Capita Public Health Research Articles

Impact of fiscal policy shocks on health outcomes in Sub-Saharan Africa: A panel structural VAR approach

This study investigates the impact of fiscal policy shocks on health outcomes in Sub-Saharan Africa (SSA). It is motivated by health systems’ increasing reliance on public funding despite growing macroeconomic uncertainties. This study adopts a regional analysis, sampling five countries with the highest per capita public health expenditure from the Central, Eastern, Southern, and Western African regions. The study employs the panel structural vector autoregression technique and expresses health outcomes as a function of fiscal policy and private health expenditure shocks. The results suggest that fiscal policy shock significantly and positively affects health outcomes in Central and Western Africa. However, health outcomes are resilient to fiscal policy shock in Eastern and Southern regions and to private health expenditure shock in all regions. The study indicates that achieving sustainable improvement in health outcomes in SSA would require policies designed to expand health financing options beyond the traditional public and private funding arrangements.

What is the best set of indices/indicators for evaluating “health promotion governance” in health systems? A proposed methodology for health promotion decision-making

ABSTRACT We aimed to identify the indices/indicators needed for assessing health promotion governance in health systems. Data were obtained from a literature review, a modified Delphi process, and an Analytic Hierarchy Process (AHP). The study was conducted from May 2021 to January 2022 using a multi-method design comprised of four sequential stages: (1) a comprehensive literature review for identifying the health promotion indices/indicators originating from the Ottawa Charter’s action areas; (2) a 3-round Delphi survey to identify, by consensus, which of those indices/indicators would be relevant to the health promotion governance in the health system;(3) Analytic Hierarchy Process technique (AHP) to prioritize the selected indices/indicators; (4) presenting the results of AHP to a group of the health promotion specialists of the selected experts to selecting other indices/indicators if necessary. Health literacy was considered the most important index to assess health promotion governance from experts’ perspectives. The per capita public health expenditure was supposed to be the second most important indicator. The indices ranked third and fourth in priority were the health equality and urban health indexes, respectively. The health promotion specialists selected three other indices: the number of policies changed due to advocacy, social capital, and positive health. Based on the results, a series of essential indices/indicators have been proposed depending on the study’s purpose, which can help health system policymakers and managers to assess the health promotion governance in the health system.

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.

Does Earmarking Lead to More Per Capita Public Health Spending?

Does Earmarking Lead to More Per Capita Public Health Spending?

A novel index reveals disconnects between recreational harmful algal bloom exposure risks and responses among U.S. states

AbstractRecreational and occupational contact with freshwater harmful algal blooms (HABs) pose human health and economic risks worldwide. Individual U.S. states control monitoring, reporting, and mitigation of recreational exposure to HABs. We surveyed states to catalog responses to HAB problems. We used this data to develop a state‐specific HAB response index (HABRI) and compared it to HAB risks derived from empirical nation‐wide data and per capita state environmental management and public health spending. States varied in regulations, reporting, monitoring, communication, and mitigation. The HABRI was not correlated with empirically based risk. Several states had no limits on toxin exposure or limits that were higher than recommended by the USEPA or World Health Organization. Other states did not provide public signage or notification when HABs were occurring and recreation could be hazardous. Increased federal involvement, communication among states, and state and federal legislation could minimize this variation and positively influence responses. We identify best practices for addressing HABs in our study that could provide guidance to authorities in any part of the world while developing new programs or enhancing existing efforts.

Green Hydrogen Production and Public Health Expenditure in Hydrogen-Exporting Countries

Energy resources play a significant role as a production input in many economic sectors, such as production of goods and transportation. Moreover, increased energy usage may result in increased air pollution, resulting in negative societal health effects. This paper aims to examine how the production of green hydrogen energy, as proxied by low-carbon energy production, and per capita public health spending are related. This study employs various techniques that are specific to panel data, such as panel cointegration tests, second-generation stationarity tests, and panel long-run estimates, The research has been conducted on a sample of 67 hydrogen exporting nations during the period from 2000 to 2021. The study revealed that hydrogen energy production causes a rise in per capita public health spending. Policymakers should encourage the usage and production of hydrogen energy to decrease the negative consequences of using energy that emits CO2. Reduction of carbon dioxide emissions helps nations to increase the proportion of government spending on public health per person. Furthermore, in hydrogen-exporting countries, an increase in the production of hydrogen leads to accumulate more funds from exporting hydrogen that will be used to increase spending on public health.

