Resource distribution, accessibility, and health equity: from global analyses to the Cuban case

Abstract

This dissertation examines interrelated questions concerning distribution of healthcare financing and human resource for health (HRH), access to healthcare services, and health outcomes on international and national levels of analysis. The dissertation is comprised of three papers, addressing the following questions: What is the relationship between the government’s share of total health spending and infant mortality? How do developing countries cluster along the lines of critical health and development indicators? How successful has Cuba been, a country with a highly public health and development model, in reducing inequality in human resource for health distribution? While this study does not ignore the relationships among inequality, per capita gross national income, food security and health outcomes, the central focus is on key dimensions of healthcare accessibility the distribution of human resources for healthcare services and the extent to which governments reduce financial barriers to care. Although previous research has examined the relationship between public health spending and the infant mortality rate (IMR), few if any studies have examined the impact of government expenditure on healthcare services as a percentage of total expenditure on health (GEHPTEH) on the IMR. In the first paper, I employ additive and interactive multivariate regression models with cross-sectional data gathered from the World Health Organization and the World Bank to examine the relationship between GEHPTEH and IMR while controlling for gross national income, doctor density, the percentage of children under 1 year vaccinated for polio, and the percentage of the population with access to improved water sources. The findings of the additive models