Healthcare spending and health outcomes: evidence from selected East African countries

Effect of public health expenditure on maternal mortality ratio in the West African Economic and Monetary Union

INTRODUCTION

Maternal mortality in West African Economic and Monetary Union countries (WAEMU) is the highest compared with other regions in the world. The majority of health care sources in WAEMU are private and largely involve out-of-pocket expenditures, which may prevent healthcare access. Maternal mortality is an important indicator of the level of attention given to mothers before, during and after childbirth and thus of a system's overall coherence and capacity for anticipation. Therefore, the objective of this study is to analyze the effects of public health expenditure on maternal mortality in WAEMU.

METHODS

The study used panel data from the World Bank Development Indicators (WDI) from 1996 to 2018 covering 7 countries in the West African Economic and Monetary Union. The two-step least squares (2SLS) on health demand function was used to test the effect of public health expenditure on maternal mortality.

RESULTS

Public health care spending showed a significant negative association with maternal mortality. However, private health expenditure was positively associated with maternal mortality.

CONCLUSION

Public health care expenditure remains a crucial component of reducing maternal mortality. In this region, the authorities need to increase public health spending to build more health centers and improve the equipment of existing infrastructures. Additionally, it is important to reduce the financial barriers for pregnant women. To this end, the operationalization of universal health insurance could help reduce these financial barriers by reducing direct household payments.

Effects of healthcare spending on public health status: An empirical investigation from Bangladesh

The escalation of healthcare spending in many nations, particularly in emerging countries such as Bangladesh, may be largely attributed to the growing demand for healthcare services. Evidently, there has been a significant expansion in the public funding allocated to the health sector in Bangladesh, intending to enhance health outcomes. Therefore, the purpose of this study was to examine the impact of healthcare expenditure on health outcomes, specifically focusing on the reduction in different mortality rates and the transmission of various infectious diseases. A total of 30 years of data (1990-2019) on the health sector of Bangladesh were collected from different national and international sources. The Vector Autoregression with Exogenous Variables (VARX) model was employed to determine the effects of healthcare expenditure on health outcomes. Results revealed that the per capita health expenditure and the number of doctors showed a significant positive impact on life expectancy and maternal and child health. Also, the government's annual budget on the health sector and number of doctors had a significant positive impact on lowering deaths by Diphtheria, Cholera, Tuberculosis, and Malaria diseases. In order to develop a sustainable healthcare system within the nation, it is imperative for the government to prioritize the allocation of sufficient and effective healthcare funding to cater to the needs of the populace.

[Health expenditure and health outcomes in Latin America and the CaribbeanGastos em saúde e resultados de saúde na América Latina e no Caribe]

Objective

To determine the effect of public and private health expenditure on health outcomes in Latin American and Caribbean countries from 2000 to 2019.

Methods

A health production function was used, wherein life expectancy at birth and infant mortality rate were considered as indicators of health outcomes. Panel data econometrics were applied, using data from a 33-country sample for the period from 2000 to 2019.

Results

According to estimates, a 1% increase in public health expenditure is associated with a 0.019% increase in life expectancy, and a 1% increase in private health expenditure increases life expectancy by 0.023%. At the same time, a 1% increase in public health expenditure reduces the infant mortality rate by -0.168%, whereas the effect of private health expenditure on infant mortality is not statistically significant.

Conclusions

The results provide evidence of the effect of public health expenditure in reducing infant mortality and increasing life expectancy, while private health expenditure has a positive effect only on the latter metric. The findings have important political implications for the countries of the Region in the post-pandemic context of limited fiscal space.

Exploring spatiotemporal trends and impacts of health resources and services on under-5 mortality in West African countries, 2010-2019: a spatial data analysis

Background

West African countries experienced the highest under-5 mortality rate (U5MR), the lowest life expectancy, and the poorest economic development. This study aimed to explore the spatiotemporal trend of U5MR and spatial spillover effects of health resources and services to provide a basis for establishing health policies and international cooperative mechanisms in West Africa.

Methods

We retrieved data from the World Health Organization's Global Health Observatory, the United Nations Human Development Report, and the Global Burden of Disease Study 2019. Joinpoint regression analysis and Moran's I method were used to examine the temporal trend and spatial dependence of U5MR, respectively. Spatial regression analysis was used to examine the spatial spillover effects.

Results

The long-term downward trends in U5MR were divided into multiple segments by two or three change points in 2013, 2014, or 2015, and the annual percentage change after 2015 was higher than before 2015. Global Moran's I was positive, significantly indicating positive spatial autocorrelation, which increased from 0.2850 (p = 0.0210) to 0.3597 (p = 0.0080). Based on spatial regression analysis, human development index (HDI), physicians density, nurses and midwives density, health center density, percentage of infants lacking immunization for diphtheria and measles, and coverage rate of at least one antenatal visit had negative spatial spillover effects on U5MR. HDI had the strongest negative correlation (β = -0.0187 to -0.1054, p < 0.0001). Current health expenditure (CHE) per capita had positive spatial spillover effects on U5MR.

Conclusion

This study revealed the spatiotemporal trend of U5MR in West African countries and spatial spillover effects of health resources and services. Promoting economic development, increasing health human resources, health expenditure, vaccination rate, antenatal care coverage, and the proportion of health professionals attending births not only reduced the local U5MR but also exerted spatial spillover effects on adjacent countries. The West African Health Organization may consider regional spillover mechanisms to develop regional health policy and intervention cooperation mechanisms, which will contribute to achieving the sustainable development goal on U5MR, Africa Agenda 2063, and universal health coverage.

The impact of health insurance enrollment on health outcomes in Kenya

BACKGROUND

The achievement of the global agenda on universal health coverage (UHC) is pivotal in ensuring healthy lives and promoting the well-being of all. However, achieving healthy lives and wellbeing of all has been hampered by the challenge of health care financing. As such, healthcare financing, through health insurance is gaining popularity in developing countries such as Kenya, in their pursuit to achieve universal health coverage. The primary purpose of health insurance and delivery is to improve health. However, there is a paucity of evidence on the effectiveness of health insurance in improving the health outcomes and health status of the Kenyan population. Therefore, this study aimed to analyze the impact of health insurance on health outcomes in Kenya.

