Public Expenditure Research Articles

Guideline Adherence as an Indicator of PET Scan Overuse in an Italian Teaching Hospital: An Observational Study.

Evidence of inappropriate overuse and underuse of medical procedures has been documented in modern healthcare systems around the world. Excessive use of health services can contribute to a rapid increase in healthcare costs and harm the patient physically and psychologically; conversely, underuse can lead to the inability to provide effective treatments when clinically indicated. The study's aim is twofold: a) to measure the appropriateness of PET prescription in a cohort of patients, offering empirical evidence of overuse of health care services; b) to evaluate how the overuse of PET could affect public health expenditure and, consequently, the system's financial sustainability. In this observational study, we have analyzed prospectively and retrospectively health patient records who underwent 18F-FDG PET/TC scan at the Nuclear Medicine Department of the University Hospital Mater Domini in Catanzaro (Italy) from 29/09/2022 to 10/02/2023. Patients' diagnostic questions have been defined as appropriate, not completely appropriate and completely inappropriate according to the 18F-FDG PET/CT recommendations defined by the "Conditions of Supply and Indications of Prescriptive Appropriateness of Italian NHS (National Health Systems)" published in the Official Gazette no. 15 of 20 January 2016 (Decree 9 December 2015) and by the AIMN (Italian Association of Nuclear Medicine) guidelines. We gathered data from 500 oncological patients (242 males and 258 females). The results show that 423/500 of patients' prescriptions were appropriate, while 77/500 of patients' prescriptions were completely inappropriate (63/77) or not completely appropriate (14/77). Analysis showed a not complete adherence to national guidelines and no shared decision-making approach.

The efficiency of public expenditures on basic services: The case of South African municipalities

AbstractThis paper examines the efficiency of service delivery across 213 local and metropolitan municipalities in South Africa, focusing on four critical areas: electricity, water, sewerage and waste removal. Utilising a order‐ partial frontier efficiency analysis (PFEA), the study calculates output‐oriented efficiency scores for each municipality, incorporating adjustments for service quality based on an ‘infrastructure quality‐index’. Our empirical findings indicate marked variations in efficiency, with electricity services exhibiting the highest efficiency rate at 35%, while waste removal lags behind at 22%. Additionally, municipalities centred around small urban towns are found to be more efficient, challenging the widely held view that larger municipalities are better equipped for efficient service delivery. The analysis offers empirical insights into local government performance in South Africa, underscoring the need for targeted policy interventions to address efficiency gaps. These results not only inform fiscal and administrative decentralisation strategies but also set the groundwork for future research exploring the underlying factors affecting municipal efficiency.

Who gets the goods? Disentangling the effects of parliamentary representation and collective action on social spending

Abstract A century of activist and academic analysis of the welfare state can be sorted into insider and outsider theories of social change. One perspective argues that working-class and poor people can achieve income redistribution through insider strategies, primarily through the legislative efforts of left-wing political parties. A competing perspective argues that political parties themselves have no inner motor and merely channel the outside pressure from disruptive collective action. This article makes a substantive and methodological contribution to the debate over the generosity of the welfare state. We analyse the extent to which collective action confounds, moderates, or operates independently of left-wing parliamentary power to explain the history of social spending in 22 countries. Our results support a strong version of the insider intuition that the parliamentary road is crucial to winning gains for poor and working people. It does so without channelling the power of mass mobilization: accounting for various forms of collective action does not reduce the impact of left parliamentary representation on public social expenditures. Nonetheless, we do find that strikes, in particular, have independent effects on social spending. These results together provide some support for what can be called a Marxist–social democratic alliance. We also find evidence for the outsider view that protests and riots matter when combined; these mobilizations, like strikes, operate independently of the role of left-wing parliamentary power.

The impact of antiretroviral treatment and child-focused unconditional cash transfers on child mortality

Although there is sufficient evidence in the epidemiological literature that antiretroviral treatment (ART) reduces child mortality, there is limited evidence of its effect in the socio-economic determinants of child mortality literature. Furthermore, evidence on the effect of child focused unconditional cash transfers (UCTs) on child mortality is limited, especially in the African context. Using South Africa's provincial level data over the period 2001 to 2019, we evaluate the effect of ART and child focused UCTs on child mortality. We use the two-stage instrumental variable mean group estimator. We find that ART reduces child mortality. Moreover, we find an inverted U-shaped non-linear relationship between UCTs and child mortality that is contingent to the level of cash transfer coverage. Our analyses also reveal that UCTs improve the effect of ART on child mortality by enhancing access and adherence to treatment. While the focus of our analyses was on the child mortality effects of ART and UCTs, our findings reaffirm the well-documented impacts of factors such as public health expenditure, HIV/AIDS, female education, and health worker density on child mortality. Collectively, the combination of high ART and UCTs coverage, increased public health expenditure, enhanced female education, and improved health worker density, represents value for money for policymakers and funders. These areas should be prioritised to improve child well-being.

