Government Healthcare Expenditure Research Articles

Addressing malaria incidence in Africa through health care expenditure and access to basic sanitation services

BackgroundMalaria is a significant public health concern, particularly in sub-Saharan Africa. This study examined the impact of health care expenditure and access to basic sanitation services on malaria incidence in 28 selected African countries from 2000 to 2019.MethodsThe study was anchored on Health Production Function [HPF] model while General Panel Linear Model was adopted to examine the relationships between the variables. The retrospective research design was utilised. The statistical diagnostics tests were performed to check for multicollinearity, hereroskedasticity, normality and model specification using correlation matrix, Breusch Pagan/Cook Weisberg, Shapiro–Wilk and the Hausman specification. The hypotheses were tested at the 5% significance level and the analysis of the data was aided by the use of the STATA 13.0.ResultsDomestic Government General Health Expenditure [DGGHE] had a positive relationship with Malaria Incidence [MI], although it was not statistically significant [coefficient = 0.0454708, p-value = 0.604]. Out-Of-Pocket Health Expenditure [OOPHE] demonstrated a statistically significant positive association with MI [coefficient = 0.2839394, p-value = 0.009]. External Health Expenditure [EHE] showed a statistically significant negative relationship with MI [coefficient = − 0.1452344, p-value = 0.012]. Moreover, People using at least Basic Sanitation Services [PBSS] exhibited a statistically significant negative relationship with MI [coefficient = − 0.3854207, p-value = 0.000].ConclusionsThe results suggested that while government health expenditure alone may not significantly impact malaria incidence, increased out-of-pocket expenditure and external health expenditure, as well as improved access to basic sanitation services, are associated with a higher likelihood of reducing malaria incidence in the selected African countries. Addressing malaria incidence in Africa requires a comprehensive approach that includes adequate government health care expenditure, reduction of out-of-pocket costs, increased external funding, and improved access to basic sanitation services. By implementing these recommendations, policymakers can make significant progress in reducing the burden of malaria and improving public health outcomes in affected African countries.

Healthcare expenditure and bank deposits

This paper investigates the effects of healthcare expenditure on bank deposits in a cross- country analysis. We use government healthcare expenditure, and government and compulsory contributions to the healthcare system as a proxy for healthcare development. The results show a positive relationship between healthcare expenditure and bank deposits. This result is stronger in high income countries and those with a high level of healthcare infrastructure. The results are robust with various specifications tests, including in the COVID-19 pandemic period.

Testing the Cointegrating Relationship between Foreign Exchange Rate Volatility and Government Health Expenditure

This paper examined the relationship between government health care expenditure and foreign exchange rate volatility in Nigeria for the period 1993-2022. We employed the multivariate cointegration technique proposed by Johansen and found the existence of at least one cointegrating vector describing a long run relationship between government health care expenditure and foreign exchange rate volatility. It is therefore suggested that an appreciable proportion of the national budget be allocated to the health care services to have a more robust health care programmes capable of fostering health development in Nigeria. The research was conducted with an objective to understand the dynamics between healthcare expenditures and the volatility in foreign exchange rate with a focus on Nigeria, enabling better policy making. The overall conclusion is that the Nigerian government health expenditure is largely dependent that its healthcare policy is not stable and sufficient is not largely dependent on volatility foreign exchange rate. However, government health expenditure is a concern for Nigeria.

Mortality and Health Spending during the First Year of the COVID–19 Pandemic. Comparing Central, Eastern and Western Europe

The article shows the relationships between the COVID and non‑COVID deaths during the first year of the pandemic, compared with the stringency of restrictions imposed and the compulsory spending on healthcare. We compare these relationships among European countries, analysing weekly data and applying cointegration models. Regarding the pandemic’s intensity, we split the period into two: March – August 2020 and September 2020 – February 2021. We find that, most often, if there was a relationship between the stringency index and COVID or non‑COVID mortality, it was usually positive and mortality driven. That suggests that although the governments tailored the restrictions to the growing mortality rate, they were unable to control the pandemic. No relationships, or negative ones, were most often found in these countries where the spending on healthcare was the highest (i.e., Northern and Western European countries). The biggest weekly changes in non‑COVID deaths during the second sub‑period were observed in the Central and Eastern European countries, where government healthcare expenditures per capita are the lowest.

