Health Expenditure Efficiency Research Articles

Assessment of the Impact of Government Health Expenditure on Economic Growth in Nigeria

This study evaluates the impact of government health expenditure on economic growth in Nigeria between 1992 and 2021 using the ordinary least squares model which was used to perform the estimation for the variables that were determined to be stationary at first difference were evaluated for stationarity. According to the model’s estimated results, neither of the independent variables government capital or recurrent health spending has a discernible impact on Nigeria’s economic expansion. The independent variables were not significantly significant, this could be attributed to the lack of strength of indirect effects and the time lag between ongoing healthcare costs and the overall economy. Additionally, in Nigeria, poor machine quality, unfinished projects, and corrupt officials might be blamed for health expenditures, which decreased the standard of healthcare and general wellness. The study recommended that the government should put in place the facilities needed for people to use healthcare and to maximize wellbeing to improve health outcomes and the government should ensure efficiency and transparency of health expenditure, alongside increased investment in the health sector to stimulate sustainable economic growth in Nigeria.

An analysis of factors influencing technical efficiency of health expenditures in China

China’s primary healthcare (PHC) system, together with rural healthcare services, remains the Achilles’ heel in the national healthcare system. Healthcare workers, specifically village doctors, are an integral part of the healthcare system. Using the two-stage data envelopment analysis (DEA) and Tobit regression analysis, this study aims to investigate the efficiency of healthcare expenditures on medical resources and services in China, as well as determine how different types of healthcare work influence efficiency. Compared with other types of healthcare workers, village doctors exerted a prominent impact on provincial and rural efficiency at all stages and played a key role in augmenting the efficiency of healthcare expenditures on health outcomes. Besides, township health centers (THCs) and village clinics (VCs) faced administrative overstaffing, mainly involving pharmacists, other nonmedical technologists, and health administrators, which adversely affected the efficiency of healthcare expenditures. This study suggests that the higher the proportion of these non-village doctor positions (e.g., pharmacists, health administrators, and nonmedical technologists) in THCs and VCs, the lower the efficiency of China’s PHC system. Overall, the priority should be enhancing the training and remuneration of village doctors and other healthcare workers in rural areas to further enhance their performance and increase the overall efficiency of China’s healthcare system.

Out-of-Pocket Health Expenditure and Associated Factors: Insights From National Health Accounts (NHA) Using Panel Data Analysis

This study investigates the relationship between out-of-pocket (OOP) healthcare spending, economic growth, population growth, and government health expenditure as a proportion of general government expenditure using National Health Accounts (NHA) estimates. Out-of-Pocket (OOP) healthcare spending imposes a substantial financial burden on households, especially in developing economies such as India. Understanding the factors that influence OOP payments is crucial for policymakers seeking to enhance healthcare systems and achieve Universal Health Coverage (UHC). High OOP expenditures often lead to impoverishment and inequitable access to healthcare, making it a critical area for reform. Despite the well-known negative economic and social consequences of high OOP spending, there is limited research that thoroughly examines the interplay between key economic variables such as economic growth, population growth, and government healthcare expenditure (GHE) as a proportion of general government expenditure (GGE) in shaping OOP healthcare spending. Furthermore, although the National Health Accounts (NHA) offers comprehensive data across Indian states, few studies have leveraged this data to explore the dynamics of these factors. This study aims to fill this gap by providing empirical insights into how these economic and demographic elements influence OOP healthcare spending in India. The analysis employed fixed and random effects models on data from 19 Indian states spanning the years 2013-14 and 2019-20. Fixed effects models were selected based on the results of the Hausman test, which indicated that these models were more effective for controlling unobserved heterogeneity across states.The results indicate that a 1% increase in Gross State Domestic Product is associated with a 0.5% reduction in OOP payments. No significant relationship was identified between population growth or GHE/GGE ratio and OOP healthcare spending. These results imply that while economic growth can contribute to lowering healthcare costs, other factors, such as public health spending, may not be as effective unless they are more strategically targeted. The study underscores the vital role of economic growth in reducing OOP healthcare spending, especially in states facing significant financial burdens. Policymakers should consider aligning economic growth strategies with healthcare reforms to ensure that the benefits of development lead to reduced OOP expenditures. As the findings also suggest that GHE/GGE does not significantly affect OOP costs, policymakers should enhance the targeting and efficiency of public health expenditures while expanding health insurance coverage, and strengthening primary healthcare systems to mitigate OOP costs.

