Analysis of the relationship between public health expenditure and health outcomes in Spain (2002-2022)

This article explores the impact of human capital on the process of economic expansion of Peru’s central region between 2009 and 2022, using data from INEI and MEF. A non-experimental design with panel data was applied, along with two econometric approaches: The Feasible Generalized Least Squares estimation method (FGLS) as well as the Generalized Least Squares (GLS) estimation, which was used to analyze how human capital stock and investment influence real GDP. The analyzed dimensions were education and health, measured through institutional indicators, teaching staff, health coverage, and public expenditure. The results reveal positive and significant effects, with the models explaining 82% and 78% of GDP variability, highlighting public spending on education as the main determinant. In summary, human capital—both in terms of stock and investment—constitutes an essential factor in regional economic growth, reinforcing the need to strengthen public and economic policies in Peru’s central macro-region.

The effectiveness of pharmaceutical tenders as a cost containment mechanism: analysis through the Synthetic Control Method. The case of Andalusia (Spain).

This study investigates the efficiency of higher education systems across the 27 Member States of the European Union during the period 2017–2022, addressing increasing policy interest in data-driven decision support and optimization techniques for performance evaluation in education systems. Efficiency is assessed using Stochastic Frontier Analysis, an optimization-based econometric approach, applied to multiple output dimensions relevant to learning analytics: alignment between graduates’ skills and labour market requirements, scientific productivity measured by published articles, and the number of higher education graduates. The model incorporates key input variables, including the student–teacher ratio, public expenditure per student, research and development expenditure, and the number of academic staff, while controlling for real gross domestic product per capita. To support integrated efficiency measurement and information-based decision-making, multidimensional outcomes are aggregated into composite efficiency indices using entropy-based weighting. The results reveal substantial cross-country heterogeneity in efficiency across EU higher education systems, identifying a cluster of high-performing countries that consistently optimize scientific output and graduate production. Financial resources and academic staff availability emerge as significant drivers of efficiency, while skill matching to labour market demand remains a persistent structural challenge. By combining Stochastic Frontier Analysis with entropy-based aggregation, this study provides a robust data-driven decision support framework for efficiency assessment, offering valuable insights for education policy design, resource allocation, and learning-oriented system optimization.

Ghana's annual public procurement expenditure of $3.5 billion, accounting for 11% of GDP, serves as a significant but underleveraged framework for addressing the country's interconnected issues of digital exclusion, climate vulnerability, and import dependency. This research goes beyond traditional administrative perspectives, introducing a transformative "Procurement 4.0" framework aimed at strategically harnessing fiscal power. The framework integrates artificial intelligence, blockchain, and multi-stakeholder governance to align procurement with three key imperatives: facilitating digital leapfrogging through AI-driven tender platforms that enhance SME access, catalyzing green industrialization with mandatory sustainability criteria and life-cycle assessments, and promoting SME-driven self-sufficiency via enforceable participation quotas and capability development. The study utilizes policy archaeology (2010-2024), multi-criteria scenario modeling, and stakeholder gap analysis to illustrate that recalibrating strategic procurement can enhance SME contributions to GDP from 17% to 25%, attain 40% green procurement compliance by 2035, and achieve notable AI-driven efficiency savings. The findings provide a clear and practical framework for Ghana and comparable Global South economies aiming to transform public spending into drivers of technological sovereignty, climate resilience, and inclusive structural change, fundamentally reshaping the role of procurement in fostering prosperity.

This study provided the relationship between healthcare financing and economic performance from 1986-2023 in Nigeria. Specifically, the study focused on the role of government capital and recurrent expenditure in health on gross domestic product. This study was based on two theoretical concepts, namely, the Human Capital Theory and the Keynesian Theory of Public Expenditure. The research design adopted ex post facto design as it is only applicable in a historical form of research where the researcher is not able to manipulate the variables. Data that were used in this study were obtained from statistical bulletins of Central Bank of Nigeria and World Bank. The data used for the research are secondary time series data. The descriptive method, unit root, Johansen co-integration and parsimonious ECM techniques were used for this study at 5% level of significance. The unit root result indicated that all the variables were stationary at first difference and require the Johansen co-integration that validate the presence of long run form among the variables. The parsimonious ECM result revealed that that Government recurrent spending in health have a statistically insignificant and negative effect on gross domestic product while government capital spending in health have positive and statistical significance influence on gross domestic product. The study concluded that government capital expenditure in health is the significant aspect of healthcare financing that, promotes the gross domestic product of Nigeria. The study recommended the Federal government of Nigeria to implement performance-based budgeting in the healthcare sector, conduct health workforce audit to reduce wastage.