METHODS

The study utilized the most recent nationally representative Kenya Integrated Household Budget Survey (KIHBS) 2015/16 dataset in order to analyze the impact of health insurance on health outcomes. The instrumental variable 2-stage least squares (IV 2SLS) and control function approach (CFA) estimation techniques were used to cater for potential endogeneity and heterogeneity biases present in ordinary least squares (OLS) estimators.

RESULTS

Health insurance enrolment leads to a reduction in mortality, thereby improving the health status of the Kenyan population, despite low levels of insurance uptake. However, the insured population experienced higher chronic illnesses and out-of-pocket (OOP) expenditures raising concerns about financial risk protection. The fact that health insurance is linked to chronic illnesses not only reinforces the reverse causality of health insurance and health status, but also that the effects of potential adverse selection strongly drive the strength and direction of this impact.

CONCLUSIONS

We conclude that health insurance enrolment reduces mortality and hence has a beneficial impact in promoting health. Health insurance coverage therefore, should be promoted through the restructuring of the National Hospital Insurance Fund (NHIF) fragmented schemes and by consolidating the different insurance schemes to serve different population groups more effectively and equitably. The government should revisit the implementation of a universal social health insurance scheme, as a necessary step towards UHC, while continuing to offer subsidies in the form of health insurance to the marginalized, vulnerable and poor populations.

Ecological Footprint and Population Health Outcomes: Evidence from E7 Countries

This study investigates the relationship between ecological footprint and health outcomes in E7 countries from 1990 to 2017. This study makes use of panel fully modified ordinary least square (FMOLS) and dynamic ordinary least square (DOLS) models to assess the relationship between the ecological footprint and health outcomes. Although the findings show that ecological footprint has a positive effect on life expectancy, implying that the current levels of ecological footprints support life expectancy, failure to strictly observe the level of ecological footprint, in the long run, may result in a negative impact on life expectancy. Therefore, more serious efforts and strategies are needed to keep the size of ecological footprints to be favorable to human life.

Analysis of Medico-Legal Complaint Data: A Retrospective Study of Three Large Italian University Hospitals

(1) Background: Identifying hospital-related critical, and excellent, areas represents the main goal of this paper, in both a national and local setting. Information was collected and organized for an internal company's reports, regarding civil litigation that has been affecting the hospital, to relate the obtained results with the phenomenon of medical malpractice on a national scale. This is for the development of targeted improvement strategies, and for investing available resources in a proficient way. (2) Methods: In the present study, data from claims management in Umberto I General Hospital, Agostino Gemelli University Hospital Foundation and Campus Bio-Medico University Hospital Foundation, from 2013 to 2020 were collected. A total of 2098 files were examined, and a set of 13 outcome indicators in the assessment of "quality of care" was proposed. (3) Results: From the total number, only 779 records (37.1%) were attributable to the categories indexable for the present analysis. This data highlights how, following a correct and rigorous categorization of hospital events, it is possible to analyze these medico-legal aspects using a small number of indicators. Furthermore, it is important to consider how a consistent percentage of remaining events was difficult to index, and was also of poor scientific interest. (4) Conclusions: The proposed indicators do not require standards to be compared to, but provide a useful instrument for comparative purposes. In fact, in addition to comparative assessment between different business realities distributed throughout the territory, the use of outcome indicators allows for a longitudinal analysis evaluating the performance of an individual structure over time.

What is the impact of national public expenditure and its allocation on neonatal and child mortality? A machine learning analysis

BACKGROUND

Understanding the impact of national public expenditure and its allocation on child mortality may help governments move towards target 3.2 proposed in the 2030 Agenda. The objective of this study was to estimate the impacts of governmental expenditures, total, on health, and on other sectors, on neonatal mortality and mortality of children aged between 28 days and five years.

METHODS

This study has an ecological design with a population of 147 countries, with data between 2012 and 2019. Two steps were used: first, the Generalized Propensity Score of public spending was calculated; afterward, the Generalized Propensity Score was used to estimate the expenditures' association with mortality rates. The primary outcomes were neonatal mortality rates (NeoRt) and mortality rates in children between 28 days and 5 years (NeoU5Rt).

RESULTS

The 1% variation in Int$ Purchasing Power Parity (Int$ PPP) per capita in total public expenditures, expenditure in health, and in other sectors were associated with a variation of -0.635 (95% CI -1.176, -0.095), -2.17 (95% CI -3.051, -1.289) -0.632 (95% CI -1.169, -0.095) in NeoRt, respectively The same variation in public expenditures in sectors other than health, was associates with a variation of -1.772 (95% CI -6.219, -1.459) on NeoU5Rt. The results regarding the impact of total and health public spending on NeoU5Rt were not consistent.

CONCLUSION

Public investments impact mortality in children under 5 years of age. Likely, the allocation of expenditures between the health sector and the other social sectors will have different impacts on mortality between the NeoRt and the NeoU5Rt.

Socioeconomic and contextual determinants of the burden of disease attributable to metabolic risks in childhood

We analyze the socioeconomic and political contextual determinants of the burden of disease attributable to three metabolic risks in children: kidney dysfunction, high fasting plasma glucose, and high body-mass index. We use data from 121 countries. We matched data of the Global Burden of Disease project, World Bank and United Nations databases. The burden of disease is measured with the Disability Adjusted Life Years lost. We explore associations with four groups of variables: (i) income level, which measures differences in socioeconomic conditions between countries; (ii) income inequality, which measures within country inequalities in the income distribution; (iii) health care expenditure, which measures the resources allocated to health and healthcare, and (iv) women empowerment, which we measure in terms of both educational and political participation. Our findings point toward the need to act at the root of the underlying factors underpinning the disease burden, namely: reducing between and, particularly, within-country income inequalities, increasing the role of expenditure on health, and ensuring women empowerment and girls education. To our knowledge, this is the first study that have identified the associations of these variables with the burden of disease that is specifically attributable to metabolic risks in childhood.