Cluster analysis of sub-national differences in life expectancy at birth in the European Union

Abstract Background Life Expectancy (LE) at birth, the average number of years a person is expected to live from birth, supposing constant age-specific mortality, is an essential indicator of a country or region's well-being, reflecting policy options at the regional level and highlighting progress and gaps in societal health, including at the sub-national level. In this study, our goal was to explore patterns on groups of European Union (EU) member states according to sub-national gaps in LE at birth, between 2000 and 2020. Methods A longitudinal retrospective analysis on differences in LE at birth among NUTS2 regions in 20 EU countries (due to data availability issues) was performed, taking the largest absolute difference between NUTS2 regions, in 2000-2020, as the country value. A hierarchical agglomerative cluster analysis was then performed. All data was retrieved from Eurostat and analysis performed in R version 4.0.0. Results 3 clusters were identified: (1) Belgium, France, Czechia, Hungary, Portugal and Spain (cluster mean: 3.78); (2) Austria, Slovenia, Croatia, Romania, Bulgaria, Poland, Finland, Germany, Italy and Greece (cluster mean: 2.44); (3) Denmark, Netherlands, Sweden and Lithuania (cluster mean: 1.17). Conclusions 3 clusters of EU member states based on sub-national gaps in LE at birth were identified. Further studies are necessary to assess possible associated factors, such as health expenditure and health system efficiency, in order to better inform public policy and close the gap on existing inequalities. Key messages • Important sub-national differences in LE at birth exist in the EU, with considerable variability across groups of countries. • These results may have an important impact on policy-making and inequalities.

Providing a model for financing the treatment costs during biological crises using the fiscal space development approach

BackgroundExpanding fiscal space for health can be defined as providing additional budgetary resources for health, which is highly important during biological crises. This study aimed to provide a model for financing the treatment costs during biological crises using the development of the fiscal space approach.MethodsThis study employed a descriptive mixed-method design, consisting of three stages. In the first stage, a systematic review of relevant literature was conducted using multiple databases, including Scopus, PubMed, and Google Scholar. A total of 45 studies that met the inclusion criteria were selected. In the second stage, a panel of 14 experts identified five primary and 32 secondary strategies using an open questionnaire. Any additional strategies not identified during the literature review were added if a consensus was reached by experts. In the final stage, the Best Worst Method (BWM) was used to prioritize the identified strategies and sub-strategies based on their feasibility, effectiveness, quick yield, and fairness.ResultsFive strategies and fifty sub-strategies were identified. The most important strategies were the increase in health sector-specific resources (0.3889), increase in efficiency of health expenditures (0.2778), structural reforms (0.1111), health sector-specific grants and foreign aid (0.1667), and conducive macroeconomic conditions (0.05556). The most important sub-strategies were establishing and increasing earmarked taxes for the health sector (0.0140), expanding Universal Health Coverage (UHC) plans (0.0103), attracting the participation of non-governmental organizations (NGOs) and charitable organizations in the health sector (0.0096), integrating basic social insurance funds (0.0934), and tax exemptions for economic activists in the health sector (0.009303) during the crisis.ConclusionThis study identified five main strategies and 50 sub-strategies for financing the treatment costs during biological crises. The most important strategies were increasing health sector-specific resources, improving efficiency of health expenditures, and implementing structural reforms. To finance health expenditures, harmful and luxury goods taxes can be increased and allocated to the health sector during crises. UHC plans should be improved and expanded, and the capacity of NGOs and charitable organizations should be better utilized during crises.

Innovative methods of determining health expenditure efficiency are urgently needed

Innovative methods of determining health expenditure efficiency are urgently needed

Phase and wave dependent analysis of health expenditure efficiency: A sample of OECD evidence.

Health expenditures are a factor that reflects the government's public health policy and contributes to the protection of national health. Therefore, this study focuses on measuring the effectiveness of health expenditures in order to evaluate and improve the public health system and policy during the pandemic period. In order to examine the effectiveness of health expenditures, the behaviors of the pandemic process were analyzed in two stages. The number of daily cases is analyzed in the first stage by dividing it into waves and phases according to the transmission coefficient (R). For this classification, the discrete cumulative Fourier function estimation is used. In the second stage, the unit root test method was used to estimate the stationarity of the number of cases in order to examine whether the countries made effective health expenditures according to waves and phases. The series being stationary indicates that the cases are predictable and that health expenditure is efficient. Data consists of daily cases from February 2020 to November 2021 for 5 OECD countries. The general results are shown that cases cannot be predicted, especially in the first stage of the pandemic. In the relaxation phase and at the beginning of the second wave, the countries that were seriously affected by the epidemic started to control the number of cas es by taking adequate measures, thus increasing the efficiency of their health systems. The common feature of all the countries we examined is that phase 1, which represents the beginning of the waves, is not stationary. After the waves fade, it can be concluded that the stationary number of health cases cannot be sustainable in preventing new waves' formation. It is seen that countries cannot make effective health expenditures for each wave and stage. According to these findings, the periods in which countries made effective health expenditures during the pandemic are shown. The study aims to help countries make effective short- and long-term decisions about pandemics. The research provides a view of the effectiveness of health expenditures on the number of cases per day in 5 OECD countries during the COVID-19 Pandemic.