This article examines the restrictive boundaries of discretion imposed by Estonian public procurement law in comparison to EU directives, highlighting the contradictions, interpretative errors, and regulatory gaps that complicate and challenge the work of Estonian procurers. The topic is significant because public procurement constitutes a substantial share of public expenditure and serves as a key mechanism for ensuring efficiency, competition, and the coherent application of EU internal market rules. The main questions addressed include whether Estonian enforcement disproportionally restricts EU-provided discretion and whether those restrictions conflict with the directive’s objectives. The study offers a critical assessment and proposes legislative guidelines. It concludes that current Estonian regulation and administrative interpretation often narrow the discretion intended by EU law, suggesting the need for legislative amendments or interpretative clarification to restore consistency and improve the effective use of procurement instruments.

Fiscal capacity is a core dimension of state capacity. Effective oversight of public expenditure is therefore essential for fiscal sustainability, a foundational element of sustainable development. As local government debt has steadily increased in China, participatory budgeting has emerged as an innovative mechanism for citizens to exercise such oversight and influence fiscal decisions. Our paper examines the effect of participatory budgeting on local government debt in China. Using a panel dataset covering 242 Chinese cities from 2013 to 2022, we examine the effect of participatory budgeting adoption on the scale of explicit government debt. Our results show that adopting participatory budgeting moderately reduces local government debt levels. Further mechanism analysis indicates that participatory budgeting operates through two channels. First, by enhancing budgetary transparency, it strengthens public scrutiny, which in turn disciplines government borrowing. Second, it redirects public spending toward welfare sectors like education and health, thereby crowding out large, debt-financed investment projects. Our findings contribute to the literature on participatory budgeting, fiscal democracy, and bottom-up accountability in public finance. The results suggest that participatory budgeting can be an effective policy tool for improving fiscal discipline and curbing government debt risks, ultimately fostering more sustainable and equitable local governance.

Income inequality is critical to social justice, and in this context, social spending is seen as one of the main policy tools for ensuring equality in income distribution. This research focuses on the relationship between social spending and income inequality. It also examines the development of social security systems, the organization and objectives of various social security frameworks, and social security spending in different countries. In this context, the study aimed to examine the impact of social security expenditures on the Gini coefficient. The study compared various selected EU countries and Türkiye in terms of these expenditures. The study was conducted using Generalized Estimation Equations method. Data was obtained from reliable sources such as the World Bank, and the OECD. The Gini coefficient was used as an indicator of income inequality, and the share of public expenditures in gross domestic product was used as the independent variable. Control variables included direct tax rates, unemployment rates, per capita income, and inflation. The findings of the analysis reveal a significant relationship between social security expenditures and the Gini coefficient. In this context, the findings are consistent with the literature and indicate that social expenditures are a fiscal policy tool that has a welfare-enhancing effect on disadvantaged segments of society.

This study examines the impact of migrant remittances on human capital development in Nigeria between 1990 and 2024, using the Human Development Index (HDI) as the primary metric of socio-economic progress. Specifically, it investigates the effects of personal remittances, institutional quality, and government education and health expenditure on HDI. Secondary time-series data were obtained from the World Development Indicators, the Central Bank of Nigeria Statistical Bulletin, and the Worldwide Governance Indicators. The study employed the Engel-Granger cointegration technique and an Error Correction Model (ECM) to estimate both short-run dynamics and the long-run equilibrium relationship. Empirical findings revealed that remittance inflows and institutional quality have positive but statistically insignificant short-run effects on HDI. In contrast, government expenditure on education and health demonstrated a strong positive and significant short-run impact. The study confirms a significant long-run cointegrating relationship among the variables, with an error correction mechanism indicating that approximately 19% of short-run deviations are corrected annually. It concludes that while remittances are substantial, their translation into tangible human development is not immediate, and effective government social spending is critical for short-term gains, with institutional quality providing the essential long-run framework. The study therefore recommends policies to channel remittances into productive human capital investments, enhance the efficiency of public social expenditure, and implement foundational governance reforms to strengthen institutional quality.

This study examines the relevance of governance quality in shaping the effect of economic policy uncertainty on several health expenditure indicators, including external health expenditure, national health expenditure, public health expenditure, and private health expenditure. The analysis is based on a sample of fifty-three African countries spanning 2005 to 2022. The adopted empirical strategy comprises the interactive dynamic two-step System Generalized Method of Moments (SGMM). The analysis is structured such that various governance dimensions-economic, political, and institutional governance moderate economic policy uncertainty to reduce health expenditure. Overall, governance dynamics do not effectively moderate economic policy uncertainty to negatively influence health expenditure dynamics. Specifically, a corresponding aggregated governance threshold of 2.2264, is needed to completely mitigate the positive effect of economic policy uncertainty on external health expenditure. Furthermore, improved infrastructure, employment, and foreign direct investment are potent channels for reducing some health expenditure dynamics within the continent. The associated policy implications of this study are discussed within the framework of the African Union's Agenda 2063 and the United Nations Sustainable Development Goals (SDGs).

