Public Health Expenditure Research Articles

The relationship between insurance development, population, economic growth, and health expenditures in OECD countries: a panel causality analysis

AbstractThis paper examines the relationship between insurance development, population, economic growth, and health expenditures for a panel of 31 OECD countries over the period 1995–2021. A dynamic panel data analysis based on cointegration, FMOLS, DOLS, VECM, and Granger causality tests is employed to suggest for the existence of a long-run relationship among variables. The long-run results show that insurance development, national income, and population exhibit positive impacts on health expenditures. The results reveal that insurance factor has larger income effects than substitution effects on health expenditures. Regarding the short-run causal relationship between the variables, the empirical results suggest that economic growth strengthens health expenditure growth, while insurance growth reduces it. In the short-run, insurance development has a crowding-out effect since it produces larger substitution effects than income effects. The results provide political implications that governments need to concern the short-run crowding-out effect of private insurance sections on health expenditures when making fiscal policies on public health expenditures.

Examining the Effect of Economic Sophistication on Public Health Expenditure? Evidence from a Global Sample

Examining the Effect of Economic Sophistication on Public Health Expenditure? Evidence from a Global Sample

Burden of disease and cost of illness of overweight and obesity in Portugal.

The prevalence of overweight and obesity has increased in the last decades, posing significant health and economic impacts globally. These conditions are related to several non-communicable diseases, including cardiovascular disease, type II diabetes and cancer. This study estimated the disease burden and healthcare costs associated with overweight and obesity in the adult population in mainland Portugal, in 2018. Burden of disease was measured in disability-adjusted life years (DALY) following Global Burden of Disease (GBD) methodology. DALY were calculated as the sum of years of life lost (YLL) and years lived with disability (YLD). The analyses included morbidity, mortality and related costs directly related to overweight and obesity, as well as the attributable morbidity, mortality and related costs of of 25 selected diseases related to obesity (DrO). A prevalence-based cost analysis was conducted a from the perspective of the public National Health Service, including costs related to inpatient, outpatient care and pharmacological treatment. In 2018, total DALY amounted to 260,943, with 75% due to premature death (196,438 YLL) and 25% due to disability (64,505 YLD). The economic burden of overweight and obesity was estimated at approximately € 1,148 million. Of these, approximately € 13.3 million (1%) were costs related to the treatment of obesity, and the remaining were costs of DrO attributed to overweight and obesity. Outpatient care corresponded to 43% of total costs, pharmacological treatment 38%, and inpatient care 19%. Cardiovascular and cerebrovascular diseases were the largest contributor to total costs (38%), followed by type II diabetes (34%). Overweight and obesity incur a large disease and economic burden to the public healthcare sector, representing approximately 0.6% of the country´s gross domestic product and 5.8% of public health expenditures.

Targeting Gut microbiota as a therapeutic target in T2DM: a review of Multi-target interactions of probiotics, prebiotics, postbiotics, and synbiotics with the Intestinal Barrier

The global epidemic of type 2 diabetes mellitus (T2DM) imposes a substantial burden on public health and healthcare expenditures, thereby driving the pursuit of cost-effective preventive and therapeutic strategies. Emerging evidence suggests a potential association between dysbiosis of gut microbiota and its metabolites with T2DM, indicating that targeted interventions aimed at modulating gut microbiota may represent a promising therapeutic approach for the management of T2DM. In this review, we concentrated on the multifaceted interactions between the gut microbiota and the intestinal barrier in the context of T2DM. We systematically summarized that the imbalance of beneficial gut microbiota and its metabolites may constitute a viable therapeutic approach for the management of T2DM. Meanwhile, the mechanisms by which gut microbiota interventions, such as probiotics, prebiotics, postbiotics, and synbiotics, synergistically improve insulin resistance in T2DM are summarized. These mechanisms include the restoration of gut microbiota structure, upregulation of intestinal epithelial cell proliferation and differentiation, enhancement of tight junction protein expression, promotion of mucin secretion by goblet cells, and the immunosuppressive functions of regulatory T cells (Treg) and M2 macrophages. Collectively, these actions contribute to the amelioration of the body's metabolic inflammatory status. Our objective is to furnish evidence that supports the clinical application of probiotics, prebiotics, and postbiotics in the management of T2DM.

