Higher Public Expenditure Research Articles

Local government expenditure and Quality of Life in Finnish municipalities

This study investigates whether local government expenditure correlate with the Quality of Life (QoL) of the local population and whether high public expenditure are indicative of high or low QoL. Data, including information on public expenditure and objective QoL indicators, were gathered for Finnish municipalities from several existing databases and cover a period of 2015–2019. A composite indicator was constructed to measure municipal QoL performance. The results indicate that there is a clear correlation between public expenditure and QoL: the higher the public expenditure the lower the QoL of the local population. This is due to a greater demand for public goods in municipalities that have low QoL levels. Further, QoL and public expenditure levels are a fairly constant phenomenon. There was no evidence that changes in public expenditure and QoL would affect each other in the short term. The added value of this paper is that it fills parts of the research gap concerning our knowledge on the empirical links between public expenditure and QoL at the local level.

Financial integration and economic growth in Africa

The main objective of this article is to assess the link between financial integration and economic growth in African countries during the period 1990-2017. To achieve this goal, we used a dynamic panel model using the generalized method of moments (GMM) in first difference with threshold effects on a sample of 29 African countries. The results of the estimates reveal, on the one hand, that the countries that benefit from the benefits of financial integration on economic growth are those with high trade and financial openness, high human capital, low inflation, democratic regime, and high public expenditure. On the other hand, these results indicate that financial integration is associated with a low probability of surviving a banking crisis in the countries studied. Thus, the governments of African countries must implement policies aimed at a progressive liberalization of trade and financial activities, coupled with the implementation of macroeconomic stability policies and the improvement of the quality of the institutional environment, which determines the impact of financial integration on economic growth.

Evaluation of a Population-Based Targeted Screening Approach for Skin Cancer with Long-Time Follow-Up in Austria including Potential Effects on Melanoma Mortality.

whether screening for skin cancer affects melanoma-specific mortality in a population-based setting remains unclear. in this population-based cohort study, we characterized and evaluated a skin cancer prevention program following a targeted screening approach conducted in 1989-1994 in the Austrian province Vorarlberg, with follow-up until 2019. The general population and attendees of a health examination program served for comparison. in the screening program including full follow-up until 2019, 207 invasive and 187 in situ melanomas were identified in 8997 individuals. Incidences of invasive and in situ melanomas were elevated compared to the general population (IRR 2.92, 95%-CI 2.49-3.41, and IRR 4.13, 95%-CI 3.53-4.83, respectively) and the health examination program (HR 3.02, 95%-CI 2.59-3.52, and HR 3.90, 95%-CI 3.30-4.61, respectively). Breslow thickness and Clark's level at time of invasive diagnosis were significantly lower in 1989-2019, but the tumor characteristics of the melanomas diagnosed during 1989-1994 did not differ from the comparison groups. Moreover, melanoma mortality was significantly elevated in the screening program (IRR 1.66, 95%-CI 1.00-2.75 vs. the general population, HR 2.12, 95%-CI 1.25-3.61 vs. the health examination cohort). Melanoma mortality in Vorarlberg declined until 2004, though statistically non-significantly. given the uncertain effectiveness and high public expenditures of population-wide mass screening programs, primary prevention and targeted risk-based skin cancer screening might be promising alternatives.

Eviction and Poverty in American Cities.

More than two million U.S. households have an eviction case filed against them each year. Policy makers at the federal, state, and local levels are increasingly pursuing policies to reduce the number of evictions, citing harm to tenants and high public expenditures related to homelessness. We study the consequences of eviction for tenants using newly linked administrative data from two major urban areas: Cook County (which includes Chicago) and New York City. We document that before housing court, tenants experience declines in earnings and employment and increases in financial distress and hospital visits. These pre trends pose a challenge for disentangling correlation and causation. To address this problem, we use an instrumental variables approach based on cases randomly assigned to judges of varying leniency. We find that an eviction order increases homelessness and hospital visits and reduces earnings, durable goods consumption, and access to credit in the first two years. Effects on housing and labor market outcomes are driven by effects for female and Black tenants. In the longer run, eviction increases indebtedness and reduces credit scores.