Effects of Vertical Fiscal Imbalance on Fiscal Health Expenditure Efficiency-Evidence from China.

Improving fiscal health expenditure efficiency is an inherent requirement of the strategy of "healthy China" and "high-quality development". The outbreak of COVID-19 has highlighted the importance of efficient health system. First, this paper systematically sorts out the multiple theoretical mechanisms of the positive and negative relationship between vertical fiscal imbalance and fiscal health expenditure efficiency. Secondly, a comprehensive index system, including the quantity and quality of medical services, is constructed, and the super-efficiency DEA model is used to measure fiscal health expenditure efficiency. There are obvious differences between eastern and western regions. Finally, the fixed effect model is constructed to carry out empirical research and it is found that the vertical fiscal imbalance in China has an overall positive and significant impact on the fiscal health expenditure efficiency, which is mainly achieved by optimizing the resources allocation between primary medical institutions and hospitals. Heterogeneity analysis shows that transfer payment scale has a corrective effect on the vertical fiscal imbalance's effect. The result of quantile regression shows that the impact of vertical fiscal imbalance is not constant, and it gradually turns from positive to negative along with the improvement of fiscal health expenditure efficiency.

Assessing the Effects of the COVID-19 Pandemic on the Evolution and Efficiency of Health Expenditure in Eastern European Countries

In the global context of the COVID-19 pandemic, economic and social systems were shaken to their foundations, in the sense that many businesses had to close or suspend their activities, which also had a negative impact on the quality of life of the population, both from a medical and economic perspective. Thus, like other countries around the world, Eastern European countries that are members of the European Union (EU) community have also faced such economic and health problems, which have led to multiple crisis situations that have not been managed in the most optimal, efficient and targeted way to meet the real needs of the population, generating discontent and protests among them. In view of these issues, the aim of this paper is to identify the main factors impacting on the evolution of health budget expenditures allocated to the management of the COVID-19 crisis in Eastern European countries and the efficiency of the allocation of these costs. Keywords: Eastern Europe, health expenditure, GDP, COVID-19

Interdependence of Public Health Expenditure Efficiency and Economic Development in Growing OECD Economies and the Republic of Serbia

Abstract Economic shocks represent a challenge for health systems because they decrease public revenue, and at the same time, increase the need for publicly funded health care. Since health expenditure is rapidly increasing in most countries, its efficiency must be tested. The subject of research in this paper is exactly the interdependence of public health expenditures and their efficiency, expressed through the anticipated life expectancy, as well as their relationship with economic growth. The correlation analysis conveyed in this paper refers to the period 2010-2019 and it is based on OECD countries’ data, growing OECD economies data, and the data for the Republic of Serbia..

A Study of the Impact of Fiscal Decentralization on the Efficiency of Public Health Expenditure

In this present-day global pandemic that has not been completely resolved, health is a major concern among people, and correspondingly, people are demanding higher standards for public health products and services provided by the government. In this paper, we measure the technical efficiency of public health expenditure in each province by using the data envelopment analysis (DEA) model, and examine the impact of decentralization on the efficiency of public health expenditure under the fiscal decentralization system using the panel data from 31 provinces from 2012–2019 in a panel model subject to fixed effects.

Evaluation of the Results of China’s Fiscal Medical and Health Expenditure

PurposeTo evaluate the resulting level of fiscal medical and health expenditure in China, and to provide the scientific basis for further improving fiscal medical and health service capacity in China.Patients and MethodsThe data envelopment method and Gini coefficient method were used to analyze the efficiency and regional fairness of fiscal medical and health expenditure results by using the relevant provincial and municipal data of China from 2007 to 2019.Results1.Overall, from 2007 to 2019, the total expenditure continued to increase, the expenditure efficiency increased first and then decreased, and the expenditure fairness continued to improve. 2. From the perspective of subregions, there are apparent differences between regions in terms of total expenditure, expenditure efficiency, and expenditure fairness, showing a better situation in the central, western, northeast and a lower situation in the east.ConclusionThe overall level of fiscal medical and health expenditure in China shows an upward trend, but there is still much room for improvement. At the same time, there are pronounced regional differences, and the problems of efficiency and fairness coexist among regions. Therefore, in the future, we should increase medical and health investment and enhance the government’s close attention; Improve the expenditure performance appraisal system; Formulate policies according to local conditions and avoid “one size fits all.”.