Public Sector Capital Expenditure and Tax Revenue Generation in Nigeria

Public sector capital expenditure is an important issue that cannot be ignored due to how it relates to tax revenue generation in Nigeria. This study examined the impact of public sector capital expenditure on tax revenue generation proxy by petroleum profit tax (PPT) in Nigeria. The baseline theory of this study is the Keynesian theory. The research design adopted in this study is the quasi-experimental research design. Secondary data was collected from the National Bureau of Statistics and CBN statistical bulletin. The multiple regression analysis based on the OLS method aided by E-view version 12 computer software was used to analyse the data, and the results were used to test the hypotheses. The findings showed positive significant relationship between the capital expenditure on road construction and PPT in Nigeria. It also revealed a significant positive relationship between capital expenditure on power, light and that PPT in Nigeria. The study revealed significant positive relationship between capital expenditure on security and PPT in Nigeria. Therefore, the study concluded that public sector capital expenditure played a vital role in improving tax revenue generation in Nigeria. The study recommends that since there is a positive relationship between capital expenditure on security, road construction and power with that of PPT, the variables should be sustained in this study. Government should look for means to solve the security challenges in the country, construct more roads, revolutionize electricity and power generation so as to enhance tax revenue generation in Nigeria.

Availability and Access to Orphan Drugs for Rare Cancers in Bulgaria: Analysis of Delays and Public Expenditures.

Rare cancers are defined by an annual incidence of fewer than 6 per 100,000. Bearing similarities to rare diseases, they are associated with substantial health inequalities due to diagnostic complexity and delayed access to innovative therapies. This situation is further aggravated in Southeastern European countries like Bulgaria, where limited public resources and expertise underscore the need for additional policy and translational research on rare cancers. This study aimed to explore the availability and access to orphan drugs for rare cancers in Bulgaria for the period of 2020-2023. We cross-compared data from both the European Union and national public sources to evaluate the number of available and accessible orphan drugs for rare cancers, the delay from market authorization to reimbursement, the dynamics of public expenditures, and regional disparities in access across the country. We juxtaposed the main characteristics of oncological and non-oncological orphan drugs as well. Only 15 out of 50 oncological orphan drugs that were authorized by the European Medicine Agency were accessible for rare cancer patients in Bulgaria. The median delay between market authorization and inclusion in the Bulgarian Positive Drug List was 760 days. The total expenditures for all orphan drugs for rare cancers amounted to EUR 74,353,493 from 2020 to 2023. The budgetary impact of this group rose from 0.24% to 3.77% of total public medicinal product expenditures for the study period. Rare cancer patients represent a vulnerable population that often faces limited to no access to treatment. We call for targeted European and national policies to address this major inequality.

Health care expenses impact on the disability-adjusted life years in non-communicable diseases in the European Union.

Non-communicable diseases are a global health problem. The metric Disability-Adjusted Life Years was developed to measure its impact on health systems. This metric makes it possible to understand a disease's burden, towards defining healthcare policies. This research analysed the effect of healthcare expenditures in the evolution of disability-adjusted life years for non-communicable diseases in the European Union between 2000 and 2019. Data were collected for all 27 European Union countries from Global Burden of Disease 2019, Global Health Expenditure, and EUROSTAT databases. Econometric panel data models were used to assess the impact of healthcare expenses on the disability-adjusted life years. Only models with a coefficient of determination equal to or higher than 10% were analysed. There was a decrease in the non-communicable diseases with the highest disability-adjusted life years: cardiovascular diseases (2,952 years/105 inhabitants) and neoplasms (618 years/105 inhabitants). Health expenditure significantly decreased disability-adjusted life years for all analysed diseases (p < 0.01) unless for musculoskeletal disorders. Private health expenditure did not show a significant effect on neurological and musculoskeletal disorders (p > 0.05) whereas public health expenditure did not significantly influence skin and subcutaneous diseases (p > 0.05). Health expenditure have proved to be effective in the reduction of several diseases. However, some categories such as musculoskeletal and mental disorders must be a priority for health policies in the future since, despite their low mortality, they can present high morbidity and disability.