Socioeconomic assessment of the restoration of highly modified coastal ecosystems by mining activities

Highly modified coasts are associated to sub-optimal provision of ecosystem services, causing biodiversity losses and negative impacts on social welfare. Although ecological arguments can justify the restoration of coastal environments, technical, social and economic issues often pose complex obstacles to implement efficient restorations. Indeed, there is a lack of socioeconomic assessments in both academic literature and policy decision-making showing whether the restoration of highly modified coasts are socially acceptable and economically efficient. This paper presents the case of the Portmán Bay (SE Spain), described as the most polluted coastal area by mining activities in the entire Mediterranean region. The question on how to restore the bay has been under debate for decades and there is not social and political consensus about its restoration yet. Our results suggest that, in terms of social preferences and net benefits, the preferred alternative would be to recover the coast and improve habitat continuity between the bay and other adjacent natural areas. Development of other economic activities incompatible with natural conservation could only compensate social welfare losses by increasing public taxation on private sector. Our results confirm that, once social preferences are taken into account, the restoration of heavily modified coastal ecosystems can be economically efficient even though it implies significant technical constraints and high public expenditures.

Epidemiological and conjunctural characterization of violence in Brazil from 2011 to 2020

Introduction: Violence is a complex phenomenon that affects individuals of different genders, ages, ethnicities and social classes, being considered an important public health problem in Brazil and in the world. Methodology: Study with a quantitative, epidemiological and analytical approach, whose objective was to characterize the main indicators and the way they are associated with violence in Brazil according to their forms, means and circumstances of occurrence, from 2011 to 2020. A dendrogram was produced through the combined application of Multiple Correspondence Analysis and Hierarchical Clustering techniques, characterizing the main profiles associated with violence in Brazil. Results: Violence is established as a complex and multicausal phenomenon, which results not only in high public expenditures, but mainly in the reduction of social cohesion due to the immeasurable damage caused to the population involved. In the present study, the violence is mostly of the physical type, affecting adult females, with low schooling and white or brown. Recurrence occurs mainly when the violence is psychological and sexual. As for the aggressor, they are usually adults, male, and the use of alcohol is common. An important participation of the Southeast region was observed in the notifications of all forms of violence. Conclusions: The magnitude and severity of the problem is brought into question, which must be investigated regionally and in a segmented manner, according to the type of violence. Thus, it infers that spending on violence prevention can mitigate economic, social and psychological problems in Brazil.

Ways of Reforming the System of Public Finance in Poland as an Implication of the Effects of the Covid-19 Epidemic. Financial and Economic Approach

Public finance management has a very global nature. Here decisions are made that determine everything related to collecting and allocating public means. However, the public finance system need to realize that this level is also highly entangled politically, with political transformations accompanying changes of governments and cooperating party coalitions. This accounts for the fact that some general recommendations are formed, specifying the ways of managing public means. The aim of the article is to identify ways to rationalize the reform of the public finance system in Poland. Induction was used as the main research method. It consists in drawing general conclusions or establishing regularities based on the analysis of empirically established phenomena and processes. The results of the presented content are proposals to optimize financing and management of the public sector in Poland. The main conclusion from the analyzes carried out assumes that the structure of public expenditure in Poland is characterized with high share of expenditure on social care, especially on allowances related to gaining and allowances for the family of a deceased person. Relatively high public expenditure is also allocated to education, mostly on higher education, and national defense. At the other end of the scale, categories which receive relatively little financing in Poland include: healthcare, with particularly low level of investment expenditure, and general state activity (public administration and interests on public debt).

Drivers of COVID-19 policy stringency in 175 countries and territories: COVID-19 cases and deaths, gross domestic products per capita, and health expenditures.