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.

The Impact of Digital Innovation on Economic Growth

Purpose: This study aimed to examine the impact of technology infrastructure, digital lending, and digital payments on real per capita income, public health, and education levels. Theoretical framework: This study is built on the relationship between technology infrastructure, digital lending, and digital payments and their impact on economic and social outcomes. The study draws on theories of technology adoption and diffusion, financial inclusion, and human development. Design/methodology/approach: This study used quantitative research to examine how technology infrastructure, digital lending, and digital payments affect income, health, and education. The sample was data from 2015-2020, cleaned and analyzed using regression analysis in E-views. Findings: The findings revealed that technological infrastructure has a significant positive effect on real per capita income and public health, but a negative and insignificant effect on the education level. Digital lending was insignificantly positive for real per capita income and negatively insignificant for public health and education levels. In contrast, digital payments had a positive and significant impact on the health and education levels but a negative and insignificant effect on real per capita income. Research, Practical & Social implications: The study suggests that governments should prioritize the development of information technology infrastructure for SMEs to increase real per capita income and public health. Furthermore, relevant laws and regulations should be improved to ensure the development of digital payments, credit investigation systems, and standardized digital payment transactions to maintain financial security and stimulate consumer demand, ultimately promoting sustainable economic development. Originality/value: The originality of this study lies in its investigation of the impact of both technology infrastructure and digital finance on income, health, and education. Additionally, the study highlights the importance of addressing regulatory issues to ensure the safe and effective use of digital finance.

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.

PEMBINAAN PEMBACAAN AYAT AL-QUR’AN MELALUI PENGADAAN BUKU TAJWID PRAKTIS

Education is a measure of a country's progress, the higher the education of a country's people, the higher the country's development will be. The high level of education will not only have an impact on one sector, but will have an impact on several sectors including the economic sector, per capita society, technology, public health and people's thinking. The recitation of the Koran must be read according to the Tajweed rules. Tajweed is an inseparable part of reading and writing the Koran (BTQ), because tajwid lessons contribute to students to read the Koran well and tartil, therefore to make it easier for students to read the Koran according to the rules / tajwid, with tajwid will help students to better understand the Koran properly and correctly. Then from there we chose a strategy for fostering the reading of Al-Quran verses through the provision of practical recitation books. In this study using Participatory Action Research (PAR) which includes planning for repetitive actions, namely planning, implementing, observing and reflecting planned.

A Study to Assess the Knowledge Regarding COVID-19 among Mother Child with Autism at District Disability Rehabilitation Centre at Agartala, Tripura, India