In the Italian legal system, the duty to contribute to public expenses, which is a concrete expression of the principle of social solidarity referred to in Article 2 of the Constitution, is delimited by the principle of ability to pay, declined by Article 53 of the Constitution, which aims at circumscribing the taxation power, in order to guarantee the taxpayer. In the historical tradition, the ability to pay has been understood in a static sense, according to a definition that circumscribed it to indices denoting the aptitude to contribute. Subsequently, the notion was extended to other parameters that assigned prominence to the contribution to public expenditure: from this perspective, the ability to pay, referring to the taxpayer's personal situation, took on the appearance of an empty box. In reality, the weight of the imposed patrimonial benefit, far from being confined solely to indicators revealing wealth, could affect any fact with economic content not necessarily having a patrimonial character. This perspective would also make it possible to call for contributions from holders of assets or activities that the taxation of income, assets or consumption fails to hit satisfactorily. By emphasising the principle of solidarity, the reconstruction assigns to Article 53 of the Constitution the function of distributing, in a fair and reasonable manner, public burdens among citizens, according to a purely distributive criterion.

This paper investigates how regional government programs supporting the real sector of the economy differ between Russia’s northern regions and other parts of the country. The study is motivated by the critical role of fiscal policy in maintaining the stability of regional economic structures and promoting socio-economic development. The study makes a novel contribution through: (1) the collection, systematization, and analysis of expenditure data from regional government programs; (2) the development of an original classification of public funding expenditures based on official functional categories; and (3) the application of formal statistical tools to assess differences in expenditures. The findings indicate that Russian regions vary in both the structure of government programs and the scale of their funding. However, the level of interregional differentiation in expenditures supporting the real sector is relatively small. This suggests that regional fiscal capacity and the sectoral structure of the economy do not substantially affect the share of budget funds allocated to the real sector through government programs. The analysis further shows that overall budget support for the real sector in northern regions is statistically similar to that in other regions. Nevertheless, in certain sectors—particularly housing and utilities, as well as information and communication technologies—budget expenditures through government programs are significantly higher in the North. The theoretical significance of this study lies in advancing knowledge of the sources and magnitude of differentiation in regional budget expenditures under conditions of pronounced interregional disparities and diverse sectoral and spatial characteristics. Its practical significance stems from clarifying the role of fiscal capacity and economic structure in shaping regional budget expenditure patterns. Future research will focus on identifying long-term trends in the number and composition of government programs across Russian regions, exploring their similarities and differences, and highlighting distinctive features of budgetary support for the real sector.

Amid growing global challenges and post-pandemic consequences, improving healthcare financing mechanisms has become a key factor in ensuring the stability and effectiveness of national health systems. Using data from international organizations, the study assesses the dynamics of current health expenditures as a share of gross domestic product, with a focus on Central Asian countries and the ongoing reforms in Uzbekistan. The analysis shows that the coronavirus pandemic caused a temporary increase in expenditures, followed by gradual stabilization, while significant differences between countries in the region persist. The study identifies several priority reform areas: increasing public funding, strengthening financial protection for the population, and transitioning to a strategic approach to purchasing medical services. The examination of reforms in Uzbekistan demonstrates progress in the development of primary health care, digital transformation, and the phased introduction of a state health insurance system. The findings highlight the need to expand public financial resources, reduce out-of-pocket spending by households, and strengthen contractual mechanisms to enhance the sustainability and efficiency of healthcare systems.Keywords: healthcare financing, primary health care, public health expenditures, financial protection of the population, health insurance, healthcare reforms.

ABSTRACT Ever-changing territorial challenges might require administrative bodies to evolve their boundaries and functions in order to adapt to new conditions. Despite the importance of mergers, the literature on the topic is rather limited and does not provide a clear and comprehensive picture of the effects of municipality mergers for several reasons. Italy is the European country that experienced the lowest number of municipal mergers in recent years, and existing evidence does not provide a complete overview of their impact. We fill this gap by analysing the causal effects of municipal mergers on the local public expenditure dynamics over the period 2016–20. We find that the larger financial capacity was not used to reduce fiscal pressure nor the cost of local services, whereas merged municipalities increased their current expenditures – particularly in education, tourism and transportation – with high geographical heterogeneity.