Modified Generalized Chen Distribution, Estimation and Application using Econometrics Data

In this study, a variant of the generalized Chen (GC) distribution with parameters α, β, γ, δ, and λ, termed the Modified Generalized Chen (MGC) distribution, was introduced. The study evaluated several Chen distribution variants theoretically, focusing on the MGC distribution. Variants considered include the Generalized Chen (GC), Half-Cauchy Chen (HCC), New Extended Chen (NEC), and Exponentially Generalized Modified Chen (EGMC) distributions. The objectives of the study was to derive the probability density function (PDF) and cumulative density function (CDF) of the MGC distribution, determine its statistical properties and reliability characteristics, compare these properties and characteristics to existing distributions, and empirically evaluate its performance. The study developed unique expressions for the PDF, CDF, survival function, and hazard function of the MGC distribution. By evaluating PDFs and performance measures such as the Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and mean square error (MSE) across various datasets, the MGC distribution consistently demonstrated superiority over other variants. The MGC distribution offers improved model fit, predictive accuracy, and interpretability without sacrificing simplicity. The dataset employed in this study was the secondary data, encompassing economic indicators from 1981 to 2021 and public health expenditure data for Nigeria and Ghana from 1995 to 2014. Statistical analyses revealed that on the average, the MGC distribution outperforms others, with superior average AIC (-509.95), BIC (-510.49), and MSE (499.89) measures across the datasets considered in the study. This superior performance indicates better fit and accuracy in predicting economic and public health outcomes, offering valuable insights for policymakers and researchers. The study underscores the importance of adopting flexible and interpretable distribution models like the MGC distribution to enhance empirical analyses, inform policy decisions, and advance knowledge in econometrics and related disciplines.

How Avoidable Mortality is influenced by health expenditure: an Italian 14-year panel data analysis

Abstract Background Avoidable Mortality is a widely used public health indicator to assess the quality of healthcare systems. The aim of this study was to investigate how the allocation of private and public health expenditure (PHE) could influence avoidable mortality (AM), treatable mortality (TM) and preventable mortality (PM) of Italian citizens. Methods A pooled cross-sectional time series study was conducted. Italian healthcare data from 2009 to 2019 was extracted from ‘Health for All’, a WHO-related database released periodically by the Italian National Institute of Statistics. PHE was divided by providers area (directly provided services (DPS), general and specialist medicine, pharmaceutical, rehabilitation). Data about private health expenditure, gross domestic product per capita (GDPPC), level of education, medical drug consumption per capita (MDCPC), general practitioners per capita (GPPC), physical exercise, tobacco use, and obesity were collected. AM was divided into TM and PM using OECD/Eurostat lists of causes of death (2022). A fixed-effects regression was used to assess the effects of economic and social variables on AM, TM and PM. Results Higher spending on DPS (-0.027), higher MDCPC (-0.859) and higher GDPPC (-0.001) were associated with lower rates of AM. Higher sport activity (c -0.673) was associated with lower rates of TM. Higher levels of private health expenditure (0.022) and higher number of GPPC (0.023) were associated with higher rates of PM; these counterintuitive results could be caused by the inappropriateness of medical treatment directly requested by patients. Other variables were not significantly associated with AM, TM or PM. Conclusions The results highlight the importance of medical DPS by NHS (emergency departments, hospital care, specialized care, primary care, etc.). Analyzing health data divided by areas of NHS we could help policy makers to allocate human and economic resources more efficiently. Key messages • The allocation of public health resources could influence the health status of the polulazion. • Italian National Health System could reduce avoidable mortality through the use of directly provided services.