In spite of high density of population, higher in poverty, lower levels of per capita public health infrastructure in our country interestingly recovery rate of COVID-19 is good. COVID-19 is a novel respiratory disease. Studies suggest that lack of proper knowledge regarding COVID-19, severe morbidity and high mortality also high in our country. During any kind of disaster or pandemic vulnerable groups or populations like mental and neorudevelopmetal disorder like child with autism spectrum disorder known to be overly effected in negative way. According to epidemiological research report during the last decade there is dramatically increase in the rate of autism with prevalence of 5 to 10 cases of classic autism per 10,000 . Knowledge regarding COVID-19 among mothers child with autism was negatively correlated with the demographical value and social functional support reported by the mothers child with autism. This study sought to assess the knowledge toward COVID-19 among mother with autism seeking care for their child with autism in the District Disability Rehabilitation Centre, Tripura. This descriptive study hypothesized there are adequate knowledge about COVID-19 as because awareness was done by mass media from government and nongovernment side in a very intensive way. We conduct an investigation how mother child with autism with their specific demographical properties shows their knowledge about COVID-19 awareness and strategy they applied to prevent and recover from COVID-19.Our sample was selected randomly. Our study shows that knowledge and strategy of mother regarding COVID-19 significantly associated with their education, mother with special training, source of income, background of family support. The awareness level high among mothers about COVID-19 in percent was high 6.7 levels. Proportion of High Strategic capacity with COVID- 19 as high percentage18.7. This descriptive study is according result is significant with selected demographical variables of mothers child with autism.Method: A descriptive study was conducted in District Disability Rehabilitation Centre, Tripura. A simple random sampling technique was conducted with structured questionnaire in this centre. A total 50 mothers with child autism were randomly sampled. Descriptive analysis was used to assess the knowledge between the mothers with autism with demographic variables. Data was analyzed depending priorities on source of hearing and visualizing awareness, awareness regarding source of infection, sign and symptoms of infection, strategies adopted to withstand challenges from COVID-19,vulnerable group’s members, Proportion of high strategies capacity with COVID-19.Result: The awareness level high among mothers about COVID-19 in percent was 6.7 levels. Because our Government did mass awareness on Covid-19 as well as District Disability Centre also. Distribution source of hearing about COVID-19 knowledge among mothers according to study mostly from newspaper is 37%. Awareness among mothers about sources of infection high in percentage via handshaking is 70.3, CoughDroplets and Public Gathering are same as 49.3.Symptom awareness of fever, cough, breathlessness are equal asin percentage 70.Strategies adopted to withstand challenges from COVID-19 in percentages in hand washing andusing sanitizer 70.9. The demographical independent variables are the age, religion, education, family income,residential area, with chronic stress child with autism. Mothers child with autism without family support andwith no formal education negatively associated with Covid-19 strategic capacity in percentage. According to ourstudy mothers have adequate knowledge regarding COVID-19 is resulted Proportion of high Strategic capacitywith COVID-19 in percentage is 18.7Conclusion: Although majority of mothers have adequate knowledge about COVID-19 and engaged in goodpractice of COVID-19, awareness level have to increase in all mothers with different demographical variables .Asa study result mothers are aware about COVID-19 in percent 33.3 in low lavel,60 percent are in medium level.From result there is some decrease in awareness depending on demographical value as education, family income,special training, background of family support and types of family negatively impact- the adequate knowledgeamong mothers. From we come in conclusion that mothers have adequate knowledge about COVID-19 withpath of strategic capacity.

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.

What drives variations in public health and social services expenditures? the association between political fragmentation and local expenditure patterns.

The US spends two times more than the OECD average in health expenditure but has a much smaller portion of public health spending to total health expenditure than other OECD countries. While it has been suggested that public health and social services spending is crucial to promoting health outcomes, less is known about what drives variations in public health expenditure across regions. This study aims to examine whether political fragmentation inlocal governance is associated with variations in public health and social services expenditures. Using the US Census of Governments, we constructed a panel dataset of political fragmentation and local government spending patterns (1997-2012) for 792 US counties (population > 60,882, top 25%) and employed Least Squares Dummy Variable (LSDV) and Generalized Estimating Equations (GEE) models. We found that per capita public health spending tended to be smaller in areas where the degree of political fragmentation was higher (Coef: - 0.034; p < 0.01), particularly when general-purpose governments were more fragmented (Coef: - 0.087; p < 0.001). The proportion of public health spending alsodecreased when local governments were more fragmented (Coef: - 0.012; p < 0.001). Social services expenditures and their proportions to total government expenditure fell with an increase in the degree of political fragmentation. Our findings suggest that fragmented governance settings, in which localities are more likely to face competition with others, may lead to a reduction in public spending essential for population health and that political fragmentation can also have a deterrent effect on broader categories of health-related social services spending.

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.

