Capita Public Health Expenditure Research Articles

The puzzle of public health expenditure and healthcare infrastructure in India: An empirical investigation

This study examines the temporal pattern of healthcare infrastructure and manpower indicators across Indian states and regions between 2006–2020 using a composite index and data from various published sources. The study also investigates the monetary factors determining the quality and provision of healthcare infrastructure and manpower for India as a whole as well as for rural and tribal areas discretely, using a panel regression model and the generalized method of moments. The results show that economically advanced states, like Haryana and Maharashtra, do not rank highly on the index based on the healthcare infrastructure and manpower indicators; rural states with smaller populations enjoy better healthcare services. Inadequate public health expenditure results in a low ranking on the composite index and is reflected in the high infant mortality rates in Bihar, Uttar Pradesh, and Madhya Pradesh, though the situation is reversed in Kerala. The panel regression model reveals that increased per capita public health expenditure has not translated into improved healthcare infrastructure and manpower in Indian states or tribal regions within those states. The public health expenditure to gross state domestic product ratio is a positively significant predictor of healthcare infrastructure and manpower in rural areas. The panel generalized method of moments results confirm that developing targeted healthcare infrastructure and manpower in India as a whole, as well as for rural and tribal areas in the short term, has been poorly realized.

Variation in perceived health across gender, working status, educational level, and regional health care expenditure in Spain (2014-2017).

A gender perspective was used to analyze whether and how education, unemployment, and per capita public health expenditure were associated with perceived health among the Spanish population between the years 2014 and 2017. Using multilevel methodologies (looking at year, individual, and region) and linear and logistic specifications, we analyzed longitudinal microdata files from the Survey on Living Conditions. The results suggest that women with lower educational levels tend to report worse health than their more educated counterparts. On the other hand, women's bad health was not associated with unemployment, unlike men's. Regional per capita public health expenditure was not associated with perceived health in either men or women.

Relation Between Per Capita Public Expenditure on Health and Income in India at Sub-National Level

Health is considered as both a source of human welfare and a detriment to overall economic growth. The relationship between public health expenditure and economic growth is an important subject of analysis that has been in debate for years. The major concern is whether income of a nation plays a significant role in the changes happening in government health spending. In order to answer this particular question, the present study investigates the relationships between public health expenditure and income in selected 23 Indian states based on the availability of data. Variables used for the study were per capita public health expenditure, per capita state gross domestic product, per capita state’s own revenue and infant mortality rate for a period of 30 years from 1990 to 2020. For the purpose of analysis, the states were divided into economically less developed and economically developed based on the revenue earned by the selected Indian states. The analysis begins with summary statistics and pair-wise correlation followed by ordinary least squares regression. The findings of the study suggest that there was a significant positive impact of per capita gross state domestic product, fiscal capacity on per capita public health expenditure, and a negative impact of infant mortality rate on per capita public health expenditure in all the 23 Indian states. And the impact of per capita state gross domestic product on per capita public health expenditure is higher in richer Indian states than poorer Indian states.

Public Health Expenditure and Life Expectancy: A Healthy Investment

During the financial crisis and subsequent economic recession, life expectancy in Spain continued its growth trend, rising from 82.3 years in 2008 to 82.92 years in 2014. However, in a context of low mortality rates, it is also important to know about the evolution of time in which we live in good and bad health. Spain’s great regional heterogeneity and its decentralised public health system make it possible to observe how a variety of regional economic and sociodemographic factors may be associated with changes in health indicators. In this study, we analyse the evolution of years lived with and without the most prevalent and disabling health conditions after the age of 50 in 17 Spanish Autonomous Communities in order to understand their association with several macro socioeconomic factors, public provision of health services, public health expenditure, and health-related behaviours. The period of analysis is from 2006 to 2019 in order to cover the phases of expansion, crisis, and economic recovery that the country has experienced in the recent years. The results show that per capita public health expenditure is one of the components that most clearly explains health differences between regions; and higher public health expenditure means more years lived in good health and fewer years lived in bad health.

Does the augmentation of monetary and non-monetary factors prerequisite for the improvement of health outcomes? Evidence from the Indian states.