New data on COVID-19 may influence the stringency of containment policies, but these potential effect are not understood. We aimed to understand the associations of new COVID-19 cases and deaths with policy stringency globally and regionally. We modelled the marginal effects of new COVID-19 cases and deaths on policy stringency (scored 0-100) in 175 countries and territories, adjusting for gross domestic product (GDP) per capita and health expenditure (% of GDP), and public expenditure on health. The time periods examined were March to August 2020, September 2020 to February 2021, and March to August 2021. Policy response to new cases and deaths was faster and more stringent early in the COVID-19 pandemic (March to August 2020) compared to subsequent periods. New deaths were more strongly associated with stringent policies than new cases. In an average week, one new death per 100 000 people was associated with a stringency increase of 2.1 units in the March to August 2020 period, 1.3 units in the September 2020 to February 2021 period, and 0.7 units in the March to August 2021 period. New deaths in Africa and the Western Pacific were associated with more stringency than in other regions. Higher health expenditure as a percentage of GDP was associated with less stringent policies. Similarly, higher public expenditure on health by governments was mostly associated with less stringency across all three periods. GDP per capita did not have consistent patterns of associations with stringency. The stringency of COVID-19 policies was more strongly associated with new deaths than new cases. Our findings demonstrate the need for enhanced mortality surveillance to ensure policy alignment during health emergencies. Countries that invest less in health or have a lower public expenditure on health may be inclined to enact more stringent policies. This new empirical understanding of COVID-19 policy drivers can help public health officials anticipate and shape policy responses in future health emergencies.

How do trade openness, public expenditure and institutional performance affect unemployment in OIC countries? Evidence from the DCCE approach

This study explores the relationship between trade openness, public expenditure, institutional performance, and unemployment in member countries of the Organization of Islamic Cooperation (OIC) (formerly the Organization of the Islamic Conference). The conventional panel data techniques overlook cross-sectional dependence and yield-biased results. A new methodology called dynamic common correlated effects (DCCE) is employed to deal with the issue of cross-sectional dependence. The long-run results demonstrate that trade openness is inversely and significantly associated with overall unemployment and youth unemployment in lower-income as well as all the OIC economies and positively correlated in the higher-income OIC group. Public expenditure has an inverse and significant correlation with unemployment in OIC countries overall and higher-income OIC countries. Moreover, institutional performance and foreign direct investment are negatively related to unemployment in all OIC economies. The research shows the need for the continuation of open trade policies, strong institutions, and higher public expenditure in the OIC countries in order to decrease overall unemployment—in particular, youth unemployment.

Costs of pediatric hydrocephalus treatment for the Brazilian public health system in the Northeast of Brazil.

To estimate the costs of the surgical treatment of pediatric hydrocephalus, specifically ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV), for the Brazilian public health system (SUS). Retrospective cohort study of health records of patients < 14years of age with a diagnosis of hydrocephalus who underwent VPS or ETV between September 2009 and June 2016, regularly followed up for 24months. Seventy-six medical records were included. The groups of children who underwent VPS and ETV consisted of 60 and 16 patients, respectively. Complications during 2years of follow-up were identified in 56% of the children undergoing VPS and in 18% of those undergoing ETV (p = 0.0103). The initial cost of VPS was lower than that of ETV up to approximately 1year of post-surgical follow-up. After that, VPS generated higher expenses for the SUS due to higher rates of late post-surgical complications and repeated readmissions. Higher public expenditures were observed in the group of children undergoing VPS due to higher rates of infectious and mechanical complications requiring repeated hospitalizations and prosthesis replacements. Public policies must be tailored to offer the best treatment to children with hydrocephalus and to make judicious use of public resources without compromising the quality of treatment.

Political Spectacle and the Decline of Public Education in Botswana

Botswana has achieved a lot in education development since the country’s independence in 1966. Public education funding and access increased significantly, literacy rates rose, more schools were constructed and student enrolment rates increased at both primary and secondary schools. However, this paper argues that Botswana’s education system has been declining over the past 10 years, but that is concealed by the use of political spectacle. The data collected from secondary sources were used and subjected to content analysis. The findings show high public education expenditure and access in Botswana, but high failure rates; success narratives and pronouncements without commitment to educational effectiveness and efficiency; massive construction of public schools, but poor teaching–learning conditions; and trivialization of meaningful education reforms. This paper concludes by recommending the introduction of learner-friendly methods of assessment, improving teacher–government relations, the inclusion of stakeholders in education decision-making and the implementation of cost–benefit and cost-effectiveness measures in Botswana’s education.