Sustainable thresholds, health outcomes, health expenditures and education nexus in selected African countries: quadratic and moderation modelling

Background

This study aligns with Sustainable Development Goal 3 which borders on “good health and well-being for people by ensuring healthy lives and promoting well-being for all at all ages”. It contributes to the health literature by evaluating the roles of health expenditures and educational quality on three health outcomes (infant mortality, maternal mortality and life expectancy at birth).

Methods

The study uses the panel spatial correlation consistent (PSCC) approach on balanced panel data on 25 selected sub-Saharan African countries from 2000 to 2020 to interrogate the nexus.

Results

The following findings are documented. First, health expenditures reveal significant asymmetric quadratic effects on health outcomes. Second, the interactions between health expenditures and educational quality reduce infant and maternal mortalities while enhancing life expectancy. Third, the threshold points from the interaction effects indicate that enhancing educational quality beyond some critical thresholds of 1.51 and 1.49 can induce a drop in maternal and child mortalities while a point beyond 1.84 exerts an improvement in life expectancy.

Conclusions

Hence, policy makers should ensure that both health expenditures and educational quality exceed the established thresholds for sustainable health outcomes.

Effect of Primary Health Care Expenditure on Universal Health Coverage: Evidence from Sub-Saharan Africa

Background

Investment in primary health care (PHC) to achieve universal health coverage (UHC) and better health outcomes remains a key global health agenda. This study aimed to assess the effects of PHC spending on UHC and health outcomes.

Methods

The study used the Grossman Health Production Model and conducted econometric analyses using panel data from 2016 to 2019 covering 34 countries in SSA. Fixed and random effects panel regression models were used for the analyses. All the analyses in this study were carried out using the statistical software package STATA Version 15.

Results

We found that PHC expenditure has a positive significant but inelastic effect on UHC and life expectancy at birth and a negative effect on infant mortality. Both the fixed and random effects models provided a robust relationship between PHC expenditure and UHC and health outcomes. Education, access to an improved water source, and the age structure of the population were found to be strongly associated with health outcomes.

Conclusion

The inelastic nature of the PHC expenditure means that the UHC goal might only be achieved at high levels of PHC expenditure. This implies that policymakers must make conscious effort to increase PHC expenditure to ensure the attainment of the UHC goal.

Ramification of healthcare expenditure on morbidity rates and life expectancy in the association of southeast asian nations countries: A dynamic panel threshold analysis

OBJECTIVE

This study has investigated the impact of healthcare expenditure on life expectancy and morbidity rates in the Association of Southeast Asian Nations to analyse whether health expenditure remains a critical component of improving health status and to determine the threshold value at which health strategy becomes cost-effective from 2000 to 2019.

METHODS

The techniques employed include the Dynamic Panel Threshold model advanced by Seo et al. (2019) to implement Seo and Shin's (2016) proposed first-differenced generalised method of moments (GMM) estimation. Furthermore, the dynamic system GMM and Pooled Ordinary Least Squares (OLS) techniques were also employed for robustness check.

RESULTS

The findings revealed that healthcare expenditure raises life expectancy and lowers the crude death rate, infant mortality rate, and maternal mortality rate. Therefore, healthcare expenditure is increasing life expectancy and reducing crude death rate, infant mortality rate, and maternal mortality rate. However, when disaggregating the impact, that of public healthcare expenditure is higher than that of private except in the case of infant mortality rate where that of private is higher. In addition, it found that the threshold value at which health strategy becomes cost-effective, thus the amount which the countries should spend for health status improvement is at least 6% and above of their Gross Domestic Product (GDP).

CONCLUSION

Healthcare expenditure is raising life expectancy and lowering the morbidity rate of the countries. Furthermore, the cost-effective level of the country's healthcare expenditure as a proportion of GDP is 6% and above.

The effect of health expenditure on average life expectancy: does government effectiveness play a moderating role?

Purpose

This study investigates the impact of total health expenditure on life expectancy in a panel of 43 African countries from 2000 to 2018.

Design/methodology/approach

The dynamic panel generalized method of moments (GMM) estimation method developed by Arellano and Bond (1991) is used in this study. This approach generates estimates that are heteroskedasticity and autocorrelation consistent, as well as controls for unobserved time-invariant country-specific effects and eliminates any endogeneity in the panel model.

Findings

The results reveal that health expenditure on its own has a positive significant influence on life expectancy. However, health expenditure via the moderating effect of government effectiveness reduces life expectancy. The authors also observe that school enrollment and the level of economic activity significantly drive life expectancy.

Research limitations/implications

The study is limited to 43 out of 54 African countries, and it covers a period of 18 years: 2000 to 2018.

Practical implications

The authors argue that larger health expenditure will aid in improving the life expectancy rate in Africa. However, in practice, this would be difficult given the needs of other priority sectors.

Social implications

Since most developing countries' health expenditures are small, a policy option is that healthcare services should be subsidized such that the poorest people can also access them.

Originality/value

The study differs from the previous attempts, and with this, the authors contribute significantly to the literature. First, to the best of the authors’ knowledge, the authors are unaware of any study considering the role of government effectiveness as a moderating factor in investigating the effect of health expenditure on life expectancy in the African context. Thus, the authors fill a yawning gap in the literature. Second, the authors employ a recent dataset with larger sample size. Finally, to address the problem of endogeneity and simultaneity bias, the authors use the system GMM technique.

Impacts of Economic Freedom, Health, and Social Expenditures on Well-Being Measured by the Better Life Index in OECD Countries

The Organization for Economic Co-operation and Development (OECD) has developed the Better Life Index (BLI), which is a multidimensional approach to well-being. This study aims to investigate the impact of health and social expenditures as well as the economic freedom index on well-being measured by BLI among 34 OECD countries for 2013-2017 period. We estimated panel models to observe the social and health expenditure effects according to their sources and the overall impact of economic changes among countries. We find that public and private social expenditures have a positive and statistically significant impact on BLI at 1% significance level. Additionally, whereas public health expenditure has a positive and statistically significant impact on BLI at 1% significance level, the effects of private health expenditure are statistically significant at 10% significance level. The economic freedom index has a positive and statistically significant impact on BLI in both models. Both social and health expenditures should take a prominent position in policy debates for a better life.