The present study was conducted in Indian states to examine the effect of monetary and non-monetary factors on Infant Mortality Rate (IMR) and Life Expectancy at Birth (LEB) by using the panel regression model. In addition, an attempt was also made to analysis the unequal pattern of health infrastructure and services across states over time with the help of a composite index on health infrastructure and services. It was found that the index value of the best performing state Chhattisgarh is more than fourth six times that of the worst performing state. The study also showed that, despite the higher level of average per capita public health expenditure and moderately better health infrastructure, the COVID 19 induced death rate was high in Punjab, Sikkim, Delhi and Goa. The panel regression results revealed that, an average increase of 1% in the monetary factor, public health expenditure to Gross State Domestic Product ratio (PHEGSDPR), would decrease the average of IMR by about 10%. Moreover, the elasticity of IMR with respect to non-monetary factor, health infrastructure and services per 0.1 million population (HISPLP), was negative and significant. Likewise, the explanatory variables, HISPLP and PHEGSDPR have a positive and significant effect on the LEB.

Multidimensional measurement of poverty and its spatio-temporal dynamics in China from the perspective of development geography

Exploring the spatio-temporal dynamics of poverty is important for research on sustainable poverty reduction in China. Based on the perspective of development geography, this paper proposes a panel vector autoregressive (PVAR) model that combines the human development approach with the global indicator framework for Sustainable Development Goals (SDGs) to identify the poverty-causing and the poverty-reducing factors in China. The aim is to measure the multidimensional poverty index (MPI) of China’s provinces from 2007 to 2017, and use the exploratory spatio-temporal data analysis (ESTDA) method to reveal the characteristics of the spatio-temporal dynamics of multidimensional poverty. The results show the following: (1) The poverty-causing factors in China include the high social gross dependency ratio and crop-to-disaster ratio, and the poverty-reducing factors include the high per capita GDP, per capita social security expenditure, per capita public health expenditure, number of hospitals per 10,000 people, rate of participation in the new rural cooperative medical scheme, vegetation coverage, per capita education expenditure, number of universities, per capita research and development (R&D) expenditure, and funding per capita for cultural undertakings. (2) From 2007 to 2017, provincial income poverty (IP), health poverty (HP), cultural poverty (CP), and multidimensional poverty have been significantly reduced in China, and the overall national poverty has dropped by 5.67% annually. there is a differentiation in poverty along different dimensions in certain provinces. (3) During the study period, the local spatial pattern of multidimensional poverty between provinces showed strong spatial dynamics, and a trend of increase from the eastern to the central and western regions was noted. The MPI among provinces exhibited a strong spatial dependence over time to form a pattern of decrease from northwestern and northeastern China to the surrounding areas. (4) The spatio-temporal networks of multidimensional poverty in adjacent provinces were mainly negatively correlated, with only Shaanxi and Henan, Shaanxi and Ningxia, Qinghai and Gansu, Hubei and Anhui, Sichuan and Guizhou, and Hainan and Guangdong forming spatially strong cooperative poverty reduction relationships. These results have important reference value for the implementation of China’s poverty alleviation strategy.

Better outcomes at lower costs? The effect of public health expenditures on hospital efficiency

ABSTRACTLocal health departments play a critical role in the community they serve as they are the foundation of the U.S. public health system providing services such as immunizations to the less affluent and advocating for state smoking bans. Research indicates public health expenditures improve overall health of the population. Importantly, a healthier population may lead to efficiency gains for surrounding health care providers. We use a two-stage semi-parametric Data Envelopment Analysis to estimate the effects of public health spending on the technical efficiency of the surrounding hospitals. Our results indicate hospitals operating in an area with a high level of per capita public health expenditures experience gains in efficiency of approximately 1.67 percentage points relative to hospitals in low spending areas suggesting a $20 billion in annual savings due to increased hospital efficiency. We also found that the more traditional approaches using the biased estimate for technical efficiency yielded the same conclusions with less computational burdens.Abbreviation: WHO: World Health Organization; NACCHO: National Association of City and County Health Organization; DEA: Data Envelopment Analysis; CMS: Centers for Medicare and Medicaid Services; FTE: Full time equivalent; AHRF: Area Health Resource Files; MSA: Metropolitan Statistical Area; AHA: American Hospital Association

Convergence in Spanish Public health expenditure: Has the decentralization process generated disparities?

This study examines the per capita public health expenditures among the Spanish regions. To that end, we employ the database elaborated by the BBVA Fundation and IVIE (2013) which covers the years 1991–2010. We first test for the null hypothesis of convergence by employing the methodology proposed in Phillips and Sul (2007) in order to determine whether the evolution of the public health expenditures has followed a similar path across the Spanish regions. This methodology leads us to reject the null hypothesis of convergence, which implies the absence of a unique pattern of behavior in the evolution of the Spanish regional public health expenditures. Instead, we find several convergence clubs which reveal the existence of different patterns of behavior and serious disparities in the Spanish health system. When trying to determine the forces which drive the creation of these clubs, we also find some partisan behavior, in the sense that the longer a right-wing party governs, the lower the per capita public health expenditure in this region of Spain.

