Capita Government Health Expenditure Research Articles

Public Versus Private Health Financing Transition in Low- and Middle-Income Countries: Exploring the Crowding-Out Effects

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.

Province-level distribution and drivers of infant mortality in mainland China: a Geodetector-based analysis of data from 2020

ObjectiveThe present study investigated the province-level distribution and drivers of infant mortality rate (IMR) in mainland China.DesignEcological analysis based on publicly available data for all 31 provinces in mainland China.Data...

How Does Fiscal Decentralization Affect Health Outcomes? Evidence from China.

The impact of fiscal decentralization on health outcomes still has not reached a consensus, and studies conducted in the context of the new round of fiscal and taxation system reform are even less available. China's fiscal decentralization system has its own special characteristics, so it is necessary to analyze the impact of fiscal decentralization on health outcomes before and after the new round of fiscal and taxation system reform in China. Panel data from 2007 to 2019 were obtained through China's Health Statistics Yearbook and China's Statistical Yearbook. The effects of fiscal decentralization on health outcomes before and after the reform are explored separately by SYS-GMM, which introduce a dynamical model with a lag period of the explained variables. The Hansen test is used to determine excessive identification. The AR(2) is used to determine whether the residual term of the differential equation has a second-order serial correlation. Fiscal decentralization consistently had a negative impact on health outcomes, yet government health expenditures did not mediate the impact of fiscal decentralization on health outcomes. Fiscal decentralization had a positive effect on per capita government health expenditure before the new reforms, yet had a negative effect on the percentage of government health expenditures, both before and after the new reform. China's fiscal decentralization has caused local governments to pay insufficient attention to the construction of people's livelihoods, and the problem of insufficient government investment in health has not been improved. The new round of fiscal and taxation system reform has not reversed this situation either. It is recommended to adjust the incentive system for local officials, include medical and health in the evaluation indicators of local governments, optimize the structure of government expenditure, and improve the efficiency of the use of government health expenditure.

Healthcare Financing and Under-5 Child Mortality Among the BRICS Nations

This article explores longitudinal trends of healthcare financing and mortality levels among the children under 5 (U5) years of age in the BRICS nations between 2000 and 2015. This analysis is based on the relevant secondary data obtained from the WHO data repository and various other publicly available sources. Inferential statistical tools like linear regression analysis was carried out to test the relationship between dependent and independent variables. The results indicate an inverse relationship between current health expenditure and U5 child deaths, revealing a decline of 29,000 U5 child deaths and 19,000 infant deaths for every US$1increase in per capita healthcare expenditure. Further, neonatal deaths declined by 1.74% and infant deaths 2.8%, while U5 child deaths declined by 4.6% per annum. India spends lowest among the BRICS nations—about US$63 per capita, while out-of-pocket expenditure (OOPE) is highest at 69.3%. Countries with higher per capita government health expenditure have better health indicators. This article, therefore, calls for strengthening public investment in healthcare to improve health outcomes.

Does Scale and Efficiency of Government Health Expenditure Promote Development of the Health Industry?

Macro-economic development of China’s health industry is essential to the sustainable development and growth momentum of the national economy. Strategies to promote the development and rebalancing of the industrial structure need to be improved in order to transform China’s health industry and drive development. Based on panel data of 25 regions in China from 2004 to 2016, this paper analyzes the linear and non-linear relationship between Chinese government health expenditure (GHE), GHE efficiency, and the macro-economic development of the health industry. It uses a novel index of industrial structure to measure the transformation of industrial sectors in China, based on a semi-parametric generalized additive model. The model shows that per capita GHE and its efficiency have a significant positive linear and comprehensive non-linear effect on the development of health industry structure. By analyzing the interaction of GHE and its efficiency, we show that high expenditure with low-efficiency regimes and high expenditure with high-efficiency regimes have a positive impact on the development of industrial structure. Following the empirical results, the paper puts forward corresponding policy suggestions for the role of fiscal policy in promoting the development of the health industry in China.

Analysis of the Government Health Expenditure in the First Decade of Chinese New Medical Reform (2009-2018): Xinjiang Uygur Autonomous Region as an Example.

