility, in marginalized, rural and fungible population and areas. This article shines a light on the notable issues in the area, whereas high fertility rate, limited government health expenditure, high employment and low awareness for pollution and environment degradation.

Objective: The objective of this paper is assessed the nexus among health status, economic growth, and the Gini index in North America and its countries using a panel model. Materials and Method: The materials consist of annual data regarding life expectancy, government health expenditure as percentage of the gross domestic product, Gini index, and gross domestic product at constant 2015 US$ for the period 2000-2019. The method applies a panel model for North America and its three countries: Canada, Mexico and The United States. North America diversity treatment among countries is dealt with fixed and random effects. Results: North America inhabitants health status are negatively influenced by an increasing income inequality, and a reduction on economic growth. The country that expends more in health care is The United States, follow by Canada and Mexico. The biggest reduction on life expectancy from an increase in income inequality is in The United States, followed by Canada and Mexico. Life expectancy increases when Canada and The United States experience economic growth. The countries with inarticulate health policy responses to an increase in income inequality are first Mexico followed by The United States. Conclusions: In North America and its countries an increasing income inequality reduces life expectancy, and government health expenditure. Economic growth benefits life expectancy and government health expenditure. Health status seems to improve with a reduction in income inequality and a greater public health expenditure. Therefore, policies that increases income inequality and reduces public health expenditure seems to be advocates of a reduction: in health status, population welfare and economic growth.

Background: The rate of substitution for private and public health expenditures is one of the factors that can explain the different effects of public and private health expenditures on health and life expectancy. Therefore, the purpose of this study was to estimate the return to scale, share, and elasticity of the substitution for public and private health expenditures in Iran. Methods: In this descriptive-analytical study, linear and nonlinear least squares methods were applied to study the share and elasticity in substitution of private and public health expenditures at national level in Iran during 2000-17. The study data included the annual time series data extracted from the World Bank website. The Stata 14 software was used to estimate the economic model. Results: In the nonlinear and linear models of Elasticity of Substitution Constant (CES) health function in Iran, elasticity of substitution for public and private health expenditures were 0.30 and 0.17, respectively. The return to scale in nonlinear and linear models was 0.07 and 0.15, respectively. The share of public health expenditures on life expectancy in the nonlinear and linear model was 54 and 53 % and the share of private health expenditures in these models was 46 and 47 %, respectively. Conclusion: Public and private health expenditures are poor substitutes of each other in Iran and increase of these health expenditures leads to an increase in life expectancy. A decreasing return exists to scale in public and private health expenditures on life expectancy in Iran. The share of public health expenditures is higher than the share of private health expenditures on life expectancy in Iran.

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.

Environmental pollution, rapid economic growth, and other social factors have adverse effects on public health, which have consequently increased the burden of health expenditures during the last two decades. This paper provides a comprehensive analysis of carbon dioxide (CO2) emissions and the environment index, as well as economic and non-economic factors such as Gross Domestic Product (GDP) growth, foreign direct investment, population aging, and secondary education impacts on per capita government and private health expenditures in 13 emerging economies for the time period of 1994–2017. We employ robust econometric techniques in this endeavor of panel data analysis to account for the issues of heterogeneity and cross-sectional dependence. This study applies the Lagrange Multiplier (LM) bootstrap approach to investigate the presence of panel cointegration and empirical results underscore the existence of cointegration among variables. For the execution of long-run analysis, we incorporate the two latest estimators, i.e., continuously updated-fully modified (CUP-FM) and continuously updated- bias corrected (CUP-BC). Findings of long-run elasticities have documented that the air-pollution indicators, i.e., CO2 emissions and the environment index, have a positive and significant influence on government health expenditures, while in contrast, both factors negatively influence private health expenditures in emerging economies. We find that economic factors such as GDP growth consistently show a positive impact on both government and private health expenditures, whereas, foreign direct investment exhibits a significant negative and positive impact on government and private health expenditures respectively. Findings of non-economic factors can be used to argue that population aging increases health expenditures while secondary education lowers private health spending in emerging markets. Furthermore, empirical analysis of heterogeneous causality indicates that CO2 emissions, the environment index, GDP growth, foreign direct investment, and secondary education have a unidirectional causal relationship with government and private health expenditures. Population aging has a strong relationship of bidirectional causality with government health expenditures and unidirectional causal relationship with private health expenditures. Findings of this paper put forward key suggestions for policy makers which can be used as valuable instruments for better understanding and aiming to maximize public healthcare and environmental quality gains which are highly connected with sustainable GDP growth and developments in emerging economies.