Impact of public health expenditure on malnutrition among Peruvians during the period 2010-2020: A panel data analysis

Background The study analyzes the impact of public health spending on malnutrition among Peruvians, using data from the National Household Survey, the Central Reserve Bank of Peru, the National Institute of Statistics and Informatics and the Ministry of Economy and Finance from 2010. -2020. Previous studies have revealed the existing relationship of health spending with the reduction of malnutrition. Methods A quantitative approach is considered, with an explanatory type of research using panel data methodology considering the bidimensionality of the data, which allows quantifying this effect for the Peruvian case using the National Household Survey, data from the Central Reserve Bank of Peru, as well as information from the National Institute of Statistics and Informatics and the Transparency Portal of the Ministry of Economy and Finance in the period 2010-2020. Results The results show that public expenditure on health has a negative relationship with malnutrition; the rural sector has a positive relationship with malnutrition given the limitations present for access to adequate food. Similarly, the unemployment rate shows a positive relationship with malnutrition, given that being unemployed leads to a higher cause of malnutrition in the population, and the gross domestic product has a negative relationship with malnutrition, given that greater economic growth produces an impact on reducing malnutrition, with the greatest impact being on the rural population and the gross domestic product. Conclusions In the analysis period 2010-2020 in Peru, based on the panel data analysis, the impact of public health expenditure on reducing malnutrition is observed in 10 departments, achieving a reduction in malnutrition; while in 14 departments, this indicator has not been reduced.

Determinants of Healthcare Expenditure: A Cross-Sectional Analysis at the Country Level

This study examines the determinants of healthcare expenditure through a cross-sectional analysis of 153 countries using 2018 data. The research employs a classical linear regression model to identify key socioeconomic and demographic factors influencing healthcare spending per capita, expressed in PPP (Purchasing Power Parity). The results show that GDP per capita, public health expenditure as a percentage of GDP, physician availability, and out-of-pocket healthcare costs are statistically significant determinants of healthcare spending. Specifically, the analysis highlights the non-linear relationship between GDP and healthcare expenditure, where wealthier nations tend to spend disproportionately more on healthcare. Public investment in healthcare and the availability of medical professionals also play crucial roles in shaping national healthcare expenditures. Out-of-pocket expenses by households further increase overall healthcare costs, especially in countries with lower public funding. The proposed model explains 96.5% of the variation in healthcare expenditure, suggesting that the selected variables are strong predictors of healthcare spending. These findings provide valuable insights for policymakers, particularly in the context of balancing public healthcare financing and improving access to medical services while managing overall costs.

Value-based care as a solution to resolve the open debate on public healthcare outsourcing in Europe: What do the available data say?

Controversy surrounds the current debate regarding the effects of outsourcing health services, as recent studies claim that increased outsourcing leads to reduced costs at the expense of worse patient outcomes. The goal of the value-based model is to enable healthcare systems to create more value for patients, and evidence points to improvements in public health outcomes, patient experience, and health expenditure in systems incorporating components of value-based healthcare. Some emerging evidence indicates promising results for outsourced hospitals which follow a value-based model of healthcare delivery. Although additional future studies are still needed to confirm these benefits, value-based healthcare merits discussion as a new perspective on the public versus private management debate. In fact, we argue that outsourcing to value-based health providers could represent a valid alternative for public health management, encouraging greater competition within the healthcare sector while ensuring quality of care for both public and private sectors.

Impact of fiscal policy shocks on health outcomes in Sub-Saharan Africa: A panel structural VAR approach

This study investigates the impact of fiscal policy shocks on health outcomes in Sub-Saharan Africa (SSA). It is motivated by health systems’ increasing reliance on public funding despite growing macroeconomic uncertainties. This study adopts a regional analysis, sampling five countries with the highest per capita public health expenditure from the Central, Eastern, Southern, and Western African regions. The study employs the panel structural vector autoregression technique and expresses health outcomes as a function of fiscal policy and private health expenditure shocks. The results suggest that fiscal policy shock significantly and positively affects health outcomes in Central and Western Africa. However, health outcomes are resilient to fiscal policy shock in Eastern and Southern regions and to private health expenditure shock in all regions. The study indicates that achieving sustainable improvement in health outcomes in SSA would require policies designed to expand health financing options beyond the traditional public and private funding arrangements.