ObjectiveTo analyze the status of government health expenditure in Xinjiang Uygur Autonomous Region since the first 10 years from the new medical reform, and find the existing problems in order to provide evidence for the government to formulate medical and health policies.MethodsBased on the health expenditure monitoring data of Xinjiang Uygur Autonomous Region government from Urumqi Central Sub-branch of the People’s Bank of China, combined with the relevant data in Xinjiang statistical yearbook, Excel2013 and SPSS19.0 were used to conduct a comparative analysis of government expenditure data from 2009 to 2018.ResultsThe average annual growth rate of the government’s health expenditure in Xinjiang Uygur Autonomous Region was 12.25%, which was similar to the national level. The proportion of government health expenditure in gross domestic product increased from 0.97% to 1.07%, while the proportion in the total fiscal expenditure decreased from 3.06% to 2.63%, which led to far behind the national and even western area level. The Gini Coefficient of per capita government health expenditure in every city (state) of the autonomous region fell from 0.46 to 0.32 between 2014 and 2018. In the past decade, the ratio between public health expenditure and medical institution expenditure has decreased from 1.01 to 0.42, led to insufficient proportion of public health expenditure. The health expenditure level of the four prefectures especially Kashgar and Hotan in Southern Xinjiang was still far lower than the whole autonomous region and the national average level.ConclusionThe government of Xinjiang Uygur Autonomous Region should continuously strengthen the financial expenditure in health, maintain the current situation of preferential policy implementation for rural and grassroots expenditure, constantly optimize the proportion of various financial expenditures, and strive for the transfer payment from the central and autonomous regional governments to the four prefectures in Southern Xinjiang.

Healthcare financing in South-East Asia: Does fiscal capacity matter?

ABSTRACT Financing healthcare and achieve sustainable development goals by 2030 is the prime focus of many low-income and middle income countries. Improved public healthcare and reduce the burden of out-of-pocket health expenditure is the overarching public health policy objective across the Asia-Pacific region. This study examines the impact of fiscal capacity on health expenditure by controlling socio-economic factors in South-East Asia for the period of 1995–2013. We have employed a panel fixed effects regression model in order to capture country-level unobserved heterogeneity and macroeconomic policy changes in the health sector. Overall result shows that annual change in per capita government health expenditure (pooled financing) is influenced positively by the per capita income, fiscal capacity, ageing, and the prevalence of tuberculosis and rate of urbanization. The income elasticity of government health expenditure is less than one, which implies that the health expenditure is treated as a necessity for the public health providers. Overall empirical analysis concludes that pooled financing mechanism positively influenced by the size of fiscal capacity thereby the share of out-of-pocket health expenditure to total health expenditure declines over the period. The result suggests that the faster movement towards health financing transition would possible through the generation of fiscal capacity by improving public finance policies.

The Fiscal Sustainability of Alberta's Public Health Care System

From 1975 to 2007, Alberta’s real per capita government health expenditures grew from $1,679 to $3,696 (in 2007 dollars), at a median annual growth rate of 3.5%. Over the same period, Alberta’s real per capita gross domestic product and real per capita total government revenues grew at median annual rates of 2.2% and 1.7%, respectively. This difference between the growth rates of health care spending on the one hand and government revenues and the economy on the other gives rise to concern about the fiscal sustainability of the province’s public health care system. This study presents projections of real per capita spending on public health care in Alberta over the medium term out to 2030. They suggest that, by then, real per capita spending could reach anywhere between $5,339 and $14,215, soaking up between 32% and 87% of total government revenues; more worrying, the high end of these ranges reflects a continuation of the policy settings that guide current provincial public health spending. Alberta is fortunate to have a wealthy economy that can support a high level of public health spending. But that support is precarious given the cyclical nature of non-renewable natural resource revenues and Alberta’s past tendency to experience periods of boom and bust. Basing the financing of key spending programs such as health care on a volatile revenue base is not advisable, for it puts them at risk should economic conditions turn unfavourable, as they have recently. Indeed, adjusting government revenues in our projections to match a more reasonable measure of what might be relied upon with a degree of certainty simply enhances the precariousness of the fiscal sustainability of the public health care system. Not all categories of provincial government health care spending — in particular, the traditional core medicare areas of physician services and hospitals — are growing faster than either the revenue base or the economy. The growth of spending on non-medicare categories such as drugs, capital, and all other health expenditures, however, is a particular source of concern. Options for sustaining provincial government health expenditures include choosing what other government programs could be allowed to grow more slowly over time, what tax rates could be increased to cause the revenue base to grow more quickly, and what health programs currently provided by the public sector instead could be provided privately. These approaches need not exist in watertight compartments, however, and a portfolio of policies that combines these solutions likely would be a pragmatic policy outcome. Such a strategy would help to ensure the fiscal sustainability of Alberta’s public health care system and responsibly provide for the future welfare of its citizens.