Economic Impact of Health Expenditures: Panel Data Analysis for Selected Economies

It is estimated that healthcare services will increasingly strain public healthcare expenditures in the near future. Public health expenditures yield more effective outputs than household expenditures do. Due to its direct impact on human capital, public health displays a positive correlation with labor productivity, personal expenditures, and GDP indicators. In welfare economics theory, the examination of economic and social welfare focuses on the analysis of the distribution of economic resources among social actors. During the 2003-2016 timeframe in Turkey, Ukraine, Moldova, Poland, and South Korea, this research examined several health care expenditures. These included the proportion of the population spending more than 10 pct of their household consumption or income on out-of-pocket health care expenses, current health expenditure per capita, domestic general government health expenditure per capita, and domestic private health expenditure per capita. To conduct the panel data analysis, the "domestic private health expenditure per capita" data was utilized. Based on the research findings, an increase in domestic government health expenditures in certain countries results in an escalation of household health expenditures, while an increase in private sector health spending leads to a reduction in household health expenditures.

A distribution dependence study on the impacts of public health expenditure on national health across countries using quantile-on-quantile method

Public health expenditures (PHEs) within a reasonable range are a subject of current research, with discussions centered on how PHEs affect population health outcomes (PHOs). Nevertheless, due to the narrow range of variables used to measure health outcomes and the inadequacy of conditional mean models in identifying distribution dependence, people have not yet come to a consensus. We build a composite index to measure the PHOs in a comprehensive way, and we use the quantile-on-quantile method to assess the impact of PHE by capturing the distribution dependence across variables. According to the findings, PHE encourages PHOs when its share of GDP is higher than 0.86% and lower than 6.63–6.82%. However, as PHOs are the outcome of a mix of other socioeconomic factors, spending within a fair range does not always have a favorable impact.

Asymmetric effects of macro policies on women’s and men’s incomes. An empirical investigation of the eurozone crisis in a gender perspective

We study how macro policies affected women’s and men’s incomes during the financial crisis in Europe. We consider the monetary stance, proxied by benchmark interest rates, and the fiscal stance, measured by the variation in public expenditures and public revenues, and investigate how they are associated to women’s and men’s labor and capital incomes, using microdata for 27 European countries between 2008 and 2016. We individualize household-level data by considering four scenarios of intra-household sharing of resources. We also explore how and to what extent macro-policies affect the distribution of labour incomes for men and women by applying a conditional quantile regression approach. Results highlight that the ECB’s expansionary policies had a positive effect on both labor and capital incomes for both men and women, while austerity policies had a mixed impact. Reductions in public expenditure had the effect of reducing labor incomes for both men and women, particularly at the median of the wage and labor distributions. In contrast, increases in public revenues benefited capital incomes, for all income quantiles.

The nonlinear dynamic effect of government expenditure on income inequality: The case of macroprudential policy switching

A panel data analysis of nonlinear government expenditure and income inequality dynamics in a macroprudential policy regime was conducted on a panel of 15 emerging countries from 1985–2019, where there had been a non-prudential regime from 1985–1999 and a prudential regime from 2000–2019. The paper explored the validity of the nonlinearity between government expenditure and income inequality in the macroprudential policy regime as well as the threshold level at which excessive spending reduces income inequality using the Bayesian spatial lag panel smooth transition regression (BSPSTR) and fix effect models. The BSPSTR model was adopted due to its ability to address the problems of heterogeneity, endogeneity, and cross-section correlation in a nonlinear framework. Moreover, as the transition variable often varies across time and space, the effect of the independent variables can also be time- and space-varying. The results reveal evidence of a nonlinear effect between government spending and income inequality, where the minimum level of government spending is found to be 29.89 percent of GDP, above which expenditure reduces inequality in emerging countries. The findings confirmed an inverted U-shaped relationship. The focal policy recommendation is that fiscal policy decisions that will reinforce the need for more emphasis on education and public expenditure on education and health, as important tools for improving income inequality, are crucial for these economies. Caution is needed when introducing macroprudential policies, especially at a low level of government expenditure.

Retraction Note: Asymmetric effect of FDI and public expenditure on population health: new evidence from Pakistan based on non-linear ARDL.