Five Years of National Health Policy in India: Critical Analysis of the Public Health Expenditure from 2017 to 2022 and Way Forward

This retrospective study assesses the impact of India’s National Health Policy (NHP) 2017 on public health expenditure and its implications for achieving Universal Health Coverage (UHC) and Sustainable Development Goal 3 (SDG-3). Using secondary data analysis from government sources, we observed health budget trends relative to GDP from 2017 to 2022. The study found a marginal increase in public health expenditure from 0.9% to 1.6% of GDP, which is below the NHP’s target of 2.5%. The results underscore the challenge of high out-of-pocket expenses, which remain a barrier to UHC. The COVID-19 pandemic has further highlighted the inadequacies of the current funding levels. We conclude that a substantial increase in health budget allocations is crucial for India to make significant strides toward UHC and meet SDG-3 targets. The study also calls for strategic enhancements in healthcare infrastructure and services to address the persistent gaps in healthcare delivery and financing. The findings advocate for a more aggressive approach to public health investment to ensure that quality healthcare services are accessible, affordable, and equitable for all citizens, thereby advancing India’s progress toward comprehensive health coverage.

Technical efficiency analysis of advanced medical centers in Burkina Faso

IntroductionBurkina Faso faces many challenges in the health domain, with no real opportunity for an increase in public health expenditures. In Burkina Faso, as in all low-income countries, health spending efficiency is crucial. The objective of this paper is to assess the efficiency of Advanced Medical Centers (AMCs)—which correspond to district hospitals—in Burkina Faso over the 2017–2020 period and identify the factors that promote—or, on the contrary, limit—the efficiency of these health structures.MethodWe first assessed the efficiency level of the 45 AMCs running in the country between 2017 and 2020 using a bootstrap Data Envelopment Analysis (DEA) methodology. Inputs include the number of doctors, nurses, other medical staff, non-medical staff, and beds, while output variables correspond to the number of inpatients, surgeries, outpatients, and inpatient days. In a second step, determinants of AMC’s efficiency levels were explored using a double-bootstrap procedure. The roles of AMCs’ internal and environmental factors were both considered.ResultsWe found a mean efficiency score of 0.51 over the study period, indicating that AMCs could have almost doubled their healthcare production without needing additional resources. The size, education level, and health status of the covered population and the density of the healthcare supply in the district appeared to be the driving factors of AMCs’ efficiency.ConclusionOur results indicate that improving the efficiency of AMCs should be a high-level priority for the Burkinabe health policy. Resources could be reallocated across AMCs to increase the overall efficiency of the health system.

Towards the cost of health in Africa: examining the synergistic effect of climate change and renewable energy on health expenditure

AbstractClimate change has become the centre of discussion among scholars and practitioners globally. This is believed to have severe consequences for the environment and human health, leading to significant implications for health financing. However, empirical investigations examining the climate change-health nexus remain scarce and underexplored. Hence, this study contributes to knowledge by exploring the direct and synergistic influence of renewable energy and climate change on health expenditure (i.e., national, public, private and external) in Africa. The study employs annual data from a panel of 47 African countries between 2006 and 2019, which are estimated using the generalised method of moments. Robustness checks are performed using alternative proxies for climate change and the Driscoll-Kraay estimation technique. The empirical outcomes reveal that high CO2 emissions increase the various indices of health expenditure, implying environmental degradation triggers higher costs in health spending. The empirical results further show that renewable energy presents a negative and significant influence on health expenditure, showing that health expenditure decreases due to the adoption of renewable energy. Additionally, the study finds that renewable energy weakens the effect of carbon emissions on health spending, including public, private and external health expenditures. This implies that the severe impact of climate change on health expenditure is reduced through the intervening role of renewable energy sources. The study recommends that policymakers implement targeted policies towards reducing carbon emissions and increasing renewable energy consumption to improve health outcomes. Governments must also promote universal health coverage to ensure inclusive coverage as climate change becomes increasingly apparent.