Macroeconomic Determinants of Household Debt in OECD Countries

This article investigates the macroeconomic determinants of household debt in developed economies using a sample comprising 26 OECD countries for the period of 2002q1–2020q4. By resorting to the unconditional quantile regression, we find relevant asymmetries in the response of household debt. According to our results, economic growth leads to lower household debt, but the beneficial effect decreases as the level of household debt increases. Inflation lowers household borrowing only if the level of debt is high. Higher house prices lead to higher household debt, with the impact becoming stronger as the level of debt is higher. Investments go hand in hand with household debt, and higher investments lead to higher levels of borrowing, even when household debt is already high. Mortgage credit interest rates are positively linked with household debt, starting with higher debt levels. A rising unemployment rate leads to lower household debt, but the link becomes weaker as the level of debt increases. Higher public expenditures are generally associated with lower household debt. In addition, we find that household debt exhibits very powerful autoregressive behavior, being difficult to reduce rapidly in the case of need.

Community welfare resources and late-life depression among older adults in Seoul: A multi-level analysis.

This study aimed to examine whether community welfare resources in neighborhoods (recreational facilities, healthcare access, and public welfare expenditure) are associated with late-life depression among older adults in Seoul, South Korea. Data for this study were obtained by merging two different data sources: the 2018 Seoul Elderly Survey for individual-level variables and publicly available administrative data for neighborhood-level variables. The sample included 3036 older adults (unweighted n=3034) living in 25 neighborhoods (Gu) in Seoul. Multilevel regression models examined the effects of neighborhood-level variables on late-life depression while controlling for individual-level variables. We also explored the extent to which individual characteristics moderate the main effects of neighborhood characteristics on late-life depression. The results indicated that recreational facilities, health care centers, and public welfare expenditure in the neighborhoods were associated with late-life depression among older adults beyond individuals' predisposing conditions. Also, the effects of recreational facilities and public welfare expenditure on depressive symptoms were larger for those with higher education level. Older adults living in neighborhoods with more recreational facilities, more health care centers, and high public welfare expenditure were less likely to experience late-life depression. Of note is that the effects of neighborhoods' recreational facilities and public welfare expenditure varied by certain individual characteristics. Hence, local governments should introduce neighborhood-based health promotion policies to prevent depression among older adults. In doing so, local governments should also consider ways to improve access to community welfare resources for underprivileged older adults.

Longitudinal analysis of the determinants of life expectancy and healthy life expectancy: A causal approach

Understanding the determinants of health is essential for designing effective strategies to advance economic growth, reduce disease and disability, and enhance quality of life. We undertake a comprehensive outlook on public health by incorporating three metrics — life expectancy (LE), healthy life expectancy (HLE), and the discrepancy between the two. We investigate the effects of various health and socio-economic factors on these metrics and employ causal machine learning and statistical methods such as propensity score matching, X-learners, and causal forests to calculate treatment effects. An increase in basic water services and public health expenditure significantly increased average LE whereas high human immunodeficiency virus (HIV) prevalence rates and poverty rates reduced average LE. High gross national income (GNI) per capita and moderate body mass index (BMI) increased HLE whilst high HIV prevalence rates decreased HLE. High public health expenditure and high GNI per capita expand the gap between HLE and LE whereas high HIV prevalence rates and moderate BMI diminish this gap. Results suggest that policymakers should utilize governmental resources to improve public health infrastructure rather than provide fiscal incentives to encourage private healthcare infrastructure. Additionally, more emphasis should be placed on increasing educational levels of the general public by increasing educational expenditure and making educational institutions, public and private, more accountable.

Fiscal Challenges in Pandemic Times

The unexpected health crises that appeared at the end of 2019 and endures currently hadtriggered serious government challenges in conducting efficient fiscal policy. The growinghealth, educational, social, and other costs corelated with the health crisis had raisedintense reactions in governments through higher public expenditures that were financeddominantly from international financial markets. Already higher public debt to GDP ratioin some countries overcome the Maastricht criteria of this crucial fiscal variable that raisedsome serious questions for future government financial responses. This pandemic openedsome suggestions and considerations for major or minor tax reforms in some countries.If previously the governments were repellent to introduce some tax changes, now they seeopportunity to easily justify this fiscal step. The people subjected to COVID-19 disease areaddressing more publicly the need for substantial government help regarding the healthcosts. The IMF surveys show that people who faced this illness are more demanding forchanges in distributional fiscal function. The companies and households with extra profitsand income should be taxed with higher income tax rates and corporate taxes. The reasonfor this demand is the ongoing process of unevenly distributed national income that inpandemic circumstances affects more lower layers of income households. However, thereal sector in North Macedonia is publicly against higher tax rates, and they demand fromgovernment first to legalize the grey economy that they perceived as serious competitiveand fiscal problem.