Retraction Note: Asymmetric effect of FDI and public expenditure on population health: new evidence from Pakistan based on non-linear ARDL.

Social and demographic determinants of health insurance status in India: Evidence from a nationally representative cross-sectional survey.

Out-of-pocket medical expenses are a crucial metric for assessing how well the healthcare system is working toward obtaining universal health coverage in any country. In India, out-of-pocket expenses for health are relatively high compared to other developed countries due to a lack of alternative finance arrangements. The disparity in out-of-pocket medical expenses largely depends upon the public health expenditure, government policies, and level of health insurance coverage. The study used a logit regression model to examine the association of the status of health insurance with socio and demographic variables using National Sample Survey 2018 data. The objective of the study is to analyze the impact of demographic variables on the status of health insurance in India. This research found that education and occupation have a significant impact on the status of health insurance, among other demographic factors. These findings underscore the importance of targeted policies and interventions aimed at improving access to health insurance among specific demographic groups. Addressing disparities in health insurance coverage based on educational and occupational factors is essential for achieving equitable healthcare access and improved health outcomes in the country. Increasing awareness of health insurance reduces out-of-pocket medical expenses and subsequently brings down economic poverty.

Public Spending and Sustainable Human Development in Cameroon: Does corruption matter?

This study analyzes the effect of public spending on Human capital on human development in Cameroon by controlling the impact of corruption. After using quantitative methods, the ARDL model was applied with the bounds testing approach with time series data from 2000 to 2021. The results indicated that public spending on education and health positively impacts the change in the human development index. Similarly, economic growth (GDP) positively affects the variation of the human development index. Meanwhile, corruption and foreign direct investment (FDI) negatively correlate with the human development index. However, these results are only valid in the short term. In the long term, there is no relationship between the variables. The government should increase the expenditure budget and expand the target sector to reach the industry needed for human development. An improvement could follow this implementation in transparency in fiscal policy management, which can help reduce the corruption perception index. One of the limitations of this research is the use of a short observation period due to data availability. Therefore, the relationship between public expenditure, corruption, and human development in the CEMAC zone is another critical issue that could be investigated.

Technology Finance and Urban Development: A Quantitative Approach to Shaping a New Future for Shrinking Cities

Using a dataset of 30 cities of different administrative levels in Liaoning Province, China, for the period 2007-2020, this study proposes a novel quantitative methodology for assessing the impact of socio-economic factors on the attractiveness of shrinking cities. By combining a shrinkage model with principal component analysis and extreme value normalisation of key indicators such as population size, GDP, retail sales of consumer goods, public budget expenditure, and secondary and tertiary employment, we provide a detailed analysis of the phenomenon of shrinking cities and its drivers. Using an interdisciplinary approach involving economics, psychology and sociology, we redefine traditional indicators for assessing the attractiveness of cities by analogising urban population dynamics to the process of molecular transfer in physical chemistry. This approach allows us to quantify the attractiveness of cities in four ways: socio-economic attractiveness, cost of living, public services and employment opportunities. The case study of Fushun illustrates the application of our model, revealing the potential for negative attractiveness across all dimensions and highlighting the multifaceted challenges facing shrinking cities. Our findings highlight the critical role of balanced socio-economic development, well-developed public services, affordable living conditions and adequate employment opportunities in enhancing the attractiveness of cities. This comprehensive framework provides valuable insights for urban planners and policymakers aiming to mitigate urban shrinkage and promote sustainable urban development.

Public Spending Composition and its Implications for Economic Growth and Poverty Reduction in Pakistan: A Dynamic Time Series Analysis

This study explores the dynamics of government spending composition in Pakistan, focusing on its impact on economic growth and poverty reduction. The study analyzes subcategories of public expenditures, including current and capital spending, and functional classifications such as education, health, physical infrastructure, and defence. Using the ARDL framework, the study finds a long-run relationship between public spending and economic growth, with capital spending positively impacting GDP growth while current expenditures have a negative effect. Education and physical infrastructure expenditures contribute positively to economic growth, while health expenditures negatively impact the long run. The study also disaggregates health and education expenditures to analyze their economic impacts. Expenditures on research and curriculum development in education and subsidiary transportation services positively affect economic growth. However, primary and secondary education expenses and tertiary education expenditures do not show a significant growth impact. Similarly, expenditures on hospital services, patient health services, and research and development in health do not contribute to economic growth. The study concludes that the composition of public expenditures is related to poverty reduction, with total government spending and investments in education, health, and physical infrastructure playing a significant role in poverty reduction.