Causal nexus between health expenditure, health outcome and economic growth: Empirical evidence from Sub-Saharan Africa countries

INTRODUCTION

The relationships among health expenditure, health outcome, and economic growth have been given significant consideration in the current literature. Nevertheless, there are potential gaps in the nature of health-growth nexus that current empirical studies have not thoroughly considered.

METHODOLOGY

This study explores Granger causality and cointegration relationships in a trivariate framework among, health expenditure, health outcome, and economic growth. We used three health outcome measures and a panel vector autoregressive model to study 45 countries in Sub-Saharan Africa between 1990 and 2018. Our innovative panel data evaluation technique allows to ascertain significant causal relationships among the studied variables in the short and long run.

RESULTS

Findings from the study include (1) health expenditure and health outcome Granger-cause economic growth in the long run; (2) economic growth Granger-cause health expenditure in the short run; (3) no causal relationship was found running from health expenditure and health outcome to economic growth in the short-run. The former result (1) may not be surprising, given that the countries considered in this study are relatively less developed countries from Sub-Saharan Africa. Hence, further health improvement may play a statistically significant role in spurring further economic growth.

CONCLUSION

Based on the results, the study presents interesting and possible effective policy perspectives for health improvement in the studied countries. Policies that stimulate health spending are needed to create a better and more industrious society that can support SSA's economic progress. This is because a healthy person may be more productive than someone who is sick, allowing them to produce greater output.

Spatial Effect Analysis of Health Expenditure and Health Output in China From 2011 to 2018

Objective

The objective of this study is to study the spatial effects of health expenditure and health output in China.

Methods

Using the spatial panel data of 31 provinces in China from 2011 to 2018, the spatial weight matrix was introduced to analyze the spatial correlation, and the spatial Durbin model (SDM) was used to investigate the health output effect of health expenditure.

Results

Excluding the number of doctors per thousand, the provincial health expenditure, the number of beds per thousand population, and per capita education level had a positive impact on the regional health output. The health effect of China's health inputs showed a spatial spillover effect.

Conclusion

Due to the significant spatial effect, the health output of 31 provinces in China benefits not only from the local health inputs, but also from the health inputs of neighboring provinces.

Suggestions

This article puts forward some suggestions based on the conclusion: China should strengthen the health cooperation among neighboring provinces, promote the free flow of various health factors among provinces, make full use of the spillover and interdependence of health investment among provinces, and improve the medical policy environment in China.

The Impact of Public, Private, and Out-of-Pocket Health Expenditures on Under-Five Mortality in Malaysia

Health financing in Malaysia is intensely subsidised by public funding and is increasingly sourced by household out-of-pocket financing, yet the under-five mortality rate has been gradually increasing in the last decade. In this context, this study aims to investigate the relationship between public, private, and out-of-pocket health expenditures and the under-five mortality rate in Malaysia using the autoregressive distributed lag (ARDL) estimation technique, whereby critical test values are recalculated using the response surface method for a time-series data of 22 years. The findings reveal that out-of-pocket health expenditure deteriorates the under-five mortality rate in Malaysia, while public and private health expenditures are statistically insignificant. Therefore, an effective health financing safety net may be an option to ensure an imperative child health outcome.

Population health outcomes in Nigeria compared with other west African countries, 1998-2019: a systematic analysis for the Global Burden of Disease Study

BACKGROUND

Population-level health and mortality data are crucial for evidence-informed policy but scarce in Nigeria. To fill this gap, we undertook a comprehensive assessment of the burden of disease in Nigeria and compared outcomes to other west African countries.

METHODS

In this systematic analysis, using data and results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we analysed patterns of mortality, years of life lost (YLLs), years lived with disability (YLDs), life expectancy, healthy life expectancy (HALE), and health system coverage for Nigeria and 15 other west African countries by gender in 1998 and 2019. Estimates of all-age and age-standardised disability-adjusted life-years for 369 diseases and injuries and 87 risk factors are presented for Nigeria. Health expenditure per person and gross domestic product were extracted from the World Bank repository.

FINDINGS

Between 1998 and 2019, life expectancy and HALE increased in Nigeria by 18% to 64·3 years (95% uncertainty interval [UI] 62·2-66·6), mortality reduced for all age groups for both male and female individuals, and health expenditure per person increased from the 11th to third highest in west Africa by 2018 (US$18·6 in 2001 to $83·75 in 2018). Nonetheless, relative outcomes remained poor; Nigeria ranked sixth in west Africa for age-standardised mortality, seventh for HALE, tenth for YLLs, 12th for health system coverage, and 14th for YLDs in 2019. Malaria (5176·3 YLLs per 100 000 people, 95% UI 2464·0-9591·1) and neonatal disorders (4818·8 YLLs per 100 000, 3865·9-6064·2) were the leading causes of YLLs in Nigeria in 2019. Nigeria had the fourth-highest under-five mortality rate for male individuals (2491·8 deaths per 100 000, 95% UI 1986·1-3140·1) and female individuals (2117·7 deaths per 100 000, 1756·7-2569·1), but among the lowest mortality for men older than 55 years. There was evidence of a growing non-communicable disease burden facing older Nigerians.

INTERPRETATION

Health outcomes remain poor in Nigeria despite higher expenditure since 2001. Better outcomes in countries with equivalent or lower health expenditure suggest health system strengthening and targeted intervention to address unsafe water sources, poor sanitation, malnutrition, and exposure to air pollution could substantially improve population health.

FUNDING

The Bill & Melinda Gates Foundation.

The Government Budget: An Overlooked Vehicle for Advancing Strategic Health Purchasing

The most effective way to finance universal health coverage (UHC) is through compulsory prepaid funds that flow through the government budget. Public funds-including on-budget donor resources-allow for pooling and allocation of resources to providers in a way that aligns with population health needs. This is particularly important for low-income settings with fiscal constraints. While much attention is paid to innovative sources of additional financing for UHC and to implementing strategic purchasing approaches, the government budget will continue to be the main source of health financing in most countries-and the most stable mechanism for channeling additional funds. The government budget should therefore be front and center on the strategic purchasing agenda. This commentary uses lessons from Tanzania and Uganda to demonstrate that more can be done to use the government budget as a vehicle for making health purchasing more strategic, across all phases of the budget cycle, and for making greater progress toward UHC. Actions need to be accompanied by measures to address bottlenecks in the public financial management system.