Explaining provincial government health expenditures in China: evidence from panel data 2007\u20132013

BackgroundSince the mid-2000s, the Chinese government has increased government health expenditures (GHE) significantly to address widespread complaints about health delivery. This study examines the real per capita provincial GHE over the period 2007–2013 to identify the determinants of provincial GHE during the most recent round of health reforms.MethodsA range of theoretically grounded socioeconomic indicators were collected from the China Statistical Yearbooks and then factored to reduce the number of highly correlated indicators. Maps were drawn to visualise the spatial patterns of key variables and fixed-effects regressions were run to test relationships between the real per capita provincial GHE and various variables. GMM estimators were used to address endogeneity problems.ResultsKey determinants of provincial GHE in China include the real per capita budgetary deficits, economy, and industrial structure (two factors composed from an exploratory factor analysis). Increasing 1000 yuan real per capita budgetary deficits was expected to increase the real per capita GHE by 34 yuan. A one-unit increase in the economy was associated with a 249 yuan higher real per capita GHE, while a one-unit increase in the industrial structure was expected to decrease the real per capita GHE by 33 yuan.ConclusionsThe findings of this study reveal a worrisome picture: potential inefficiencies of the central government’s funding efforts and the overwhelming importance of economic development for GHE.

政府医疗卫生支出结构——基于省际与国际对比

本文从医疗卫生支出结构以及我国政府与的医疗支出与其他国家的支出结构比较分别展开研究，分析我国医疗卫生支出中的结构问题。发现医疗保障支出开始在政府医疗卫生支出中占据重要地位，显示政府医疗卫生支出向需求方倾斜，政府卫生政策从供给方为主向需求方的重大转变；人均政府卫生支出各省份投入极不均衡；按全国三个区域平均分配来看，三个区域的人均政府卫生支出西部地区大于东部地区，而东部地区大于中部地区，中部地区的人均政府卫生支出水平最低。总体看中央财政收入仍占有较大比重，而中央财政医疗卫生支出的增长幅度要远低于国家财政医疗卫生支出的增长幅度。国际比较中，中国中央政府卫生支出占GDP的百分比很低，除了在中央和地方支出结构上存在负担结构失衡，在省级、市级政府以及地级、乡镇级政府负担结构上同样存在此问题。最后针对存在的问题，提出相应政策建议。 This paper analyzes the structural problems of medical and health expenditure in China from the aspects of medical and health expenditure structure and the expenditure structure of medical expenditure between our government and other countries. It is found that medical insurance spending occupied an important position in government health expenditure at the beginning, indicating that the government health care spending tilts to the demand side, the government health policy changes from the supply side to the demand side. Per capita government health expenditure investments in provinces are very uneven. According to the three regional average distributions, per capita government health expenditure in the western region is greater than the eastern region, while the eastern region is greater than the central region, which means per capita government health expenditure of the central region is in the lowest level. Overall, the central government still accounts for a large proportion of revenue, and the central financial health expenditure growth rate is much lower than the national financial and health expenditure growth. In the international comparison, the percentage of China's central government's health expenditure as a percentage of GDP is very low. In addition to the structural imbalance in the central and local expenditure structure, this problem is also present at the provincial, municipal and prefecture-level governments. Finally, according to the existing problems, the corresponding policy recommendations are putting forward.

Demographic and Clinical Predictors of Mortality from Highly Pathogenic Avian Influenza A (H5N1) Virus Infection: CART Analysis of International Cases

BackgroundHuman infections with highly pathogenic avian influenza (HPAI) A (H5N1) viruses have occurred in 15 countries, with high mortality to date. Determining risk factors for morbidity and mortality from HPAI H5N1 can inform preventive and therapeutic interventions.MethodsWe included all cases of human HPAI H5N1 reported in World Health Organization Global Alert and Response updates and those identified through a systematic search of multiple databases (PubMed, Scopus, and Google Scholar), including articles in all languages. We abstracted predefined clinical and demographic predictors and mortality and used bivariate logistic regression analyses to examine the relationship of each candidate predictor with mortality. We developed and pruned a decision tree using nonparametric Classification and Regression Tree methods to create risk strata for mortality.FindingsWe identified 617 human cases of HPAI H5N1 occurring between December 1997 and April 2013. The median age of subjects was 18 years (interquartile range 6–29 years) and 54% were female. HPAI H5N1 case-fatality proportion was 59%. The final decision tree for mortality included age, country, per capita government health expenditure, and delay from symptom onset to hospitalization, with an area under the receiver operator characteristic (ROC) curve of 0.81 (95% CI: 0.76–0.86).InterpretationA model defined by four clinical and demographic predictors successfully estimated the probability of mortality from HPAI H5N1 illness. These parameters highlight the importance of early diagnosis and treatment and may enable early, targeted pharmaceutical therapy and supportive care for symptomatic patients with HPAI H5N1 virus infection.