Drug-resistant Pantoea agglomerans Causing Bacteremia at a Tertiary Care Hospital in Kolkata, India: First Report of Carbapenem Resistance Mediated by OXA-181.

The spread of antibiotic resistance (ABR) in uncommon human pathogens endangers global public health, escalating morbidity, death, and healthcare expenditures. Pantoea agglomerans, a member of the Erwiniaceae family that rarely infects humans, is emerging as a drug-resistant nosocomial pathogen. Seven P. agglomerans isolates were recovered from bacteremia patients at a tertiary care hospital in Kolkata, West Bengal, between March 2022 and October 2022. The isolates were evaluated for phenotypic resistance, β-lactamase and plasmid-mediated quinolone resistance (PMQR) genes, plasmid profiling, and clonality assessment. All isolates were resistant to fluoroquinolones and third-generation cephalosporins, with four resistant to carbapenems. The following β-lactamases and PMQR genes were identified: blaOXA-1 (n = 1), blaTEM (n = 1), blaCTX-M-1 (n = 2), blaNDM (n = 5), blaOXA-181 (n = 1), qnrB (n = 2), and qnrS (n = 4). Six isolates carried up to seven plasmids ranging in size from 2kb to > 212kb. IncFI, FII, HI, and X3 plasmid types were detected in three isolates, while the rest remained untypable. Four different genetic patterns were noted. Four isolates were clonally related, with three being clonal. The swap of environmental isolates to human pathogens exacerbates the ABR dilemma, periling patient care and outcomes. This is the first report in India of a carbapenem-resistant P. agglomerans blood isolate carrying blaOXA-181. In-depth genomic research of drug-resistant microbes adapted to the environment-human interfaces might underpin the source-route-containment of ABR.

Which socio-economic groups benefit most from public health expenditure in Senegal? A dynamic benefit incidence analysis

Despite efforts to enhance public investment in Senegal’s health sector, the equitable distribution of benefits between socioeconomic groups remains largely unexplored. To address this gap, our study examines the progressive (or regressive) nature of public health expenditure. Utilizing data from the latest survey on household living conditions (2018–2019) in conjunction with administrative data on health expenditure from the same period (provided by the Ministry of Health of Senegal), we performed a benefit incidence analysis. This entailed segmenting the population by poverty quintiles and subsequently estimating how each group utilized and benefitted from public health expenditure, according to level of care and geographical location. Additionally, we performed a marginal benefit analysis to discern the impact of an increase in public health expenditure on various socioeconomic groups. Our findings unveil a pro-rich distribution of benefits at both primary healthcare and hospital levels, observable both at national and regional levels. Moreover, disparities in the distribution of resource allocation between Senegal's 14 administrative regions were observed. Ultimately, our results indicate that under prevailing conditions, increasing public health expenditure would not yield a pro-poor distribution of benefits. Therefore, our research underscores the imperative of better targeting populations for greater equity between regions and social groups.