Why Is Strategic Purchasing Critical for Universal Health Coverage in Sub-Saharan Africa?

To make progress toward universal health coverage (UHC), most countries need to commit more public resources to health. However, countries can also make progress by using available resources more effectively. Health purchasing, one of the health financing functions of health systems, is the transfer of pooled funds to health providers to deliver covered services. Purchasers can be either passive or strategic in how they transfer these funds. Strategic purchasing is deliberately directing health funds to priority populations, interventions, and services, and actively creating incentives so funds are used by providers equitably and aligned with population health needs. Strategic purchasing is particularly important for countries in sub-Saharan Africa because public funding for health has often not kept pace with UHC commitments. In addition, there is wide variation in progress toward UHC targets and health outcomes on the continent that does not always correlate with per capita government health spending. This paper explores the critical role strategic purchasing can play in the movement toward UHC in sub-Saharan Africa. It explores the rationale for strategic purchasing and makes the case for a more concerted effort by governments, and the partners that support them, to focus on and invest in improving strategic purchasing as part of advancing their UHC agendas. The paper also discusses the promise of strategic purchasing and the challenges of realizing this promise in sub-Saharan Africa, and it provides options for practical steps countries can take to incrementally improve strategic purchasing functions and policies over time.

Determinants of life expectancy in most polluted countries: Exploring the effect of environmental degradation

BACKGROUND

Better understanding of the determinants of national life expectancy is crucial for economic development, as a healthy nation is a prerequisite for a wealthy nation. Many socioeconomic, nutritional, lifestyle, genetic and environmental factors can influence a nation's health and longevity. Environmental degradation is one of the critical determinants of life expectancy, which is still under-researched, as the literature suggests.

OBJECTIVES

This study aims to investigate the determinants of life expectancy in 31 world's most polluted countries with particular attention on environmental degradation using the World Bank annual data and British Petroleum data over the period of 18 years (2000-2017).

METHODS

The empirical investigation is based on the model of Preston Curve, where panel corrected standard errors (PCSE) and feasible general least square (FGLS) estimates are employed to explore the long-run effects. Pairwise Granger causality test is also used to have short-run causality among the variables of interest, taking into account the cross-sectional dependence test and other essential diagnostic tests.

RESULTS

The results confirm the existence of the Preston Curve, implying the positive effect of economic growth on life expectancy. Environmental degradation is found as a threat while health expenditure, clean water and improved sanitation affect the life expectancy positively in the sample countries. The causality test results reveal one-way causality from carbon emissions to life expectancy and bidirectional causalities between drinking water and life expectancy and sanitation and life expectancy.

CONCLUSION

Our results reveal that environmental degradation is a threat to having improved life expectancy in our sample countries. Based on the results of this study, we recommend that: (1) policy marker of these countries should adopt policies that will reduce carbon emissions and thus will improve public health and productivity; (2) environment-friendly technologies and resources, such as renewable energy, should be used in the production process; (3) healthcare expenditure on a national budget should be increased; and (4) clean drinking water and basic sanitation facilities must be ensured for all people.

Examining the Economic Perspective of Treatable Mortality: The Role of Health Care Financing and the Importance for Economic Prosperity

Health is an essential element of economic life and is therefore considered a source of comparative economic development of countries. The aim of the study was to examine the associations between health care financing, specific treatable mortality of males and females of working age, and economic prosperity, taking into account to the classification of health systems applied in the countries of the Organization for Economic Co-operation and Development (OECD). An insurance-based health system and a tax-based health system were identified in these countries, and data were collected for the period 1994-2016. Descriptive analysis, panel regression analysis and cluster analysis were used to achieve the aim. The analytical process included economic indicators [health expenditure, gross domestic product (GDP)] and health indicators (treatable mortality from circulatory system diseases and endocrine, nutritional and metabolic diseases). The results revealed significant negative associations of health care financing with treatable mortality from circulatory system diseases and endocrine, nutritional, and metabolic diseases in both health systems and both gender categories. There were also negative associations between treatable mortality in both diagnosis groups and economic prosperity. These results have shown that health care financing is linked to economic prosperity also through health variability in the working age population. In terms of assessing economic and health outcomes, less positive and more positive countries were identified using cluster analysis. Countries such as Latvia with a tax-based health system and Hungary, Lithuania, Estonia with an insurance-based health system were characterized by great potential for improvements. Although reducing treatable mortality is a great motivation for public health leaders to increase health care financing, the importance for economic prosperity may be a more compelling argument. Effective interventions should be considered in the light of their regional, social and economic contexts.

Democracy, Culture and Cancer Patients' Willingness to Pay for Healthcare Services: A Meta-analysis

Cancer is one of the leading causes of death globally and expenditure associated with cancer is quite high. Efficient resource allocation needs information on economic evaluations of healthcare interventions. The purposes of the study are to provide a comprehensive overview of cancer patients’ willingness to pay (WTP) for healthcare services and to investigate the influence of democracies, culture dimensions, and other factors on WTP. A meta-analysis was conducted using PubMed, Scopus, and Google Scholar to identify all studies of stated preference approach to estimate cancer patients’ WTP healthcare services. A set of criteria was constructed for selecting relevant studies. A total of 79 studies were related to selection criteria and held sufficient information for the purposes of meta-analysis. A total of 393 estimates of WTP from 79 healthcare valuation studies were pooled to identify the links between WTP and influential factors. The findings suggest that values of benefits in healthcare services are higher in more democratic nations, but they are lower in cultural traits that are stronger indulgence and uncertainty avoidance. Further, the types of cancer matter. Compared to breast cancer, WTP is higher for skin cancer, yet lower for liver cancer and lymphoma. A higher national income and public health expenditure increase WTP for healthcare services, while a higher death rate by cancer leads to lower values of healthcare benefits.

Re-opening Sudan: the Balance Between Maintaining Daily Living and Avoiding the Next Peak of COVID-19

Purpose of the Review

To describe the intersectionality of healthcare and economy, and potential solutions to prevent the next peak of COVID-19 in Sudan.