Current challenges to health care access in Guatemala

Guatemala is an upper-middle-income country in Central America, with a high poverty rate and significant inequality. The health care system is divided into three large sectors: the private sector, the Guatemalan Social Security Institute, and the public sector. However, the government's health care expenditure is low, which has resulted in inadequate access to medical services for many citizens, especially for the indigenous population, who face disproportionately high poverty levels and limited health care services compared to non-indigenous individuals. Over the past 63 years, various international efforts have tried to address the inequity in health care access, with one example being the Behrhorst program. This program aimed to offer basic medical care to impoverished rural communities in the late 20th century and was a success but faced significant challenges due to the widespread violence and oppression that took place in the late 1970s and the early 1980s. Despite many efforts, significant challenges remain, particularly in addressing the health disparities between urban and rural areas.

Government healthcare financing and dwindling oil prices: Any alternatives for OPEC countries?

Crude oil is one of the sources by which budgets are financed in OPEC countries. However, the fall in oil prices in 2014 put their governments’ finances under significant pressure. Healthcare was one of the sectors experiencing fiscal strain. This study examined the effect of a fall in oil prices on healthcare financing in eight OPEC countries and whether such financing has shifted away from the dependence on oil. Quantitative healthcare expenditure data from the WHO covering the period from 2003 to 2019 were evaluated using a comparison of means Welch’s t-test. The result showed that government healthcare expenditure in Iran, Venezuela, and Kuwait increased in the period post-2014 compared to the expenditure after 2008 and 2002, suggesting that these countries succeeded in shielding such spending against the fall in oil prices. By contrast, the United Arab Emirates, Saudi Arabia, Iraq, Nigeria, and Algeria did not, highlighting that they have not yet moved from dependence on oil. With the economic uncertainty caused by oil fluctuations, global political and economic developments, and the world transitioning to green energy, oil-dependent countries should free their governments’ healthcare expenditure from dependence on such sources of funding. Furthermore, they should not focus on temporary plans by shifting the burden to private spending at a time of falling oil prices, but to utilize different financing approaches.

Determining the temporal patterns of the impact of financial determinants and public health factors on the local community resilience in the context of overcoming the consequences of the COVID-19 pandemic

In the article it is developed a methodological toolkit for determining the temporal patterns of the influence of financial determinants and public health factors on the local community resilience in the context of overcoming the consequences of the COVID-19 pandemic, based on the use of panel data regression modeling (testing for the presence of a lag of up to 3 years). The practical approbation of the approach was carried out on the basis of a sample from 21 European countries for the period 2000-2021. The following indicators were chosen as local community resilience parameters (outcome indicators): level of tax revenue decentralization; the level of income decentralization (ratio of own incomes of local budgets to central government incomes); the level of expenditure decentralization (the ratio of own expenditures of local budgets to central government expenditures). The financial and infrastructural factors of public health, the impact of which on performance indicators was studied, are the following: the number of beds (per 1,000 people); capital expenditures for health care (% of GDP); current health care expenditures (% of GDP); domestic government health care expenditures (% of current health care expenditures); domestic private health care expenditures (% of current health care expenditures); out-of-pocket health care expenditures (% of current health care expenditures). Based on the results of the approbation of the developed approach, immediate drivers and inhibitors of ensuring local community resilience, as well as drivers and inhibitors of delayed action, were identified. The obtained results allow us to note that in the context of strengthening the financial resilience of local community, it is necessary to increase the number of hospital beds, as well as the volume of current expenditures on health care, and to ensure this growth mainly by the expenditures from private financial resources and out-of-pocket expenditures.

Management of chronic non-cancer pain in primary care.

Management of chronic non-cancer pain in primary care.