Research about the relationship between the health, economic development and public health expenditure----Evidence: From 11 coastal cities in China

This paper firstly makes a statement on the necessity of this topic and the practical significance behind it. Then it combs through the relevant theories and literature on health capital, public health expenditure, health economics, and economic growth, and analyses the impact and effect of public health expenditure on health capital as well as economic growth in light of scholars' explorations and findings. By collecting relevant data in recent years in Beijing, China, the impact of public health expenditure on economic growth is explored using econometric methods with Beijing as the main research object. The explanatory variable is public health expenditure, the explanatory variables are health capital and economic growth situation in Beijing, and the rest of the control variables are environment, education, and social situation. According to the data relationship between the explanatory variables and the explanatory variables, the authors put forward different research hypotheses and establish different regression models respectively, so as to explore their correlation. The results of the study show that: Beijing government health expenditure has a great role in promoting health capital, and there is still much room for the government to improve it at present; public health expenditure has a significant positive impact on the economy of Beijing, indicating that increasing public health expenditure helps to promote economic growth, which provides theoretical support and empirical evidence for further improvement of public health policy. Finally, on the basis of empirical analysis, this paper puts forward policy recommendations to increase public health expenditure and improve health capital level in Beijing, so as to promote the economic growth of Beijing based on the correlation between the actual health expenditure, health capital and economic growth in Beijing.

Retraction Note: Revisiting the proven relationship of green leadership, green education, and green finance with sustainable development goal 3 in the context of China: does public health expenditure really mediate the relationship?

Retraction Note: Revisiting the proven relationship of green leadership, green education, and green finance with sustainable development goal 3 in the context of China: does public health expenditure really mediate the relationship?

Assessing the Impact of Environmental Quality on Public Health Expenditure Central Asia

This study utilizes panel data from 2002 to 2022 in Central Asia to analyze the impact of environmental quality on public health expenditures. This study employs the ARDL model to examine the short-run and long-run relationships between healthcare expenditure and pollution levels, namely carbon dioxide (CO2), sulfur dioxide (SO2), and nitrogen dioxide (NO2). The data indicate a robust positive correlation between greenhouse gases and healthcare expenditures, demonstrating the effect of environmental pollution on public health. The study examines the relationship between socioeconomic variables, including GDP, death rates, and healthcare expenditures. This study concludes that reversing this trend hinges on improving environmental policy in the energy and industrial sectors. This research contributes to the existing knowledge by analyzing how various environmental elements and economic structures persistently impact health policy evolution in the region.

Examining the Relationship Between Local Governmental Expenditures on the Social Determinants of Health and County-Level Overdose Deaths, 2017-2020.

Prior studies have examined the social determinants of health (SDOH) characteristics of counties with elevated rates of overdose deaths. However, this research often ignores variation in upstream governmental investment in these SDOH categories. To examine the association of local governmental investments in SDOH with drug overdose mortality at the county level, controlling for demographic and socioeconomic characteristics. Longitudinal analysis from 2017 to 2020. United States counties. 3126 counties. The primary study outcome was county overdose death rates per 100000 population taken from the Centers for Disease Control and Prevention. The main predictor of interest was the per capita average of local governmental expenditures in public health, social service, and education drawn from the U.S. Census of Governments, categorized into quartiles. Covariates included county-level socioeconomic and demographic characteristics as well as county-level SUD services from the AHRQ SDOH Database. In longitudinal multivariate linear regression models with state and year fixed effects, counties in the highest 3 quartiles of SDOH spending had significantly lower rates of overdose deaths compared with counties in the lowest quartile of SDOH spending; in particular, counties in quartile 2 had an average of 9.09 fewer overdose deaths per 100000 population (95% CI: -12.58, -5.60), counties in quartile 3 had an average of 13.18 fewer deaths per 100000 population (95% CI: -17.56; -8.80), and counties in quartile 4 had an average of 13.92 deaths per 100000 population (95% CI: -19.16, -8.68). Our findings demonstrate that higher levels of local governmental investments in SDOH were associated with significantly lower rates of overdose death in U.S. counties after controlling for socioeconomic and demographic characteristics. Going forward, research should focus on determining causality in this relationship, the mechanisms through which this relationship occurs, as well as assess the impact of local public health expenditures allocated toward SUD prevention and treatment specifically on substance use outcomes at the local level.

Good Governance, Public Health Expenditure and Economic Growth in Nigeria and South Africa

Good Governance, Public Health Expenditure and Economic Growth in Nigeria and South Africa