Recent Findings

Sudan has recently emerged from a 30-year dictatorship to face the COVID-19 pandemic in the midst of the worst economic crisis. Disease control measures that have been used in developed countries have been difficult to implement in Sudan due to economic, social, and structural challenges. There is a need for integration of data into the disease response plan and for community engagement to help with mitigation efforts. Youth-led community organizations were critical in the success of the Sudanese revolution. Their formal involvement in contact tracing and community awareness campaigns can be beneficial.

Summary

The COVID-19 pandemic has brought to the surface many of the challenges facing the healthcare system in Sudan. Culturally tailored interventions are needed to prevent the next peak of COVID-19 in the country.

Impact of Healthcare Expenditures on Healthcare Outcomes in the Middle East and North Africa (MENA) Region: A Cross-Country Comparison, 1995-2015

The association between healthcare expenditures and outcomes, mainly mortality and life expectancy, is complex. The real explanation for this association is not clear, especially in the Middle East and North Africa (MENA) region. This study assesses the impact of health expenditures on improving healthcare systems and health status and finds a relationship between health expenditures and health outcomes across different region. Annual time series data on healthcare spending and outcomes from 1995 to 2015 were used for MENA region in comparison to developed and developing countries. Health expenditure was adjusted by the consumer price index equation to the 2015 US dollar eliminate the impact of inflation on our results. For many countries, spending on healthcare continues to rise, Among MENA countries, we found that the United Arab Emirates and Kuwait spent more per capita on health, $1,711 and $1,420, respectively, than any other countries in the region. Although this study demonstrated a relationship between total healthcare expenditure and outcomes, some countries spend more on healthcare but have shorter life expectancy. In most countries, efficient and effective utilization of healthcare resources is the key strategy for improving health outcomes in any country. The lack of a positive correlation between healthcare spending and life expectancy may indicate that health resources are not allocated effectively. In those cases, increasing health spending does not guarantee that there is any kind of improvement in healthcare.

A Systematic Review of Sociodemographic, Macroeconomic, and Health Resources Factors on Life Expectancy

This review was aimed at systematically synthesizing and appraising the existing literature of sociodemographic, macroeconomic, and health resources factors on life expectancy. A systematic literature search of English databases, that is, PubMed/MEDLINE were scrutinized for exploring sociodemographic, macroeconomic, and health resources factors on life expectancy. The literature search was conducted in January 2020, covering a total of 46 articles from 2004 to 2019 met the review criteria, which were fully discussed subsequently. Among sociodemographic factors, infant mortality rate, literacy rate, education level, socioeconomic status, population growth, and gender inequality have a significant impact on life expectancy. Gross domestic product, Gini, income level, unemployment rate, and inflation rate are the main macroeconomic factors that significantly correlated with life expectancy. Among various health care resources, health care facilities, the number of the health care profession, public health expenditure, death rates, smoking rate, pollution, and vaccinations had a significant correlation with life expectancy. The systematic review showed general conformity of different studies, with a significant association between life expectancy and factors comprising several sociodemographic, macroeconomic, and various health care variables. This review found that only one study examined factors affecting life expectancy in Arabic countries. More studies on this region to fill this research gap were highly recommended.

COVID Health Structure Index: The Vulnerability of Brazilian Microregions

Many developing countries have highly unequal health systems across their regions. The pandemic of COVID-19 brought an additional challenge, as hospital structures equipped with doctors, intensive care units and respirators are not available to a sufficient extent in all regions. Using Data Envelopment Analysis, we create a COVID Index to verify whether the hospital structures in 543 Brazilian microregions are adequate to deal with COVID-19 and to verify whether public policies were implemented in the right direction. The results indicate that hospital structures in the poorest microregions were the most vulnerable, although the peak of COVID-19 occurred in the richest microregions (Sao Paulo). The Southeast states could relocate hospital resources or even patients between their regions. The relocation was not possible in many states in the Northeast, as the health system poorly assisted the interior of these states. These findings reveal that the heterogeneity of microregions' hospital structures follows the patterns of socioeconomic inequalities. We conclude that it is easier for the wealthier regions to reallocate hospital resources internally than for the poorest regions. By using the COVID Index, policymakers and hospital managers have straightforward information to decide which regions must receive new investments and reallocate underutilized resources.

Cancer presentation patterns in Lagos, Nigeria: Experience from a private cancer center

Background

Cancer incidence and mortality is increasing worldwide. In 2018, there were an estimated 18.1 million new cancer cases and 9.6 million cancer deaths. In Nigeria, it is estimated that 100,000 new cases occur annually, with a high case fatality ratio. The burden of cancer in Nigeria is significant, as the country still grapples with infectious diseases and has limited data on cancer epidemiology. Our study is descriptive using data from a hospital-based registry.

Objectives

This retrospective study assesses the characteristics of patients that presented to a private cancer center in Lagos, Nigeria. We aimed to update knowledge on the current trends of cancer in Nigeria as exemplified by the experience of this cancer center and set a foundation for guiding future research and policy efforts in cancer screening, prevention, and control.

Methods

The records of all the 548 oncology patients registered at the Lakeshore Cancer Center (LCC) cancer registry from January 2015 to June 2018 were reviewed for this study.

Results

Most common cancer types were breast cancer for females (46%) and prostate cancer for males (32%). 92% of the tumors were malignant and 97% of the patients were symptomatic. Among patients diagnosed with cancer, 49% were ≤ 50 years old, 90% paid for their healthcare out of pocket, and 67% did not complete treatment.

Conclusions

This study highlights the state of cancer care in Nigeria and should guide future research, with a focus on public awareness, screening programs and implementation of novel cancer control policies and infrastructure that supports early detection.