Strategic management as adaptation to changes in the ecosystems of public hospitals in Israel

BackgroundHealth systems worldwide function in constantly changing local and global ecosystems. This is the result of economic, demographic, and technological changes, among others. In recent decades Israel has started implementing reforms in the public health services that have led to far-reaching changes in the health system, and consequently, increased competition within it. The impact of these changes has been exacerbated by pressure to reduce per capita public health costs, coupled with increased demand and greater health awareness. All these changes have created a turbulent environment for healthcare organizations in Israel. To cope with this dynamic environment, various parts of the system have had to adopt appropriate management behaviors and business styles. This study, carried out in six public hospitals in Israel, evaluates the nature and degree of adaptation, implementation, and inculcation of management strategies in public hospitals in Israel, using the Ginter model of strategic management of health organizations.MethodsThe study used semi-structured in-depth interviews of key figures in the health system and managers at various levels in the hospitals and HMOs included in the sample. The 55 interviews, conducted in two time periods, were analyzed in accordance with an established theory of qualitative methodological analysis.ResultsThe main findings are that the health market and hospitals in Israel are increasingly adopting competitive business behaviors. But strategic managerial behavior has been adopted only in part, and there is a lack of collaboration between staff and management in defining goals and strategic activity. These are obstacles to change and inculcation of the strategy in hospitals.ConclusionsThis study affords an important view over time and a better understanding of the behavior and adaptation of hospitals in Israel to their constantly changing surroundings. Adapting and inculcating appropriate managerial strategies in hospitals requires close collaboration between staff and management; its absence is an obstacle that contributes to partial, and possibly counter-productive, strategic behavior.The solution may lie in a combination of changes: providing hospital management with the necessary tools and broad professional support by the Ministry of Health; organizational changes in hospital management and departments; the creation of a clinical leadership role; and a self-supervised planning system .Policy recommendationsThese recommendations regarding training and the direction and organization of the change, coupled with systemic oversight of them by the Ministry of Health, will enable the system to become more efficient. They are particularly relevant today because the Covid-19 pandemic has exacerbated and highlighted Israeli public hospitals’ financial and organizational problems. Hospitals that already faced many challenges have had to cope with an unfamiliar medical crisis and a reduction of elective medical activity, causing them various types of damage, especially in term of economic stability.The hospitals’ fragile situation must become a top government priority because it can no longer be ignored. To achieve a strong healthcare system with stable hospitals, able to respond both to everyday challenges and to crises like the current pandemic, policymakers must provide financial and organizational support alongside managerial training, while maintaining an overall systemic plan.

Integration of Health and Social Services at the Systems Level: A Framework for Addressing Funding and Jurisdictional Silos.

Objectives. To examine spending and resource allocation decision-making to address health and social service integration challenges within and between governments.Methods. We performed a mixed methods case study to examine the integration of health and social services in a large US metropolitan area, including a city and a county government. Analyses incorporated annual budget data from the city and the county from 2009 to 2018 and semistructured interviews with 41 key leaders, including directors, deputies, or finance officers from all health care-, health-, or social service-oriented city and county agencies; lead budget and finance managers; and city and county executive offices.Results. Participants viewed public health and social services as qualitatively important, although together these constituted only $157 or $1250 total per capita spending in 2018, and per capita public health spending has declined since 2009. Funding streams can be siloed and budget approaches can facilitate or impede service integration.Conclusions. Health and social services should be integrated through greater attention to the budgetary, jurisdictional, and programmatic realities of health and social service agencies and to the budget models used for driving the systems-level pursuit of population health.

Sex Differences in the Association between Local Government Spending and Mortality: Evidence from Tennessee.

A growing body of research has demonstrated the effect of local government spending on health outcomes; however, the effect of spending on different demographic groups is unclear. We combined national and local data to examine the impact of public spending on mortality rates in Tennessee. Within-between random effects models to examine the relation between county-level spending and mortality rates. We found a significant association between per capita library and kindergarten through grade 12 education spending and mortality outcomes. We also found sex differences in the effects of per capita public health spending and highway spending. This study provides further evidence that local government spending plays a role in addressing and improving population health and suggests that public spending can have differential effects within a population.

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.