Economic Growth in Saudi Arabia through Sectoral Reallocation of Government Expenditures

The article employs auto-regressive distributed lag (ARDL) cointegration and error-correction modelling to study the long-run impact of investment, exports, imports, and three components of government expenditures (expenditures on health, education, and other government spending) on GDP growth in Saudi Arabia from 1985 to 2018. We observe the long-run positive relationship between GDP, investment, exports and government education expenditure, but a negative relationship between GDP, imports, government health spending, and government other expenditures. The analysis reveals that investment, exports, and government educational expenditures all have long-run positive effects on the GDP growth, while imports, government health expenditures, and government other expenditures negatively affect GDP growth in Saudi Arabia. The Toda-Yamamoto causality test that applies the Modified Wald test establishes causality from exports, government education spending, and government health spending to GDP. We deduce that education expenditures stimulate economic growth in Saudi Arabia in contrast to health expenditures. Additionally, we infer that the various categories of government expenditures have varying effects on GDP. This necessitates a prudent sectoral allocation of public expenditures to maximize its positive effects on GDP growth and stimulate economic growth in Saudi Arabia. Moreover, the above findings have policy implications for the government in Saudi Arabia while allocating its expenditures. Allocating more government expenditures to education, cutting down inessential spending, and downsizing government healthcare expenditures will enhance long-run economic growth in Saudi Arabia. JEL Classification: O470; I15; I25

Adverse Impacts of Imposing International Economic Sanctions on Health.

International economic sanctions (IES) influence a country's economic development and the overall welfare of a nation's population. An electronic search of PubMed, Embase and Web of Science was conducted until July 31, 2019. Additionally, a list of references to related articles was reviewed. Key search terms were "Economics", "Health", "Sanction", and their equivalents with no language or time restriction. Totally, 8624 records were identified of which 2869 duplicates were deleted. Finally, 24 papers met the inclusion criteria and were selected for drafting. The number of papers included for evaluating each factor included healthcare (n=16) and pharmaceutical industry (n=10). Nine and eight studies examined the effect of sanctions imposed on Iran and Iraq, respectively. France, Haiti, Serbia, Cuba, Syria, and other areas such as Africa were also evaluated. Sanctions lead to a decrease in immunization rates and government health care expenditures. Sanctions increase infant and under-five mortality rate, road traffic injuries and fatalities, severe malnutrition, infective diseases, neurologic and visual disorders, as well as shortage of medical or dental instruments and a variety of medicines. Sanctions have adverse impacts on female labor and are associated with disabling hospitals, dispersing medical workers, and facilities for radiation therapy. The health status of sanctioned nations in terms of healthcare, and pharmaceutical industry was adversely affected in targeted countries.

The efficiency of provincial government health care expenditure after China's new health care reform.

ObjectiveWe aim to estimate the total factor productivity and analyze factors related to the Chinese government’s health care expenditure in each of its provinces after its implementation of new health care reform in the period after 2009.Materials and methodsWe use the Malmquist DEA model to measure efficiency and apply the Tobit regression to explore factors that influence the efficiency of government health care expenditure. Data are taken from the China statistics yearbook (2004–2020).ResultsWe find that the average TFP of China’s 31 provincial health care expenditure was lower than 1 in the period 2009–2019. We note that the average TFP was much higher after new health care reform was implemented, and note this in the eastern, central and western regions. But per capita GDP, population density and new health care reform implementation are found to have a statistically significant impact on the technical efficiency of the provincial government’s health care expenditure (P<0.05); meanwhile, region, education, urbanization and per capita provincial government health care expenditure are not found to have a statistically significant impact.ConclusionAlthough the implementation of the new medical reform has improved the efficiency of the government’s health expenditure, it is remains low in 31 provinces in China. In addition, the government should consider per capita GDP, population density and other factors when coordinating the allocation of health care input.SignificanceThis study systematically analyzes the efficiency and influencing factors of the Chinese government’s health expenditure after it introduced new health care reforms. The results show that China’s new medical reform will help to improve the government’s health expenditure. The Chinese government can continue to adhere to the new medical reform policy, and should pay attention to demographic and economic factors when implementing the policy.