OECD 고등교육 재정의 국제 비교

In this article we compare the higher education finance of advanced countries using OECD’s “Education at a Glance” data from 1998~2018. We first investigate the relationship among input side variables such as relative size of number of college students, relative size of per student expenditure, the portion of public expenditure in higher education finance. We find fundamental trade-off between the quality and quantity, as captured by the negative correlation between the per student expenditure-GDP per capita ratio and the number of college students compared to the total population. We also investigate the relationship between the input and outputs of higher education. The major findings are that the higher the portion of public expenditure in higher education finance, the lower the chance of having world’s top research universities. Meanwhile, the youth unemployment tends to be lower in countries that governments’ portion of higher education finance are large.

Contribution of high-technology procedures to public healthcare expenditures: the case of ischemic heart disease in Portugal, 2002-2015.

The magnitude of the impact of technological innovations on healthcare expenditure is unclear. This paper estimated the impact of high-technology procedures on public healthcare expenditure for patients with ischemic heart disease (IHD) in Portugal. The Blinder-Oaxaca decomposition method was applied to Portuguese NHS administrative data for IHD discharges during two periods, 2008-2015 vs. 2002-2007 (N = 434,870). We modelled per episode healthcare expenditures on the introduction of new technologies, adjusting for GDP, patient age, and comorbidities. The per episode healthcare expenditure was significantly higher in 2008-2015 compared to 2002-2007 for IHD discharges. The increase in the use of high-technology procedures contributed to 28.6% of this growth among all IHD patients, and to 18.4%, 6.8%, 11.1%, and 29.2% for acute myocardial infarction, unstable angina, stable angina, and other IHDs, respectively. Changes in the use of stents and embolic protection and/or coronary brachytherapy devices were the largest contributors to expenditure growth. High-technology procedures were confirmed as a key driver of public healthcare expenditure growth in Portugal, contributing to more than a quarter of this growth.

The return of expansionary austerity: Firms' investment response to fiscal adjustments in emerging markets

In emerging markets, unexpected public expenditure reductions increase firm-level investment, which quickly surpasses pre-shock levels after a temporary contraction, owing to a decline in financing costs. Consistent with the role played by financing cost dynamics and financial frictions, we show that countries with lower sovereign credit ratings (those that are not investment grade) experience a sharper boost in investment. In addition, we find that investment's recovery is facilitated by trade openness, public spending predictability, and exchange rate flexibility. In fact, exchange rate flexibility facilitates the real depreciation that result from the fiscal adjustment, which decreases (relative) domestic demand for non-tradable (akin to Diaz-Alejandro, 1966) and increases external demand for tradables, boosting investment. We show that adjustment composition matters: reductions in public consumption (vis-à-vis public investment) yield larger private investment contractions on impact but result in quicker and more sustainable recoveries. Exploiting firm-level heterogeneity we show that investment's expansion is stronger in the tradable-sector, in larger, and in less indebted firms. We provide evidence that the medium-term benefits of fiscal shocks to firm-level activity outweigh their short-run costs.

Economic Globalization, Taxation and Public Expenditures: Evidence From OECD Countries

Globalization shapes the fiscal policies of countries, leading to changes in the structure of taxation and public expenditures. According to the theory of international tax competition, as globalization increases, countries use their tax policies to attract more mobile factors, resulting in tax competition. This competition causes capital tax rates to decrease and labor tax rates to increase, which is known as the efficiency effect of globalization. On the other hand, governments expand the welfare state to compensate for the increased economic risks resulting from globalization. This is known as the compensation effect of globalization. The purpose of this paper is to empirically test these hypotheses using a dataset of 26 OECD countries from the period 1990-2020. The study employed the Driscoll-Kraay estimator, which produces reliable estimates with robust standard errors in the presence of heteroscedasticity, autocorrelation, and cross-sectional dependency issues. The results indicate that economic globalization has a negative effect on corporate tax rates and a positive effect on labour tax rates. Additionally, it was observed that a high level of social spending is linked to an increase in economic globalization. These results emphasise that the efficiency effect and the compensation effect coexist and complement each other rather than being rivals.&#x0D; Key words: Globalization, tax competition, public expenditure, panel data &#x0D; JEL Classification: E15, E62, C23