ABSTRACT Public waste management can minimize environmental impacts by ensuring efficiency in waste reduction, recycling, and waste disposal processes. When combined with effective waste management, biomass energy can effectively replace fossil fuels. It is essential to protect natural resources in order to maximize the effects of waste management and biomass energy. In this context, this study investigates the effects of biomass energy, public waste management expenditures, and natural resource depletion on the load capacity factor in selected EU countries for the period 1995–2021. The findings of the dynamic common correlated effects estimator (DCCE) reveal that biomass energy has a positive effect on the LCF in Spain, Denmark, the Netherlands, and Portugal. Waste management expenditure has a positive impact on the LCF in the Netherlands. Although the impact of natural resource depletion is negative on the LCF in most nations, it significantly decreases the LCF only in Hungary. A harmonized framework specific to each state’s unique characteristics is proposed to address variable impacts across EU countries. The challenges of waste management, biomass energy, and natural resource depletion can be solved through a unified, adaptable approach within the EU.

This study aims to analyze the influence of government functional expenditure in the health, environment, and social protection sectors on the achievement of Sustainable Development Goals (SDG) 3 which focuses on health and welfare aspects. This study uses panel data from 2020-2022 with a purposive sampling approach. Data was obtained from 526 district/city governments in Indonesia, resulting in a total final sample of 1,578 observations. Using multiple linear regression analysis, the results show that government functional expenditure in the health and environment sectors has a positive and significant influence on the achievement of SDG 3. However, expenditure on social protection functions has a significant negative influence. These findings indicate that the increase in government functional expenditure in the three sectors is followed by changes in the achievement of SDG 3. Although there have been many studies examining the relationship between government functional expenditure and public welfare, research integrating these three strategic sectors simultaneously is still relatively limited. Therefore, this research implies that the achievement of health and well-being requires meaningful investment and effective governance. This emphasizes the importance of improving the quality of transparent, efficient, and targeted public expenditure to support the optimal achievement of SDG 3. Further research is recommended to add other variables and extend the study period to obtain more comprehensive results.

Quasi-experimental studies of mortality variation and trends among large administrative areas of England in the 2000s and early 2010s have suggested that more deprived populations gain larger mortality benefits from marginal increases in public expenditure on secondary care. To identify causal effects of marginal changes in expenditure on mortality variation in 2018 among 32,784 more and less deprived small areas of England, with a mean population of 1700, allowing more fine-grained measurements of deprivation and mortality. We used cross-sectional data on secondary-care funding allocated to 195 National Health Service administrative areas in England in 2018/19 and employed a well-established instrumental variable approach based on the "distance from target" component of the funding formula, which generates quasi-exogenous variation in funding based on historical factors unrelated to current need for secondary care. We found an inverted U-shape pattern of mortality gains by deprivation group, whereby the middle group gained significantly more than others. However, we could not reject the null hypothesis that the two more deprived groups received the same mortality gain as the two less deprived groups. These findings were robust to extensive sensitivity analysis using different levels of analysis, control variables, mortality outcomes, functional forms, first-stage regression specifications, and exclusions, and our preferred specifications all satisfied standard instrumental variable diagnostic tests. We found that the poor do not always gain more from marginal increases in public expenditure on secondary care and, conversely, might not always bear the largest share of the health opportunity costs of cost-increasing programmes.

In the context of a distressed fiscal position that the state holds in terms of lower capacity to source funds through taxation and restrictions on borrowing funds, it is imperative for Kerala to ensure distributional efficiency of its funds. The state has largely used public expenditure as its major channel of redistribution. However, cases of exclusion from these achievements are not far from reality in Kerala, notwithstanding its development achievements. This study uses the benefit incidence analysis (BIA) on two separate rounds of the National Sample Survey data to assess the distributional effects of public spending on crop insurance and rural housing schemes in India, with special reference to Kerala. We find that the Crop Insurance Scheme shows a pro-rich trend. Agricultural development policies are effective only with adequate safety nets for small and marginal farmers; otherwise, in agriculture-distressed states like Kerala, regressive expenditure distribution may lead to negative impacts that overshadow positive outcomes. While rural housing demonstrates a pro-poor trend, with a heavy capturing of benefits by the high-income deciles, a strong decentralised government and private sector, and the self-selective nature of the scheme can be identified as some of the reasons for this trend. However, a higher elite capture in the case of a highly targeted scheme, such as rural housing, raises concerns about the state’s fiscal management. JEL Codes: H4, H5, H530, I13, I380

We approach emergency department delay-related harm as though it were a distinct condition and explore use of an explicit cost-effectiveness threshold as a guide to management. Based on the reported association of delayed emergency admission with short-term mortality, to prevent loss of one quality-adjusted life year per patient harmed in Ireland, annual resources equivalent to 70 additional bed years, or infrastructure funding for 90 new beds, could be considered cost-effective. The additional commitment represents under 1% of annual public acute hospital sector expenditure in Ireland, an OECD member country.