Road to family planning and RMNCHN related SDGs: Tracing the role of public health spending in India

Globally, public health expenditure (PHE) is closely associated with Reproductive, Maternal, Newborn, Child Health, and Nutrition (RMNCHN) and Family Planning (FP) outcomes. In India, the role of PHE in shaping the progress towards the attainment of RMNCHN and FP-related Sustainable Development Goals (SDGs) is not widely documented. Using the four consecutive rounds of National Family Health Survey (NFHS), we have investigated the progress in RMNCHN and FP indicators and their association with PHE by applying robust econometric modelling. The findings suggest that although there is noticeable progress in the RMNCHN indicators from 1992-93-2015-16, India has failed to achieve RMNCHN targets related to Millennium Development Goals (MDGs). Lack of noteworthy correlation between FP indicators and PHE supports the argument that post National Rural Health Mission (2005), the core family welfare expenditure suffered a setback despite the absolute rise in PHE. However, correlation plots and the multivariate panel data regression analyses affirm that even with a moderate rise, PHE emerges as an important predictor of RMNCHN outcomes in the country. Thus, the road to achieving RMNCHN and FP-related SDGs demands to avoid austerity on PHE and strengthen the integration of RMNCHN and FP programmes at the operational level.

Assessment of Health Budgetary Allocation and Expenditure Toward Achieving Universal Health Coverage in Nigeria

Context: The implementation of the Universal Health Coverage (UHC) promotes access to quality health care delivery through cost-effective initiatives to ensure good health and wellbeing without discrimination. This study examines government finance, budgetary allocation, and expenditure as key health development indicators towards achieving the UHC in Nigeria. Evidence Acquisition: Data analyzed in the study were gotten from journal articles, reports and other secondary sources. Searches were conducted in PubMed, Google Scholar, and WHO Library Database with pre-determined search terms. Further publications were identified through snowballing of citations and references. We reviewed only papers written in English with no date restrictions placed on searches. Results: Within the period of analysis, the annual national health budgetary allocation in Nigeria has been below the 2001 Abuja declaration of allocating 15% of the national budget to health. Our analysis also revealed that if the Abuja declaration was implemented, additional allocations of NGN 4.99 trillion should have been injected into the health sector between 2014 and 2020. In addition, Nigeria also lags behind relative to some other low-and middle-income countries in terms of government expenditure to the health sector in achieving the UHC. Conclusions: The inadequate budgetary allocation in Nigeria to healthcare has significantly influenced recurrent and capital health expenditure. It is worthy to note that the insufficient allocation will continue to significantly affect capital expenditure which is a large determinant of the development of any health system. With the current state of healthcare budget allocation in Nigeria, efforts need to be intensified to ensure the achievement of UHC. In the face of achieving UHC, reviewing the system of healthcare financing and ensuring prudent allocation of resources while shifting the focus from out-of-pocket payments for health is essential. We also recommend increase in political commitment towards improving the health of the populace so as to ensure health systems goals of efficiency, equity, quality of care, sustainability, financial risk protection for all citizens are achievable.

Gender Inequalities in Health and Their Effect on the Economic Prosperity Represented by the GDP of Selected Developed Countries-Empirical Study

The objective is to evaluate the relations between gender health inequalities and economic prosperity in the Organisation for Economic Co-operation and Development (OECD) countries. The groups included health indicators in the specification of men, women and gender inequalities: life expectancy, causes of mortality and avoidable mortality. The variable determining the economic prosperity was represented by the Gross Domestic Product (GDP). The analytical processing included descriptive analysis, analysis of differences and analysis of relationships. The regression analysis was presented as the main output of the research. Most of the significant gender differences in health showed a more positive outcome for women. It is possible to identify a certain relation between gender health inequalities and economic prosperity. If there is some reduction in gender inequalities in health, the economic prosperity will increase. The reduction seems to be more effective on the part of men than women. The output of the cluster analysis showed the relations of indicators evaluating the inequalities and the prosperity. The countries such as Luxembourg, Norway or Switzerland showed very positive outputs, on the other hand, the countries with a potential for the improvement are Lithuania, Latvia or Estonia. Overall, the policies should focus on reducing the inequalities in avoidable mortality as well as reducing the frequent diseases in younger people.

The association between medical spending and health status: A study of selected African countries

Background

The report from the World Health Organization (WHO) reveals that health spending worldwide remains highly unequal as more than 80% of the world's population live in low and middle-income countries but only account for about 20% of global health expenditure. Another report by the WHO on the state of health financing in Africa published in 2013 intimates that countries that are part of their member states are still on the average level in meeting set goals in financing key health projects.

Objective

The study set out to investigate the association between public and private spending and health status for eight selected African countries, namely Burundi, Eritrea, Ethiopia, Kenya, Rwanda, Sudan, Tanzania and Uganda. Health status indicators include the incidence of tuberculosis, mortality rates, maternal deaths and prevalence of HIV.

Methods

Descriptive statistics and pairwise correlation are used to assess the relationship between healthcare spending and health status. Random and fixed effect models are further employed to provide insights into the association between descriptive statistics and pairwise correlation. We used annual data from the year 2000 to 2014 obtained from world development indicators.

Results

The relationship between healthcare spending (public and private) and health status is statistically significant. Public healthcare expenditure has a higher association than private expenditure in reducing the mortality rate, tuberculosis and HIV for the average country in our sample. For example, an increase in public healthcare spending is negatively associated and statistically significant at 5% or better in reducing female mortality, male mortality, tuberculosis and HIV. Private healthcare spending is more impactful in the area of maternal deaths, where it is associated negatively and statistically significant at 1%. An increase in private healthcare spending is linked to a reduction in maternal deaths. We also compared the association between an increase in healthcare spending on males versus females and observed that public health expenditure impacts the health status of both sexes equally, however, private health expenditure provides a greater positive benefit to males. It is worth remembering that two goals of the United Nations agenda on sustainable development are gender equality and ensuring healthcare for all.

Conclusion

The findings of this research call for the selected African countries to pay more attention to public healthcare expenditure in order to improve health status, especially since private healthcare which provides access to healthcare facilities for some poor people leads to costs that are a burden. So, future research should focus on analyzing components of private healthcare spending such as direct household out-of-pocket spending, private insurance and direct service payments by private corporations as dependent variables to understand what form of private investment should be encouraged.