Determinants of Public Health Expenditure Growth in Tanzania: An Application of Bayesian Model

This paper identifies some major drivers of per capita public health expenditure growth in Tanzania using nationally representative annual data between 1995 and 2014. It used Bayesian model based on Markov Chain Monte Carlo (MCMC) simulation. The empirical result shows that both the real GDP per capita and population age 65 years and older exert a positive effect on per capita public health expenditure growth in Tanzania. Advances in medical technologies represented by life expectancy seem to reduce real per capita public health expenditure growth in Tanzania. However, the credible intervals for life expectancy and population age 65 years and older are very wide suggesting a lot of uncertainty with these estimates. The results imply that, future trends in per capita public health spending would mainly depend on the development of the economy such as real per capita gross domestic product. The result suggests the rapid growth in real per capita public health expenditure is likely to continue in future when the country economy becomes more robust and increase of population age 65 years and above. Keywords: Bayesian Approach, per capita GDP and Real per capita public health expenditure

Examining the state level heterogeneity of public health expenditure in India: an empirical evidence from panel data

This study explores the relationship over an extended period of time between an increase in per capita public health expenditure and per capita state's domestic product (per capita income) of 16 states of India from 1980 to 2014. We consider eight panels of states based on geographical region and levels of economic development for examining the level of heterogeneity in the share of public health expenditure with respect to states' domestic product by using panel unit root, panel co-integration and panel Granger causality techniques. The empirical result shows that public health expenditure and states' domestic product are co-integrated in the long-run. The result also shows a positive and significant effect of per capita income in the growth of public health expenditure in the long-run. It finds that there is a bi-directional Granger causality between per capita income and public health expenditure in the short-run while the causality is unidirectional in the long-run. The overall result implies the existence of inequalities in the share of government health expenditure with respect to state's level of economic development in India. This study would offer effective fiscal policy instruments to minimising geographical inequity of health finance for achieving universal health coverage of Indian states.

Exploring sociodemographic and economic factors that promote adverse drug reactions reporting by patients

BackgroundAdverse drug reactions (ADRs) are recognized as a leading cause of morbidity and mortality, and an important cost factor to health systems. Patient reporting of ADRs has emerged as an important topic in recent years but reporting rates are still low in many countries. ObjectiveTo explore different countries’ sociodemographic and economic features as explanatory factors for population ADRs reporting, including the propensity of patients’ reporting to pharmacovigilance authorities. MethodsCross-sectional observational design. A data set of 42 global sociodemographic and economic factors for 44 countries were retrieved, as to analyse statistical associations between these factors and the patient reporting rate of ADRs. Multivariate logistic regression models were designed to identify the predictive covariables. ResultsHealth investment indicators, such as per capita public health expenditure, hospital bed density and under five mortality rate were the relevant factors responsible to discriminate between countries that have higher patient reporting rates. ConclusionsThis study shows that healthcare investment-related factors help explain the propensity of patients to report suspected ADRs, while pharmacovigilance features were not directly associated with higher patient participation in drug safety mechanisms. Although general, these results point a direction in further policy making to improve resources allocation concerning the promotion of patients’ participation.

Per capita income and public health expenditure: what makes good child health outcomes in Tanzania? a comparison of Frequentist and Bayesian approach (1995-2013)

Using data for World Bank Development Indicators (2015) database from 1995 to 2013, this paper explores the impact of public health expenditure on national health outcomes in Tanzania while GDP per capita and improved sanitation facilities as explanatory variables were controlled for. Two national health outcomes indicators namely, infant and under-five mortality were used as dependent variables. With separate modeling approach, Frequentist and Bayesian based on time series and Markov Chain Monte Carlo (MCMC) respectively, empirical evidence shows that income, represented by real GDP per capita lower infant and under-five mortality in Tanzania. Under both methodological approach regardless of the sample size, we failed to support evidence that, public health expenditure and improved sanitation facilities had an impact on child health outcomes. Our results imply that, public health spending in Tanzania is poorly targeted to bring good child health outcomes. The paper draws attention to policy makers in Tanzania to focus either within public health spending composition or beyond to other close determinants of infant and under-five mortality.

Intersystem return on investment in public mental health: Positive externality of public mental health expenditure for the jail system in the U.S.

