Why do some countries spend more for health? An assessment of sociopolitical determinants and international aid for government health expenditures
Why do some countries spend more for health? An assessment of sociopolitical determinants and international aid for government health expenditures
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DOI：
10.1016/j.socscimed.2014.05.044
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发表时间：
2014-08-01
影响因子：
5.4
通讯作者：
Mirelman, Andrew J.
中科院分区：
文献类型：
--
作者：
Liang, Li-Lin;Mirelman, Andrew J.
人们普遍认为，收入水平的提高和技术发展是医疗总支出的关键驱动因素之一。相比之下，人们对公共部门医疗支出的决定因素知之甚少。这项研究考察了政府卫生支出(GHE)、社会政治风险和国际援助之间的复杂关系，同时考虑了国民收入、债务和税收融资以及人口老龄化对卫生支出的影响。我们将固定效应两阶段最小二乘回归方法应用于包含120个国家的面板数据集，时间跨度从1995年到2010年。我们的结果表明，民主问责与GHE之间的正相关性逐渐减弱，并且政府越稳定，GHE水平越高。在发展中国家，腐败与较低的GHE值有关，但在发达国家与较高的GHE值有关。我们还发现，卫生发展援助(DAH)可以与国内资助的政府卫生支出(DGHE)相替代。对于一个普通国家来说，对政府的DAH每增加1%，DGHE就会下降0.03-0.04%。此外，在腐败或种族紧张局势普遍存在的国家，大坝对政府的替代程度更高。然而，对非政府组织的DAH不能与DGHE替代。(C)2014爱思唯尔有限公司。保留所有权利。
A consensus exists that rising income levels and technological development are among key drivers of total health spending. Determinants of public sector health expenditure, by contrast, are less well understood. This study examines a complex relationship across government health expenditure (GHE), sociopolitical risks, and international aid, while taking into account the impacts of national income, debt and tax financing and aging populations on health spending. We apply a fixed-effects two-stage least squares regression method to a panel dataset comprising 120 countries for the years 1995 through 2010. Our results show that democratic accountability has a diminishing positive correlation with GHE, and that levels of GHE are higher when government is more stable. Corruption is associated with less GHE in developing countries, but with higher GHE in developed countries. We also find that development assistance for health (DAH) is fungible with domestically financed government health expenditure (DGHE). For an average country, a 1% increase in DAH to government is associated with a 0.03-0.04% decrease in DGHE. Furthermore, the degree of fungibility of DAM to government is higher in countries where corruption or ethnic tensions are widespread. However, DAH to non-governmental organizations is not fungible with DGHE. (C) 2014 Elsevier Ltd. All rights reserved.