To analyze the equity of total health expenditure in China from 2015 to 2021 and to provide a scientific basis for promoting the healthy development of total health expenditure in China. Total health expenditure was divided into three components: government health expenditure, social health expenditure, and out-of-pocket health payments. Data from 2015 to 2021 were extracted, and the concentration index and Kakwani index were used to evaluate the equity. Mainland China (excluding Hong Kong, Macau, and Taiwan) was divided into the northeast, east, central, and west regions, and the health resource density index (HRDI) of the China average was used as the reference standard to calculate the deficiency and deficiency ratio in each region. The stepwise regression analysis was used to analyze the influencing factors of per capita total health expenditure in China. The average percentages of government health expenditure, social health expenditure, and out-of-pocket health payments were 28.26%, 43.94%, and 27.79%, respectively, from 2015 to 2021. The concentration indices of total health expenditure, government health expenditure, social health expenditure, and out-of-pocket health payments were all greater than 0. The Kakwani index of total health expenditure, government health expenditure, and out-of-pocket health payments was less than 0, while the Kakwani index of social health expenditure was greater than 0 overall but became less than 0 in 2021. Both GDP and total health expenditure in the northeast region moved toward lower percentages, and GDP and total health expenditure in the east region moved toward higher percentages. Taking the HRDI of China’s average as the reference standard, the HRDI for total health expenditure, government health expenditure, social health expenditure, and out-of-pocket health payments in the east and central regions were higher than the reference standard, and the health expenditure in the east was more than 50% of the reference standard and the central region was more than 4% of the reference standard. The HRDI of total health expenditure, government health expenditure, social health expenditure, and out-of-pocket health payments in the west region was less than the reference standard, and the deficiency ratio of health expenditure in the west region was more than 46%. The HRDI of out-of-pocket health payments in the northeast region was higher than the reference standard from 2015 to 2020, and the HRDI of total health expenditure, government health expenditure, and social health expenditure in the northeast region was lower than the reference standard. Per capita disposable income and the number of health technicians per 1,000 population were the main factors influencing per capita total health expenditure in China from 2015 to 2021. The health financing structure was inappropriate, with a low percentage of government health expenditure and a high percentage of out-of-pocket health payments. Total health expenditure, government health expenditure, social health expenditure, and out-of-pocket health payments, all of the health expenditure tended to regions with higher levels of economic development. Total health expenditure, government health expenditure, and out-of-pocket health payments were regressive, and social health expenditure was progressive overall. Health expenditure was more adequate in the east and central regions and more inadequate in the west region. Per capita disposable income and the number of health technicians per 1,000 population had a greater impact on per capita total health expenditure in China.

This study examines the effectiveness of health expenditure on healthcare goals in South-East Asia Region for the period from 2000 to 2014 using system generalized method of moment model. In this study, aggregate health expenditure data have been divided into two components—public and private. Both public and private health expenditure components are segregated into four categories of expenditure—government health expenditure from domestic sources, external assistance of health to the government, private out-of-pocket (i.e., household expenditure), and private not out-of-pocket (i.e., insurance). Certain health status indicators have been adopted as healthcare goals—life expectancy, infant mortality, universal health coverage index; immunization coverage, the prevalence of undernourishment, and Tb cases detection rate. The empirical result finds that aggregate health expenditure, especially public health expenditure, shows positive effects on the improvement in life expectancy and reduction of infant mortality. But the relationship between health expenditure and healthcare goals is weak (i.e., inelastic) and the elasticity values are numerically small than the non-health factors especially female education and per capita income. We have found a strong positive association between health expenditure and universal health coverage index that implies a 1% increase in public health expenditure leads to a 0.26% rise in healthcare services coverage. Further, female education has shown strong effects on the reduction of undernourishment population and increase immunization coverage. Increased public expenditure on health through domestic revenue generation and improved government effectiveness could be suggestive policy implications for achieving better health outcomes.

I examined the association between income inequality and population health and tested whether this association was mediated by interpersonal trust or public expenditures on health. Individual data on trust were collected from 48 641 adults in 33 countries. These data were linked to country data on income inequality, public health expenditures, healthy life expectancy, and adult mortality. Regression analyses tested for statistical mediation of the association between income inequality and population health outcomes by country differences in trust and health expenditures. Income inequality correlated with country differences in trust (r = -0.51), health expenditures (r = -0.45), life expectancy (r = -0.74), and mortality (r = 0.55). Trust correlated with life expectancy (r = 0.48) and mortality (r = -0.47) and partly mediated their relations to income inequality. Health expenditures did not correlate with life expectancy and mortality, and health expenditures did not mediate links between inequality and health. Income inequality might contribute to short life expectancy and adult mortality in part because of societal differences in trust. Societies with low levels of trust may lack the capacity to create the kind of social supports and connections that promote health and successful aging.

BackgroundThe total health expenditure (as a percentage of GDP) and health outcomes in the region of South Asian Association for Regional Cooperation (SAARC) and Association for South East Asian Nations (ASEAN) are lower than that of the OECD region and the world. This study investigated the relationship between different types of healthcare expenditures (public, private and total) and three main health status outcomes - life expectancy at birth, crude death rate and infant mortality rate - in the region.MethodologyUsing the World Bank data set for 15 countries over a 20-year period (1995–2014), a panel data analysis was conducted where relevant fixed and random effect models were estimated to determine the effects of healthcare expenditure on health outcomes. The main variables studied were total health expenditure, public health expenditure, private health expenditure, GDP per capita, improved sanitation, life expectancy at birth, crude death rate and infant mortality rate.ResultsTotal health expenditure, public health expenditure and private health expenditure significantly reduced infant mortality rates, and, the extent of effect of private health expenditure was greater than that of public health expenditure. Private health expenditure also had a significant role in reducing the crude death rate. Per capita income growth and improved sanitation facilities also had significant positive roles in improving population health in the region.ConclusionsHealth expenditure in the SAARC-ASEAN region should be increased as our results indicated that it improved the health status of the population in the region. Public sector health funds must be appropriately and efficiently used, and accountability and transparency regarding spending of public health funds should be ensured. Finally, government and private institutes should implement appropriate strategies to improve sanitation facilities.