The efficiency of provincial government health care expenditure after China’s new health care reform

ABSTRACT By drawing on the panel data of health care inputs and outputs from 31China’s provinces in the period 2004–2020, we apply the Malmquist DEA model to measure the TFP, TC (Technology change), EC (Efficiency change), PEC (Pure efficiency change or pure technical efficiency change) and SEC (Scale efficiency change) of the provincialgovernment’s health care expenditure. We find that the average TFP of China’s 31 provincial health care expenditure was lower than 1. We note this applies irrespective of the implementation of NHCR (New Health Care Reform), and also observe the average TFP was much higher after NHCR was implemented.

Economic and utilization outcomes of medication management at a large Medicaid plan with disease management pharmacists using a novel artificial intelligence platform from 2018 to 2019: a retrospective observational study using regression methods.

BACKGROUND: Medication therapy management (MTM) and comprehensive medication management (CMM) have been practiced by clinical pharmacists as a predominantly manual activity with interventions documented in a record-keeping system. Program evaluations, largely based on estimations of projected savings and utilization reductions, have not accurately predicted actual claims and utilization changes, leading many to doubt the efficacy of medication management. OBJECTIVE: To assess the impact on actual medical claims of a novel artificial intelligence (AI) platform that identifies members and provides decision support to clinicians in performing telephonic interventions similar to MTM and CMM with high-risk Medicaid members. METHODS: This retrospective observational study used mixed-effects regression models that flexibly account for general trends in cost, as measured by actual claims, to identify the amount of savings and associated impact. To study the economics, total cost of care (TCoC), defined as all medication costs plus all noncapitated medical costs, was evaluated. Utilization was evaluated through the number of emergency department (ED) visits, hospital admissions, bed days, and readmissions. The study included 2,150 predominantly middle-aged (aged 40-64 years) Medicaid members with an average of 10 medications for chronic conditions among an average of 25 total medications. The analysis considered cost and utilization data from August 2017 through April 2019. Interventions occurred between January 2018 and February 2019. RESULTS: Statistically significant correlations were found between receiving interventions and decreased costs and utilization. The economic study found a 19.3% reduction in the TCoC (P < 0.001) that, applied to a preintervention monthly cost of $2,872, yielded a savings of $554 per member per month (PMPM). Medication costs showed a 17.4% reduction (P < 0.001), which, when applied to preintervention cost of $1,110, yielded a savings of $192 PMPM. The utilization study found a 15.1% reduction in ED visits (P = 0.002), a 9.4% reduction in hospital admissions (P = 0.008), and a 10.2% reduction in bed days (P = 0.01). Return on investment is 12.4:1 based on TCoC savings and program costs. CONCLUSIONS: This study evaluated the CMM-Wrap program, which used an advanced AI platform integrated with health plan data, clinical pharmacists trained in disease management, telephonic patient engagement, and closed-loop provider coordination. The results correlate cost and utilization savings with the program. The TCoC savings of $554 PMPM translates to approximately $1.2M a month and more than $14M annually for the 2,150 members in the study. We believe Medicaid and Medicare payment of AI enhanced telephonic CMM services would substantially decrease government health care expenditures, whereas improving health program expansion to Medicaid members with similar risks could save the Health Plan $109M annually. For instance, we estimate that California's Medicaid (Medi-Cal) program could save more than $1B annually by applying the program's observed impact to a similar high-risk cohort (about 1.6%) of Medi-Cal members. Additionally, benefits will accrue to nonmanaged health plans based on the savings themselves. DISCLOSURES: There was no external funding for this study. The program itself was funded by Inland Empire Health Plan. The retrospective study was a collaboration of the 3 partners (Surveyor Health, Inland Empire Health Plan, and Preveon Health) each of which funded its additional costs of preparing the study. Kessler, Mebine, E. Von Schweber, and L. Von Schweber are employed by Surveyor Health. McConnell and Jai are employed by Inland Empire Health Plan. Nguyen, Kiroyan, and Ho are employed by Preveon Health. Desai reports fees from Surveyor Health for work on this study. E. Von Schweber and L. Von Schweber have 2 patents licensed to Surveyor Health: Unified Evaluation, Presentation and Modification of Healthcare Regimens Method and Apparatus for Information Surveying.