Development Expenditure in Low-Income Indian States

The under-developed economies spend more on public goods and services. The low income states in India spend relatively more on public goods and services as compared to middle-income and high-income states. These low-income Indian states, however, perform relatively poor in socio-economic indicators such as poverty, health facilities, education, etc. This raises a question that why low-income states in India are more deprived despite of high public expenditure. The question has been addressed by testing the Wagner's law for low-income states in India for the period 1980-81 to 2014-15. Wagner's law states that public expenditure increases with rise in state activity. The study considers development expenditure-social sector and economic services. Each head is further categorized into revenue and capital expenditure. Since the study uses time series data for each panel, IM-Pasaran test is used for testing stationarity, and ARDL Model is used for obtaining long-term estimates of Wagner's law. We find that on average low income states in India tend to spend more on social sector and economic services as the output increases. However, the analysis of individual low-income states is different. Results of Odisha and West Bengal validate Wagner's law, public expenditure on both social sector and economic services had increased with output. In Rajasthan, expenditure on social sector is revenue in nature and expenditure in economic services is dominated by capital outlay (elasticity less than one). Although rest of the low income states spends on social sector and economic services with growth in output, the expenditure is revenue in nature. The results indicate that majority of low income states spends more on maintenance of available social services and less on creation of infrastructure. The expenditure on creation of infrastructure is necessary for the development of industries and agriculture in under-developed economies, and thus, capital expenditure is crucial for overall wellbeing of society. The low-income states in India had spent only 37% (average) of total expenditure on capital outlay of economic services during the period from 1980-81 to 2014-15. Apart from having revenue expenditure on social services, low-income states should focus on the development of economic services.

Risk factors, revascularization therapies and cardiovascular mortality in countries with middle and low public health expenditure

Abstract Background Studies from countries with high public health expenditure (PHE) have reported a decline of the rates of mortality from cardiovascular disease (CVD).Given that most mortality from CVD occurs in countries with low and middle PHE, there is a need for broader information on the relationship between variability in disease burden and outcomes in such countries. Purpose The aim of this study was to evaluate the relation among risk factors, revascularization therapies and short-term mortality from acute coronary syndromes (ACS) in patient admitted to hospitals in middle versus low PHE countries. Methods Data were derived from 18,704 patients admitted to 41 hospitals referring data to the ISACS-TC registry (NCT0128776). Patients were divided in two groups:low and middle PHE. Bosnia and Herzegovina,Croatia,Hungary,Italy,and Serbia have high PHE values, whereas Macedonia, Romania, Lithuania, Russian Federation, Kosovo,Moldova, and Montenegro, have low values. Main outcome measure was 30-day mortality. We used logistic-regression models to assess the effect of variables on the associations of interest. Results There were 18,704 patients admitted to hospital for an ACS. Of these patients, 45% were in the low PHE group and 55% in the middle PHE group. Patients in middle PHE group were older (64% vs 61%), had higher prevalence of traditional risk factors, namely hypertension (75% vs 66%), hypercholesterolemia (55% vs 31%), diabetes (28.58% vs 23.10%), and positive family history of coronary artery disease (45.66% vs 17.56) as compared with patients in the low PHE group.Furthermore, patients in the middle PHE group had more frequently history of prior ischemic heart disease and higher rate of ST segment elevation myocardial infarction (STEMI) as clinical presentation (63.91 vs 61.98). The crude 30-day mortality rate was 6.97% in the middle PHE and 5,82% in the low PHE group. After multivariable adjustment for comorbidities and treatment covariates, patients in the middle PHE group had a better outcome compared with those in the low PHE group (OR 0.64; 95% CI 0.45–0.93).As most patients presented to hospital with STEMI we performed separate analyses for such patients and stratified outcomes in function of time to hospital presentation from initial symptom onset. The odds of mortality were still lower in patients in the middle PHE group (OR 0.41; 95% CI 0.22–0.76) if they presented within 6 hours from symptom onset.In contrast there were no difference in outcomes between middle and low PHE groups (OR 0.69; 95% CI 0.34–1.44) in patients with delayed presentation.This held true even in patients undergoing primary percutaneous intervention (OR 1.02; 95% CI 0.43–2.39). Conclusions There are significant costs and infrastructure limitations that prohibit most countries with low PHE from having timely admission to hospital of patients with suspected ACS. Currently, many of the Eastern European countries are facing an enormous burden of mortality from CVD. Funding Acknowledgement Type of funding source: None