Allocating Scarce Resources Strategically - An Evaluation and Discussion of the Global Fund's Pattern of Disbursements

BackgroundThe Global Fund is under pressure to improve its rationing of financial support. This study describes the GF's pattern of disbursements in relation to total health expenditure (THE), government health expenditure (GHE), income status and the burden of HIV/AIDS, TB and malaria. It also examines the potential for recipient countries to increase domestic public financing for health.MethodsThis is a cross-sectional study of 104 countries that received Global Fund disbursements in 2009. It analyses data on Global Fund disbursements; health financing indicators; government revenue and expenditure; and burden of disease.FindingsGlobal Fund disbursements made up 0.37% of THE across all 104 countries; but with considerable country variation ranging from 0.002% to 53.4%. Global Fund disbursements to government amounted to 0.47% of GHE across the 104 countries, but again with considerable variation (in three countries more than half of GHE was based on Global Fund support). Although the Global Fund provides progressively more funding for lower income countries on average, there is much variation at the country such that here was no correlation between per capita GF disbursements and per capita THE, nor between per capita GF disbursement to government and per capita GHE. There was only a slight positive correlation between per capita GF disbursement and burden of disease. Several countries with a high degree of 'financial dependency' upon the Fund have the potential to increase levels of domestic financing for health.DiscussionThe Global Fund can improve its targeting of resources so that it better matches the pattern of global need. To do this it needs to: a) reduce the extent to which funds are allocated on a demand-driven basis; and b) align its funding model to broader health systems financing and patterns of health expenditure beyond the three diseases.

The tradeoff between centralized and decentralized health services: Evidence from rural areas in Mexico

This study investigates the effectiveness of centralized and decentralized health care providers in rural Mexico. It compares provider performance since both centralized and decentralized providers co-exist in rural areas of the country. The data are drawn from the 2003 household survey of Oportunidades, a comprehensive study of rural families from seven states in Mexico. The analyses compare out-of-pocket health care expenditures and utilization of preventive care among rural households with access to either centralized or decentralized health care providers. This study benefits from differences in timing of health care decentralization and from a quasi-random distribution of providers. Results show that overall centralized providers perform better. Households served by this organization report less regressive out-of-pocket health care expenditures (32% lower), and observe higher utilization of preventive services (3.6% more). Decentralized providers that were devolved to state governments in the early 1980s observe a slightly better performance than providers that were decentralized in the mid-1990s. These findings are robust to decentralization timing, heterogeneity in per capita government health expenditures, state and health infrastructure effects, and other confounders.

Government health expenditures and health outcomes

This paper provides econometric evidence linking a country's per capita government health expenditures and per capita income to two health outcomes: under-five mortality and maternal mortality. Using instrumental variables techniques (GMM-H2SL), we estimate the elasticity of these outcomes with respect to government health expenditures and income while treating both variables as endogenous. Consequently, our elasticity estimates are larger in magnitude than those reported in literature, which may be biased up. The elasticity of under-five mortality with respect to government expenditures ranges from -0.25 to -0.42 with a mean value of -0.33. For maternal mortality the elasticity ranges from -0.42 to -0.52 with a mean value of -0.50. For developing countries, our results imply that while economic growth is certainly an important contributor to health outcomes, government spending on health is just as important a factor.

Government Health Expenditures and Health Outcomes

This paper provides econometric evidence linking a country's per capita government health expenditures and per capita income to two health outcomes: under-five mortality and maternal mortality. Using instrumental variables techniques (GMM-H2SL), we estimate the elasticity of these outcomes with respect to government health expenditures and income while treating both variables as endogenous. Consequently, our elasticity estimates are larger in magnitude than those reported in literature, which may be biased up. The elasticity of under-five mortality with respect to government expenditures ranges from -.25 to -.42 with a mean value of -.33. For maternal mortality the elasticity ranges from -.42 to -.52 with a mean value of -.50. For developing countries, our results imply that while economic growth is certainly an important contributor to health outcomes, government spending on health is just as important a factor.Note: Final version of the paper was published in Health Economics 16(3),257-273, 2007.