Spatial and Temporal Differences in the Health Expenditure Efficiency of China: Reflections Based on the Background of the COVID-19 Pandemic

The outbreak of the COVID-19 pandemic has brought several challenges to China's national health services, causing great risks and uncertainties to people's lives. Considering China's huge population and relatively small medical investment and its good performance in the COVID-19 pandemic, this research utilizes the hybrid meta-frontier model to analyze health expenditure efficiencies of 30 provinces in China from 1999 to 2018 and compares spatial and temporal differences of the efficiencies in regards to regional forward position and national common frontier. The results show an obvious difference in health expenditure efficiency in different provinces along the regional frontier, in which the efficiency gap in the eastern region is the largest. Moreover, the room for improvement in health expenditure efficiency varies from region to region. For the national common frontier, Beijing is the most efficient, while Guizhou is the least. The eastern region owns the most efficient technical level of health expenditure efficiency, and there is a large efficiency distance between it and the western region. The findings offer effective guidance for elevating the expenditure structure and spatial resource allocation of public health and for promoting the equalization of high quality basic medical services.

Efficiency of district hospitals in Zimbabwe: Assessment, drivers and policy implications.

The Government of Zimbabwe is committed to making progress towards universal health coverage. Unmet health needs are huge and the health system suffers from serious dysfunctions and weaknesses. The situation is further complicated by a weak governance. To address these challenging issues, many of which would require an increase in public health expenditures, the government faces severe macroeconomic constraints. In this context, improving the efficiency of public health expenditures is of paramount importance. This study focuses on the efficiency of district hospitals, whose role is crucial for the strengthening of the health care system and achieving significant results in implementing the universal health coverage. Based on a sample of 31 district hospitals observed from 2015 to 2017 we use the double bootstrap procedure developed by Simar and Wilson to (a) estimate bias-adjusted DEA efficiency scores and to (b) investigate the factors associated with the previously calculated scores using truncated regression. The average efficiency of district hospitals is low and stagnant over 2015-2017. The findings suggest the existence of a significant room for maneuver to get more results with the resources spent. The analysis of the efficiency drivers shows the importance of both supply and demand-side factors, leading to several policy-oriented considerations. The study also highlights important shortcomings in the routine collection of basic data that need to be addressed by the Ministry of Health and Child Care.

Macro-level efficiency of health expenditure: Estimates for 15 major economies

The coronavirus disease 2019 (COVID-19) pandemic highlights the importance of strong and resilient health systems. Yet how much a society should spend on healthcare is difficult to determine because additional health expenditures imply lower expenditures on other types of consumption. Furthermore, the welfare-maximizing (“efficient”) aggregate amount and composition of health expenditures depend on efficiency concepts at three levels that often get blurred in the debate. While the understanding of efficiency is good at the micro- and meso-levels—that is, relating to minimal spending for a given bundle of treatments and to the optimal mix of different treatments, respectively—this understanding rarely links to the efficiency of aggregate health expenditure at the macroeconomic level. While micro- and meso-efficiency are necessary for macro-efficiency, they are not sufficient. We propose a novel framework of a macro-efficiency score to assess welfare-maximizing aggregate health expenditure. This allows us to assess the extent to which selected major economies underspend or overspend on health relative to their gross domestic products per capita. We find that all economies under consideration underspend on healthcare with the exception of the United States. Underspending is particularly severe in China, India, and the Russian Federation. Our study emphasizes that the major and urgent issue in many countries is underspending on health at the macroeconomic level, rather than containing costs at the microeconomic level.

Health care system efficiency and life expectancy: A 140-country study.

Despite the evidence of links between health expenditure and health care efficiency, it is still unclear why countries with similar levels of health expenditures experience different outputs in terms of life expectancy at birth. Health care system efficiency might shed some light on the question. Using output-oriented data envelopment analysis, we compared the health systems of 140 countries in terms of attained life expectancy. Efficiency is determined by the distance from the closest country on the best practice frontier, which identifies the highest attainable life expectancy observed for any given level of health care spending. By using national data form the Human Development Data, we built the efficiency frontier and computed the potential life expectancy increase for each country. The potential improvement was, on average, 5.47 years [95%CI: 4.71-6.27 years]. The least efficient countries (10th percentile of the efficiency score) could improve by 11.78 years, while the most efficient countries (90th percentile of the efficiency score) could only improve by 0.83 years. We then analyzed, with regression analysis stratified by average education level, and by the role of health-related variables in differentiating efficient and inefficient countries from each other. The results suggest that, among countries with lower levels of education, decreasing unemployment and income inequality increases average life expectancy, without increasing health expenditure levels.