Decentralisation and fiscal performance in Central and Eastern Europe

ABSTRACT This paper provides empirical evidence on the association between decentralisation and budget deficits of the general government for a panel of 11 former transition countries during 1991–2018, controlling for the effects of various demographic, institutional, and macroeconomic variables. We provide evidence that decentralising government activities in Central and Eastern Europe (CEE) has favourable effects on the fiscal position of general government. Also, we show that the greater reliance on intergovernmental grants as a source of finance of local governments does not have detrimental effects on the overall fiscal discipline. Therefore, we cannot support the so-called ‘common pool’ hypothesis, which predicts that intergovernmental transfers lead to higher public expenditure, thus exacerbating the fiscal imbalances of the general government. On the other hand, we show that the effects of revenue decentralisation depend critically on the specific measure of local government revenue.

Impact of Out of Pocket Health Expenditure on Consumption Pattern of Below Poverty Line Households in India

Financial burden from health expenditure is a serious cause of concern for low-income and developing countries. Studies have shown that low public investment in health, lack of adequate safety net mechanisms and poor quality of public health system in these countries are few basic grounds for placing high financial burden on people. In order to make both ends meet during illness, poor people resort to various alternative means. One of the popular strategies adopted is to reduce or reallocate the consumption bundle, so as to meet the medical expenditure. The impact of out of pocket (OOP) health expenditure on the consumer expenditure has immediate and direct impact especially among the poor sections of the society. This article aims to study the impact of out of pocket health expenditure on the constituents of consumer expenditure and how the composition of consumer expenditure differs with the levels of out of pocket expenditure among different consumption quintiles. The study uses IHDS household level survey data for the year 2011–2012. A mean comparison test is carried out to check whether significant difference exists in the consumption bundles of households with and without medical expenditure. A system of Engel curves is estimated with seemingly unrelated regression equation (SURE) to study the impact of out of pocket medical expenses on the consumption bundle. The results show that there exists significant difference in the share of different consumption items in the consumption bundles of households with and without out of pocket expenditure. Despite having larger share for food expenditure, poor households tend to protect the consumption of food share in the bundle. Compensation for rise in medical expenses is reflected in the reduced share of non-food expenditure items like fuel, education, entertainment, clothing and footwear. With high share of out of pocket expenditure, poor households in the states with high public health expenditure mainly reduced their education expenditure whereas consumption of most of the non-food items were reduced by poor households in low public health expenditure states.

Switzer-Land of Opportunity: Intergenerational Income Mobility in the Land of Vocational Education

This study documents intergenerational income mobility in Switzerland and analyzes the role of educational tracks, local policies, and socio-demographic characteristics. We match the universe of labor incomes over generations and add census and survey data. Using over 900,000 observations from 18 cohorts (1967-1984), we show that income mobility in terms of rank-rank slope (0.14) is higher than in the US and even higher than in Nordic countries. At the same time, educational mobility is low. This shows that low educational mobility does not need to translate into low income mobility. We find high income mobility for individuals with vocational education and training (VET), suggesting that the divergence between educational and income mobility is due to the prominent VET system. Further, children of immigrants show higher mobility rates than children of Swiss born parents. Besides, regions with higher public expenditures, lower tax rates, and higher income inequality exhibit greater income mobility.