This study examines the extent to which increased public mental health expenditures lead to a reduction in jail populations and computes the associated intersystem return on investment (ROI). We analyze unique panel data on 44 U.S. states and D.C. for years 2001–2009. To isolate the intersystem spillover effect, we exploit variations across states and over time within states in per capita public mental health expenditures and average daily jail inmates. Regression models control for a comprehensive set of determinants of jail incarcerations as well as unobserved determinants specific to state and year. Findings show a positive spillover benefit of increased public mental health spending on the jail system: a 10% increase in per capita public inpatient mental health expenditure on average leads to a 1.5% reduction in jail inmates. We also find that the positive intersystem externality of increased public inpatient mental health expenditure is greater when the level of community mental health spending is lower. Similarly, the intersystem spillover effect of community mental health expenditure is larger when inpatient mental health spending is lower. We compute that overall an extra dollar in public inpatient mental health expenditure by a state would yield an intersystem ROI of a quarter dollar for the jail system. There is significant cross-state variation in the intersystem ROI in both public inpatient and community mental health expenditures, and the ROI overall is greater for inpatient mental health spending than for community mental health spending.

On the nexus of environmental quality and public spending on health care in China: a panel cointegration analysis

Does pollution drive up public spending on health care? This paper aims to answer such a crucial question empirically using a panel data set of 31 Chinese provinces during the period 1997–2014. In particular, this paper explores the non-stationarity and cointegration properties between health care expenditure and environmental indicators in a panel cointegration framework; in doing so, it examines both the long-run and the short-run impacts of the per capita provincial GDP, waste gas emissions, dust and smog emissions, and waste water emissions on the per capita public health expenditure. We apply panel unit root tests, heterogeneous panel cointegration tests, FMOLS techniques, and a panel-based error-correction model. The conclusion is that, both in the long run and in the short run, public health care expenditure is positively affected not only by the provincial economy but also by the environmental quality.

Characteristics of Local Health Departments Associated with Implementation of Electronic Health Records and Other Informatics Systems.

Assessing local health departments' (LHDs') informatics capacities is important, especially within the context of broader, systems-level health reform. We assessed a nationally representative sample of LHDs' adoption of information systems and the factors associated with adoption and implementation by examining electronic health records, health information exchange, immunization registry, electronic disease reporting system, and electronic laboratory reporting. We used data from the National Association of County and City Health Officials' 2013 National Profile of LHDs. We performed descriptive statistics and multinomial logistic regression for the five implementation-oriented outcome variables of interest, with three levels of implementation (implemented, plan to implement, and no activity). Independent variables included infrastructural and financial capacity and other characteristics associated with informatics capacity. Of 505 LHDs that responded to the survey, 69 (13.5%) had implemented health information exchanges, 122 (22.2%) had implemented electronic health records, 245 (47.5%) had implemented electronic laboratory reporting, 368 (73.0%) had implemented an electronic disease reporting system, and 416 (83.8%) had implemented an immunization registry. LHD characteristics associated with health informatics adoption included provision of greater number of clinical services, greater per capita public health expenditures, health information systems specialists on staff, larger population size, decentralized governance system, one or more local boards of health, metropolitan jurisdiction, and top executive with more years in the job. Many LHDs lack health informatics capacity, particularly in smaller, rural jurisdictions. Cross-jurisdictional sharing, investment in public health informatics infrastructure, and additional training may help address these shortfalls.

Determinants of Child Mortality in Africa: A Methodological Discussion

Current literature is ambiguous regarding the significance of public health expenditure in reducing mortality rate among children in cross country studies. In fact, several previous studies found the relationship between these two variables to be insignificant. Such findings indicate the existence of a huge inefficiency in public sector of struggling countries and discourage supports provided by donating entities. This study addresses the disagreement in the literature by pointing out how results are sensitive to the use of non-stationary variables that are used often in the literature. Using a Panel Vector Autoregressive model, no empirical evidence for the role of public health expenditure in reducing child mortality is found when non-stationary variables are used. However, results are significantly different as soon as stationary variables are substituted in the same model. In fact, the elasticity of under five mortality rate with respect to per capita public health expenditure is about -0.22 for African countries in the sample.

