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Wan S, Wang M. Population mobility : spatial spillover effect of government health expenditure in China. Glob Health Action 2024; 17:2319952. [PMID: 38465634 PMCID: PMC10930106 DOI: 10.1080/16549716.2024.2319952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/13/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Since the 20th century, pursuing Universal Health Coverage (UHC) has emerged as an important developmental objective in numerous countries and across the global health community. With the intricate ramifications of population mobility (PM), the government faces a mounting imperative to judiciously deploy health expenditure to realise UHC effectively. OBJECTIVE This study aimed to construct a comprehensive UHC index for China, assess the spatial effects of Government Health Expenditure (GHE) on UHC, and explore the moderating effects of PM on this association. METHOD A Dynamic Spatial Durbin Model (DSDM) was employed to investigate the influence of the GHE on UHC. Therefore, we tested the moderating effect of PM. RESULTS In the short-term, the GHE negatively impacted local UHC. However, it enhanced the UHC in neighbouring regions. Over the long term, GHE improved local UHC but decreased UHC in neighbouring regions. In the short-term, when the PM exceeded 1.42, the GHE increased the local UHC. Over the long term, when the PM exceeded 1.107, the GHE impeded local UHC. If the PM exceeded 0.91 in the long term, the GHE promoted UHC in neighbouring regions. The results of this study offer a partial explanation of GHE decisions and behaviours. CONCLUSIONS To enhance UHC, a viable strategy involves augmenting vertical transfer payments from the central government to local governments. Local governments should institute healthcare systems tailored to the urban scale and developmental stages, with due consideration for PM. Optimising the information disclosure mechanism is also a worthwhile endeavour.
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Affiliation(s)
- Simin Wan
- School of Public Finance & Public Administration, Jiangxi University of Finance and Economics, Nanchang, China
| | - Mengying Wang
- School of Public Finance & Public Administration, Jiangxi University of Finance and Economics, Nanchang, China
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Wahl B, Nama N, Pandey RR, Garg T, Mishra AM, Srivastava S, Ali S, Verma SK, Erchick DJ, Sauer M, Venkatesh U, Koparkar A, Kishore S. Neonatal, Infant, and Child Mortality in India: Progress and Future Directions. Indian J Pediatr 2023; 90:1-9. [PMID: 37695418 DOI: 10.1007/s12098-023-04834-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/08/2023] [Indexed: 09/12/2023]
Abstract
In India, considerable progress has been made in reducing child mortality rates. Despite this achievement, wide disparities persist across and socio-economic strata, and persistent challenges, such as malnutrition, poor sanitation, and lack of clean water. This paper provides a comprehensive review of the state of child health in India, examining key risk factors and causes of child mortality, assessing the coverage of child health interventions, and highlighting critical public health programs and policies. The authors also discuss future directions and recommendations for bolstering ongoing efforts to improve child health. These include state- and region-specific interventions, prioritizing social determinants of health, strengthening data systems, leveraging existing programs like the National Health Mission (NHM) and Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), and the proposed Public Health Management Cadre (PHMC). The authors argue that reducing child mortality requires not only scaled-up interventions but a comprehensive approach that addresses all dimensions of health, from social determinants to system strengthening.
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Affiliation(s)
- Brian Wahl
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
- Johns Hopkins India, Lucknow, Uttar Pradesh, India.
| | - Norah Nama
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Raghukul Ratan Pandey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins India, Lucknow, Uttar Pradesh, India
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Tushar Garg
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins India, Lucknow, Uttar Pradesh, India
| | - Aman Mohan Mishra
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins India, Lucknow, Uttar Pradesh, India
| | - Swati Srivastava
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins India, Lucknow, Uttar Pradesh, India
| | - Sana Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins India, Lucknow, Uttar Pradesh, India
| | - Shival Kishore Verma
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins India, Lucknow, Uttar Pradesh, India
| | - Daniel J Erchick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Molly Sauer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - U Venkatesh
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Gorakhpur, India
| | - Anil Koparkar
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Gorakhpur, India
| | - Surekha Kishore
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Gorakhpur, India
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Mor N, Ashraf H. Is contributory health insurance indeed an addiction to a bad idea? A comment on its relevance for low- and middle-income countries. Soc Sci Med 2023; 326:115918. [PMID: 37116430 DOI: 10.1016/j.socscimed.2023.115918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/16/2023] [Indexed: 04/30/2023]
Abstract
Financing of health systems is an enduring concern world wide. Yazbeck and colleagues in their paper make an important point that when there is a choice between financing in which contributions from citizens take place in the form of generalised taxes versus those in which they are in the form of insurance premiums, the overwhelming evidence suggests that tax-based financing is unambiguously superior even in low- and middle-income countries. Despite the strength of their case against contributory insurance, we suggest that the path forward may be more complex than they envisage for a number of reasons. The problem of a high proportion of informal sector workers that they argue impacts contributory approaches is also an issue with taxes because of the very low numbers of people who file returns. Taxes in most developing countries are in fact largely derived from highly regressive indirect taxes which the poor are forced to pay. Additionally, in most developing countries, including large ones like India and Nigeria, the only choice on offer is continued dependence on out-of-pocket expenditures. In such a situation exploring alternatives which are superior to out-of-pocket expenditures becomes imperative. Asking citizens to wait interminably for additional tax resources to be made available would be a grave disservice to them.
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Affiliation(s)
- Nachiket Mor
- Banyan Academy of Leadership in Mental Health, Chennai, India.
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