This study employs Autoregressive Distributed Lag (ARDL) bounds testing approach to co-integration and Granger causality technique to empirically examines the nature of relationship between infant mortality and public expenditure on health in Nigeria from 1980 – 2016. In addition, the study considers the roles of immunization, private health expenditure and external health resources on infant mortality in Nigeria. Among other things, the empirical results indicate the presence of significant conintegrating (long-run) relationship between infant mortality and government health expenditure (and private health expenditure, immunization and external health resources), coupled with the existence of bi-directional causal relationship between infant mortality and government health expenditure. In addition, the results also demonstrate that, government health expenditure, private health expenditure, immunization, and external health resources significantly influence infant mortality negatively both in the long and short term. Although, private health spending is shown as the major determinant of the reduction of infant mortality rate in Nigeria, due to the size of the coefficient of private health expenditure. In essence, the total overhaul of the Nigerian health sector, so as to improve the efficiency of the sector, as well curb the incidents of fund mismanagement which has plagued the sector overtime, coupled with the intensifying of immunization programs and activities are however recommended.

Life expectancy effects of public and private health expenditures in OECD countries 1970–2012: Panel time series approach

Healthcare is a serious issue confronting governments and households and calling for repeated deliberations in international forums. Ensuring good health for all was the predominant call of the millennium development goals (MDGs), re-echoed again in the sustainable development goals (SDGs). The first objective of this study is to evaluate and compare the impact of public and private health spending on life expectancy, and the second objective is to examine the causal link among public health expenditure, private health expenditure and life expectancy in Cameroon. We used annual time series data from 1980 to 2014. Ordinary least squares (OLS) regression was employed to evaluate the effect of public and private health expenditure on life expectancy while the Toda and Yamamoto causality test was used to examine the relationship among public health expenditure, private health expenditure and life expectancy in Cameroon. The result shows that private health expenditure has a positive and significant impact on life expectancy while public health expenditure has no significant impact on life expectancy in Cameroon. The results of the causality test show a bidirectional causality between private health expenditure and life expectancy and a unidirectional causality running from life expectancy to public health expenditure. The findings of this study suggest that the Cameroonian government should continue to embark on its poverty reduction strategy elaborated in its Growth and Employment Strategy Paper (GESP) and in pursuing its vision of attaining the SDGs by 2030. In addition, establishing effective public-private partnerships in developing the health sector could go a long way to improve the health status of the population.

Italy's health system reforms on hold

Background: In the recent decades, most studies have paid more attention to community expenditures in health sector and health outcomes. This study provides econometric evidence linking countries’ health expenditures to 3 health outcomes: (1) infant mortality, (2) under 5 mortality and (3) life expectancy within 4 different health care systems. Methods: In this study, we used the econometric method to estimate the effect of health expenditure on health status. Panel data were collected and grouped for 25 countries according to the health care system over 15 years (2000-2015). The random effects model was selected over the fixed effects model based on the Hausman test to assess the effect of different factors on the 3 mentioned health outcomes. Results: A significant relationship was found between health expenditures and health indicators. The effect of private health expenditures on health outcomes in countries with mixed health financing system and traditional sickness fund insurance was higher than public expenditures. Also, after comparing the results between different health care systems, we found that the effect of health expenditure on the health outcome in countries with national health system (NHS) was more than other health care systems. Conclusion: To improve health status, health policymakers should focus on the factors that lie inside the health care system. Therefore, since private and public health expenditures have different effects on health outcomes in each health care system, countries should choose an optimal combination of private and public health expenditures.

Health care expenditure in Zimbabwe has fallen below budgetary allocations since 2000. Health care financing in Zimbabwe rely more on donor funding and private expenditure than on government resources. These expenditures are unsustainable and inadequate considering the huge health care burden in Zimbabwe. The study sought to examine the association between government health expenditure and maternal mortality, and make policy recommendations. Association was examined using survey and annual expenditure data from Zimbabwe between 1980 and 2011. The study used multiple regression analysis to find the association between government health expenditure and maternal mortality while controlling for potential confounding variables. Government health expenditure had a statistically significant association with maternal mortality, with less expenditure associated with high rates of maternal mortality. This substantiates the proposition that government health expenditure is a major determinant of maternal mortality in Zimbabwe. Increasing government health expenditure will contribute to significant reduction in maternal mortality. Institutional delivery and the proportion of people living below the Total Consumption Poverty Line (TCPL) were negatively correlated with maternal mortality. The association of maternal mortality and other socio-economic determinants of health were examined. These included political and economic factors, isolationism, hyper-inflation, household income versus household expenditure and allocation of resources.