Has healthcare expenditure converged across Australian states and territories?

We employ the Phillips and Sul (Econometrica 75(6):1771–1855, 2007) methodology to test for the convergence of healthcare expenditure across Australian states and territories. We utilise a nonlinear model that allows for heterogeneity and transitional dynamics and consider the convergence patterns of total, government and non-government healthcare expenditures. The results display varying degrees of convergence, specifically in government and non-government expenditures. The formation of convergence and non-convergence clusters suggests that health policies need not be uniform across all Australian states and territories but within convergent clubs. As a result, healthcare policies need to be implemented at the state level rather than at the national level.

Государственные расходы на здравоохранение и экономический рост в России: региональный аспект

The aim of this paper was to investigate the influence of an increase in government healthcare expenditures on regional economic growth in Russia. Studies have shown that an increase in healthcare expenditures stimulate an increase in GDP through several channels. Firstly, it improves the quality of labor force, which can lead to an increase in labor productivity. Secondly, an increase in productivity and size of labor force lead to consumption expansion and then to firms’ income growth, so there is a multiplication effect. Including the assumption that the relationship between healthcare expenditure and economic growth may be non-linear we formed the hypothesis of the existence of the average optimal share of healthcare expenditure in GRP that maximizes average regional economic growth rate. In this research it was suggested that an increase in healthcare expenditures besides the direct effect on economic growth of a particular region also affects economic growth of neighboring regions. The possible explanation of this is the positive impact of healthcare services received in the neighboring regions on nearby territories, joint national healthcare projects, and distribution of scientific knowledge. Using the spatial Durbin model focusing on regional data of 2005–2017, it was shown that the average optimal share of healthcare expenditures equals to 5,9% of GRP with an inclusion of spatial effects and 7,6% without them, outlining the importance of including interconnection variables between Russian regions into the model. The regional statistics analysis showed the failure to reach the recommended share by most Russian regions, which can be viewed as a possibility for economic growth stimulation in case of the increase in governmental spending on healthcare in the future

The organisational context of nursing practice in hospitals in China and its relationship with quality of care, and patient and nurse outcomes: A mixed-methods review.

Achieving high-quality care and retention of nurses are major concerns for nurse leaders in hospitals. The organisational context is theorised to influence the quality of care and patient and nurse outcomes. This review focuses on China where the healthcare system is different from most Western countries in terms of government healthcare expenditure, public health insurance and healthcare delivery system. To explore the organisational context of nursing practice in hospitals in China and its relationship with quality of care, patient outcomes (patient adverse events, safety and satisfaction) and nurse outcomes (burnout, job satisfaction and intention to leave). A mixed-methods review. The electronic databases PubMed, EMBASE, CINAHL, PsycINFO and China Academic Journals Database were used. This review was conducted using the SALSA (Search, Appraisal, Synthesis and Analysis) framework. Quality assessment was conducted using the Joanna Briggs Institute (JBI) critical appraisal checklists for cross-sectional studies and qualitative research. A narrative synthesis was conducted and was supported by tabulation of study data. The PRISMA guidelines were used for this review. Twenty-three articles met the inclusion criteria and were retrieved, analysed and synthesised. This review supports the link between organisational context, quality of care, and patient and nurse outcomes in the Chinese healthcare system. Aspects of organisational context warrant attention including nurse staffing levels, the shortage of nurses, a lack of nurse participation in hospital affairs and support for the professional development of nurses. The findings suggest that tailored interventions are needed to improve the organisational context of nursing practice in Chinese hospitals and, in particular, to address the nurse workforce issues and organisational leadership and support. The unique policy context of the Chinese healthcare system should be considered when developing these interventions. Recognising the importance of the organisational context, it is imperative that nurse leaders make every effort to legislate for safe nurse staffing and to establish a caring culture to improve quality of care and nurse and patient outcomes.