Psychosocial work environment risk factors among university employees – A cross-sectional study in Hungary

IntroductionNational and international research results have highlighted the fact that workplace stress causes mental and somatic problems. The aim of the present paper is to define exposure to workplace-related risk factors, with special focus on psychosocial risk factors, and the way they interconnect with workplace conditions, relationships with superiors and colleagues, and moral, professional and financial appreciation.MethodsCross-sectional research with the help of an anonymous online self-administered questionnaire was carried out among 261 higher education employees (67% women, 33% men, mean age 43.4 years) from 12 faculties of the University of Szeged, Hungary. Statistical analysis was performed using IBM SPSS 22.0.ResultsThe primary workplace stress factors for university employees were strict deadlines (80.4%), frequent overwork (64.2%) and difficulty in meeting requirements (56.7%). Communication problems with colleagues and superiors were also highlighted (47.5%). Job strain was higher for women than for men. With regard to low financial, professional, and moral appreciation, employees were characterised by the existence of work requirements impossible to meet, as well as by low autonomy. Experience of anxiety and aggression came along with low financial and moral appreciation (p<0.001).ConclusionsOur data suggests that employees at the university were subject to several psychosocial risk factors, and worked under considerable mental stress, leading to a higher prevalence of mental health problems. The results highlight the need for a health-focused policy-making in higher education to reduce health expenditure and increase efficiency at work.

Measuring and Assessing the Wealth Influence on the Efficiency of the Health System through the Private Sector

The aim of the paper is to provide an analysis of the dynamics of the public and private health sectors in Romania. Using descriptive statistics, it first investigates whether the public health sector follows the reformation trends suggested by official strategies and reports, and to what extent the private health sector is a viable alternative to the public one, by analysing the demand for private inpatient services. We look into the reduction in the occupancy degree in public hospitals as a means to increase the efficiency of public health expenditures, which represents one way to reform the public health sector. We also find that the increase in the occupancy degree in private hospitals is negatively correlated with the quality of services provided by public hospitals, but positively correlated with population wealth. Increase in the occupancy degree in private hospitals is an indicator of poor quality of services in public hospitals. It can also be explained by increasing expectations and requirements of beneficiaries as a reflection of increase in wealth and of their will to preserve their health capital. Using regression models, the paper then proposes the Wealth-Health Index, a composite indicator to explore the connection between wealth and health and the dynamics of the private health sector. Investment in physical infrastructure and the size of medical staff in the private sector is positively correlated with wealth increase.

Energy Efficiency and Health Efficiency of Old and New EU Member States.

Environmental protection and health issues have always been of great concern. This study employed modified Meta-Frontier Dynamic Network Data Envelopment Analysis to explore the environmental pollution effects from energy consumption on the mortality of children and adults, tuberculosis rate, survival rate, and health expenditure efficiencies in 15 old EU states and 13 new EU states from 2010 to 2014. We calculated the overall efficiency scores and technology gap ratios for each old EU and new EU states as well as the efficiencies of non-renewable energy, renewable energy, PM2.5, CO2, labor, GDP, tuberculosis, child mortality, adult mortality, health expenditure efficiency, and survival efficiency at the health stage. The average annual overall efficiencies of the old EU states are higher than that of the new EU states. Whether in terms of energy efficiencies or health efficiencies, the inputs and outputs of the old EU states are always higher than that of the new EU states. Overall, developing countries in Eastern Europe are lagging behind in terms of energy and health efficiencies. At the same time, the efficiency of child mortality is lower than that of adult mortality, and the efficiency of PM2.5 is higher than that of CO2 in both old and new EU states.

Efisiensi Belanja Kesehatan Kabupaten/Kota di Jawa Tengah Tahun 2015-2017

This study aims to analyze the level of efficiency of health expenditure from 35 regencies / cities in Central Java in the 2015-2017 period and what factors influence the level of efficiency. The method used to measure the level of efficiency in spending on health expenditure is Data Envelopment Analysis (DEA), while the logistic regression method is used to analyze the factors that influence the level of efficiency. Based on the DEA analysis, during the 2015-2017 period, there were 3 districts / cities (8.57%) that had been efficient in managing health spending. The results of logistic analysis showed that the ratio of the number of doctors per 100,000 population, the ratio of the number of hospital beds per 100,000 population, the level of public knowledge proxied to the average length of school, and the ratio of the number of midwives per 100,000 population, did not significantly influence the level of efficiency health expenditure with R2McF value of 0.06965 and LRstat probability value of 0.75458