Public health expenditure of BRICS countries - an empirical analysis

Background: Health expenditure is vital as it increases labor productivity which further induces growth and development. Health-care expenses in BRICS countries are not only inadequate and access to them varies across countries which are mainly influenced by the socioeconomic conditions as well as by the health policies in place. Objective: The purpose of this study was to analyze the per capita public health expenditure of BRICS countries in relation to exogenous explanatory variables. Materials and Methods: The study used panel data of five countries from 1995 to 2013. Data for the per capita public health expenditure, per capita GDP, and the other six variables were obtained from the World Bank. Hausman test was in favor of fixed effect panel data regression model to determine the effects of public health expenditure on health outcomes. Result: The results indicate per capita GDP, death rate, life expectancy at birth, and infant mortality rate under five were significantly contributing to the increase in the per capita public health expenditure. Variables such as infant mortality rate and percent of population above 65 years show negative correlation with that of per capita public health expenditure. Conclusion: The findings imply that public health expenditure plays a crucial role in providing better health care to people in BRICS countries. The policy implication is that government of respective BRICS countries has to increase its budgetary allocation to the health sector to catch up with the standard of human capital achieved by developed countries.

Mathematical Models and Effectiveness Analysis of Government Education and Health Expenditures on Economic Growth

This paper establishes a novel mathematical model to analyze the effects of government education and health expenditures on the economic growth. Based on the Cobb-Douglas production function, the analysis of education and health expenditures is conducted using the two-stage least square method and applying the Gaussian mixture model as the estimation method. The results provide not only the long-term relationship between education and economic growth, but also between health expenditure and economic growth. In addition, they show that both education and health expenditures have different contributions to economic growth, resulting in unbalanced development in various districts. We also compare the per capita public health and education expenditures and their economic effects in different regions. We conclude that the district with relatively less contribution may not necessarily increase their expenditure; hence, effective management may be more important. In accordance with the regional contribution divergence, the government should formulate corresponding policies to improve the allocation of education and health resources and ensure rational capital flow among regions.

Provision of Personal Healthcare Services by Local Health Departments: 2008-2013.

The scope of local health department (LHD) involvement in providing personal healthcare services versus population-based services has been debated for decades. A 2012 IOM report suggests that LHDs should gradually withdraw from providing personal healthcare services. The purpose of this study is to assess the level of LHD involvement in provision of personal healthcare services during 2008-2013 and examine the association between provision of personal healthcare services and per capita public health expenditures. Data are from the 2013 survey of LHDs and Area Health Resource Files. The number, ratio, and share of revenue from personal healthcare services were estimated. Both linear and panel fixed effects models were used to examine the association between provision of personal healthcare services and per capita public health expenditures. Data were analyzed in 2014. The mean number of personal healthcare services provided by LHDs did not change significantly in 2008-2013. Overall, personal services constituted 28% of total service items. The share of revenue from personal services increased from 16.8% in 2008 to 20.3% in 2013. Results from the fixed effect panel models show a positive association between personal healthcare services' share of revenue and per capita expenditures (b=0.57, p<0.001). A lower share of revenue from personal healthcare services is associated with lower per capita expenditures. LHDs, especially those serving <25,000 people, are highly dependent on personal healthcare revenue to sustain per capita expenditures. LHDs may need to consider strategies to replace lost revenue from discontinuing provision of personal healthcare services.

Factors driving the adoption of quality improvement initiatives in local health departments: results from the 2010 profile study.

Over the past decade, quality improvement (QI) has become a major focus in advancing the goal of improving performance of local health departments (LHDs). However, limited empirical data exists on the current implementation of QI initiatives in LHDs and factors associated with adoption of QI initiatives. (1) To examine the current implementation of QI implementation initiatives by LHDs and (2) to identify factors contributing to LHDs' decision to implement QI initiatives. In this study, a novel theoretical framework based on analysis of QI in medicine was applied to analyze QI by LHDs. LHDs' QI adoption was assessed by the number of formal QI projects reported by LHDs that responded to module 1 of the 2010 National Profile of Local Health Department Study (Profile Study) conducted by the National Association of County & City Health Officials. The Profile Study data were merged with data from the Health Resources and Services Administration's Area Resource Files and the Association of State and Territorial Health Officials' 2010 Survey. Logistic regression analyses were conducted using Stata 11 SVY procedure to account for the complex sampling design. The Profile Study data indicated that about 73% of the LHDs reported implementing 1 or more QI projects. LHDs with large jurisdiction population (>50 000), higher per capita public health expenditure, a designated QI staff member, or prior participation in performance improvement programs were more likely to have undertaken QI initiatives. According to the Profile Study, more than a quarter of LHDs surveyed did not report implementing any formal QI projects. Greater investments in QI programs and designation of QI staff can be effective strategies to promote QI adoption. The validity of the definition of a formal QI project needs to be established. More research to identify the barriers to successful QI implementation at LHDs is also needed.