The Economic Impacts of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome in an Australian Cohort.

Objectives: This study aims to estimate direct and indirect health economic costs associated with government and out-of-pocket (OOP) expenditure based on health care service utilization and lost income of participants and carers, as reported by Australian Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) patient survey participants.Design: A cost of illness study was conducted to estimate Australian cost data for individuals with a ME/CFS diagnosis as determined by the Canadian Consensus Criteria (CCC), International Consensus Criteria (ICC), and the 1994 CDC Criteria (Fukuda).Setting and participants: Survey participants identified from a research registry database provided self-report of expenditure associated with ME/CFS related healthcare across a 1-month timeframe between 2017 and 2019.Main outcome measures: ME/CFS related direct annual government health care costs, OOP health expenditure costs, indirect costs associated with lost income and health care service use patterns.Results: The mean annual cost of health care related expenditure and associated income loss among survey participants meeting diagnostic criteria for ME/CFS was estimated at $14.5 billion. For direct OOP and Government health care expenditure, high average costs were related to medical practitioner attendance, diagnostics, natural medicines, and device expenditure, with an average attendance of 10.6 referred attendances per annum and 12.1 GP visits per annum related specifically to managing ME/CFS.Conclusions: The economic impacts of ME/CFS in Australia are significant. Improved understanding of the illness pathology, diagnosis, and management, may reduce costs, improve patient prognosis and decrease the burden of ME/CFS in Australia.

Impact of Federal Government's Healthcare Expenditure on Economic Growth of Nigeria

Impact of Federal Government's Healthcare Expenditure on Economic Growth of Nigeria

Effects of Government Healthcare Expenditure on Economic Growth Based on Spatial Durbin Model: Evidence from China

The proportion of government healthcare expenditure in China increases due to rapid economic development in recent years. The growth of government healthcare expenditure can promote physical health improvement of human capitals and thereby facilitate economic growth. Hence, exploring the effects of government healthcare expenditure on economic growth is important. Spatial correlation of economic growth under different spatial weights was tested, and the effects of government healthcare expenditure on economic growth were analyzed by constructing a spatial Durbin model with the panel data of 31 provinces in China gathered from 2005 to 2017. Government healthcare expenditure in China significantly and positively affects economic growth under three spatial weight matrices. The spatial weight of economic distance influences economic growth more significantly compared with the 0-1 spatial weight and the spatial weight of geographical distance. The total and the direct effects of government healthcare expenditure are significantly positive. Furthermore, the direct effects are significant, whereas the indirect effects show different degrees of significance. The total effect of government healthcare expenditure on economic growth is significant and positive, with direct effects exceeding the indirect ones. Hence, the China's government must continue to increase financial investment to public health services to promote high-quality economic growth in the country.

Choosing Wisely: The Korean Perspective and Launch of the 'Right Decision in Cancer Care' Initiative.

Government healthcare expenditure is rising in Korea, and the costs incurred by patients in Korea exceed those incurred by patients in other Organization for Economic Co-operation and Development countries. Despite the increasing health expenditure, patient demand for services is increasing as well, so it is now becoming recognized that cancer care needs to be balanced. The most important measure in cancer care optimization is to provide high-quality care while keeping costs sustainable. The Korean Cancer Association considers the current situation of cancer therapy in Korea the foremost issue, which has led to the implementation of the nationwide ‘Right Decisions in Cancer Care’ initiative. This initiative is based on the concepts of medical professionalism in that it should be led by physicians working in the field of oncology, that education should be offered to patients and clinicians, and that it should influence healthcare policy. In this article, we introduce the nationwide ‘Right Decision in Cancer Care’ initiative and highlight the five initial items on its agenda. The agenda is open to expansion and update as the medical environment evolves and additional clinical evidence becomes available.