Health Care Financing Systems and Their Effectiveness: An Empirical Study of OECD Countries

Background: The primary aim of the research in the present study was to determine the effectiveness of health care in classifying health care financing systems from a sample of OECD (Organisation for Economic Co-operation and Development) countries (2012–2017). This objective was achieved through several stages of analysis, which aimed to assess the relations between and relation diversity in selected variables, determining the effectiveness of health care and the health expenditure of health care financing systems. The greatest emphasis was placed on the differences between health care financing systems that were due to the impact of health expenditure on selected health outputs, such as life expectancy at birth, perceived health status, the health care index, deaths from acute myocardial infarction and diabetes mellitus. Methods: Methods such as descriptive analysis, effect analysis (η²), binomial logistic regression analysis, linear regression analysis, continuity analysis (ρ) and correspondence analysis, were used to meet the above objectives. Results: Based on several stages of statistical processing, it was found that there are deviations in several of the relations between different health care funding systems in terms of their predisposition to certain areas of health outcomes. Thus, where one system proves ineffective (or its effectiveness is questionable), another system (or systems) appears to be effective. From a correspondence analysis that compared the funding system and other outputs (converted to quartiles), it was found that a national health system, covering the country as a whole, and multiple insurance funds or companies would be more effective systems. Conclusions: Based on the findings, it was concluded that, in analyzing issues related to health care and its effectiveness, it is appropriate to take into account the funding system (at least to verify the significance of how research premises affect the systems); otherwise, the results may be distorted.

Performance of primary care in different healthcare facilities: a cross-sectional study of patients' experiences in Southern Malawi

OBJECTIVE

In most African countries, primary care is delivered through a district health system. Many factors, including staffing levels, staff experience, availability of equipment and facility management, affect the quality of primary care between and within countries. The purpose of this study was to assess the quality of primary care in different types of public health facilities in Southern Malawi.

STUDY DESIGN

This was a cross-sectional quantitative study.

SETTING

The study was conducted in 12 public primary care facilities in Neno, Blantyre and Thyolo districts in July 2018.

PARTICIPANTS

Patients aged ≥18 years, excluding the severely ill, were selected to participate in the study.

PRIMARY OUTCOMES

We used the Malawian primary care assessment tool to conduct face-to-face interviews. Analysis of variance at 0.05 significance level was performed to compare primary care dimension means and total primary care scores. Linear regression models at 95% CI were used to assess associations between primary care dimension scores, patients' characteristics and healthcare setting.

RESULTS

The final number of respondents was 962 representing 96.1% response rate. Patients in Neno hospitals scored 3.77 points higher than those in Thyolo health centres, and 2.87 higher than those in Blantyre health centres in total primary care performance. Primary care performance in health centres and in hospital clinics was similar in Neno (20.9 vs 19.0, p=0.608) while in Thyolo, it was higher at the hospital than at the health centres (19.9 vs 15.2, p<0.001). Urban and rural facilities showed a similar pattern of performance.

CONCLUSION

These results showed considerable variation in experiences among primary care users in the public health facilities in Malawi. Factors such as funding, policy and clinic-level interventions influence patients' reports of primary care performance. These factors should be further examined in longitudinal and experimental settings.

Antineoplastic-related cardiovascular toxicity: A systematic review and meta-analysis in Asia

BACKGROUND

Cancer and heart diseases are the leading causes of morbidity and mortality in many countries worldwide. Recent advancement in chemotherapy and targeted therapies has led to an improvement in cancer survival rates, but at a cost of higher cardiac side effects. However, report on antineoplastic-related cardiotoxicities incidence in Asia is lacking.

METHODS

We systematically searched multiple databases to identify studies reporting incidence of antineoplastic-related cardiovascular toxicity in Asia published from inception to November 2018. Pre-specified subgroups were performed to explore heterogeneity and study quality assessed and reported according to PRISMA guidelines.

RESULTS

A total of 61 studies across 11 countries in Asia reported 8 types of cardiovascular toxicities were included. These studies mostly reported on adult populations, and usually examined cardiotoxicities related to anthracycline use. The most frequently reported cardiotoxicities were heart failure, electrocardiogram abnormalities and left ventricular dysfunction. The pooled estimated incidence of cardiotoxicity was 4.27% (95% CI: 3.53-5.07). Subgroup analysis showed higher incidence in middle income countries compared to high income countries.

CONCLUSIONS

Although robust incidence studies are sparse, cardiovascular complications affects approximately one in twenty cancer patients in Asia. This highlights a unique opportunity of cancer patients caring that need cardiologists and oncologist to become familiar with this emerging sub-specialty.

Of Mice, Whales, Jellyfish and Men: In Pursuit of Increased Longevity

The quest for increased human longevity has been a goal of mankind throughout recorded history. Recent molecular studies are now providing potentially useful insights into the aging process which may help to achieve at least some aspects of this quest. This chapter will summarize the main findings of these studies with a focus on long-lived mutant mice and worms, and the longest living natural species including Galapagos giant tortoises, bowhead whales, Greenland sharks, quahog clams and the immortal jellyfish.

Health care expenditure and health outcome nexus: new evidence from the SAARC-ASEAN region

Background

The total health expenditure (as a percentage of GDP) and health outcomes in the region of South Asian Association for Regional Cooperation (SAARC) and Association for South East Asian Nations (ASEAN) are lower than that of the OECD region and the world. This study investigated the relationship between different types of healthcare expenditures (public, private and total) and three main health status outcomes - life expectancy at birth, crude death rate and infant mortality rate - in the region.

Methodology

Using the World Bank data set for 15 countries over a 20-year period (1995–2014), a panel data analysis was conducted where relevant fixed and random effect models were estimated to determine the effects of healthcare expenditure on health outcomes. The main variables studied were total health expenditure, public health expenditure, private health expenditure, GDP per capita, improved sanitation, life expectancy at birth, crude death rate and infant mortality rate.

Results

Total health expenditure, public health expenditure and private health expenditure significantly reduced infant mortality rates, and, the extent of effect of private health expenditure was greater than that of public health expenditure. Private health expenditure also had a significant role in reducing the crude death rate. Per capita income growth and improved sanitation facilities also had significant positive roles in improving population health in the region.

Conclusions

Health expenditure in the SAARC-ASEAN region should be increased as our results indicated that it improved the health status of the population in the region. Public sector health funds must be appropriately and efficiently used, and accountability and transparency regarding spending of public health funds should be ensured. Finally, government and private institutes should implement appropriate strategies to improve sanitation facilities.