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This study examined the differences in health spending within the World Health Organization (WHO) Europe region by comparing the EU15, the EU post-2004, CIS, EU Candidate and CARINFONET countries. The WHO European Region (53 countries) has been divided into the following sub-groups: EU15, EU post-2004, CIS, EU Candidate countries and CARINFONET countries. The study period, based on the availability of WHO Global Health expenditure data, was 1995 to 2014. EU15 countries have exhibited the strongest growth in total health spending both in nominal and purchasing power parity terms. The dynamics of CIS members’ private sector expenditure growth as a percentage of GDP change has exceeded that of other groups. Private sector expenditure on health as a percentage of total government expenditure, has steadily the highest percentage point share among CARINFONET countries. Furthermore, private households’ out-of-pocket payments on health as a percentage of total health expenditure, has been dominated by Central Asian republics for most of the period, although, for the period 2010 to 2014, the latter have tended to converge with those of CIS countries. Western EU15 nations have shown a serious growth of health expenditure far exceeding their pace of real economic growth in the long run. There is concerning growth of private health spending among the CIS and CARINFONET nations. It reflects growing citizen vulnerability in terms of questionable affordability of healthcare. Health care investment capability has grown most substantially in the Russian Federation, Turkey and Poland being the classical examples of emerging markets.

Background Child undernutrition remains the major public health problem in low and middle-income countries including Ethiopia. The effects of good governance, urbanization and public health expenditure on childhood undernutrition are not well studied in developing countries. The objective of the study is to examine the relationship between quality of governance, public health expenditures, urbanization and child undernutrition in Ethiopia. Methods This is pooled data analysis with ecological design. We obtained data on childhood undernutrition from the Ethiopian Demographic and Health Surveys (EDHS) that were conducted in 2000, 2005, 2011 and 2016. Additionally, data on quality of governance for Ethiopia were extracted from the World Governance Indicators (WGI) and public health spending and urbanization were obtained from the World Development Indicators and United Nations’ World Population Prospects (WPP) respectively. Univariate and multivariate analysis were done to assess the relationship between governance, public health expenditure and urbanization with childhood undernutrition. Result Government effectiveness (adjusted odd ratio (AOR) = 20.7; p  = 0.046), regulatory quality (AOR = 0.0077; p  = 0.026) and control of corruption (AOR = 0.0019; p  = 0.000) were associated with stunting. Similarly, government effectiveness (AOR = 72.2; p  = 0.007), regulatory quality (AOR = 0.0015; p  = 0.004) and control of corruption (AOR = 0.0005; p  = 0.000) were associated with underweight. None of the governance indicators were associated with wasting. On the other hand, there is no statistically significant association observed between public health spending and urbanization with childhood undernutrition. However, other socio-demographic variables play a significant effect on reducing of child undernutrition. Conclusion This study indicates that good governance in the country plays a significant role for reducing childhood undernutrition along with other socio-demographic factors. Concerned bodies should focus on improving governance and producing a quality policy and at the same time monitor its implementation and adherence.

The COVID-19 epidemic has crashed on the social and economic stability of China and even the world, and raised the question: how has the Chinese government done with public health in recent years? The purpose of this paper is to clarify the definition and items of Chinese public-health expenditure, then to objectively evaluate the Chinese government’s performance, so as to help the government to perform better in public health. To achieve this goal, we measure the Chinese public-health expenditure at national and provincial levels based on our definition, and then compare it with the expenditures of other countries. The results show that: (1) the level of public-health expenditure in China is relatively low and far lower than that in developed countries; (2) Chinese governments have not paid enough attention to the prevention and control of major public-health emergencies, which may be an important reason for the outbreak of COVID-19; (3) Chinese public-health expenditure shows a fluctuating growth trend, but the growth rate is so slow that it is lower than that of GDP and fiscal expenditure; (4) although the Chinese government inclines the public-health expenditure to the poor provinces in central and western regions, the imbalance and inequity of public-health resource allocation are still expanding among provinces; (5) there is a lot of waste of resources in the public-health system, which seriously reduces the efficiency of public-health expenditure in China. Therefore, the Chinese government should improve the quantity and quality of public-health expenditure in the above aspects.

Introduction: Chronic Non-Communicable Diseases are a major public health problem in Brazil, with notable social and regional disparities. Objective: examine the relationship between the number of doctors in the Unified Health System and the number of hospitalizations and mortality rates due to Non-Communicable Diseases, and how income inequality might influence such outcomes. Methods: ecological study using secondary data from Brazil’s public health system (2016-2018). Mortality rates were age-standardized based on WHO’s population. All rates were standardized per 100,000 inhabitants, and costs were converted to US dollars. Linear regression was performed using backward elimination strategy. Results: 2,423,251 deaths were recorded, with a total expenditure of US $3.2 billion. Both deaths and costs were higher in men. The Gini index was inversely correlated with total spending (p < 0.05) and hospital admissions for most Non-Communicable Diseases (p < 0.001), except for metabolic diseases. No correlation was found between the Gini index and mortality. Conclusions: Non-Communicable Diseases accounted for over 2 million deaths in adults during 2016-2018, with a greater impact on men. A negative relationship between income inequality and Non-Communicable Diseases outcomes was found, but no significant association with the number of Unified Health System’s doctors was identified.   Introdução: Doenças Crônicas Não Transmissíveis são um grande problema de saúde pública no Brasil, com notáveis ​​disparidades sociais e regionais. Objetivo: examinar a relação entre o número de médicos no Sistema Único de Saúde e o número de hospitalizações e taxas de mortalidade por Doenças Não Transmissíveis, e como a desigualdade de renda pode influenciar tais resultados. Métodos: estudo ecológico usando dados secundários do sistema público de saúde do Brasil (2016-2018). As taxas de mortalidade foram padronizadas por idade com base na população da OMS. Todas as taxas foram padronizadas por 100.000 habitantes, e os custos foram convertidos para dólares americanos. A regressão linear foi realizada usando a estratégia de eliminação para trás. Resultados: 2.423.251 mortes foram registradas, com um gasto total de US$3,2 bilhões. Tanto as mortes quanto os custos foram maiores em homens. O índice de Gini foi inversamente correlacionado com o gasto total (p < 0,05) e internações hospitalares para a maioria das Doenças Não Transmissíveis (p < 0,001), exceto para doenças metabólicas. Não foi encontrada correlação entre o índice de Gini e mortalidade. Conclusões: As Doenças Não Transmissíveis foram responsáveis ​​por mais de 2 milhões de mortes em adultos durante 2016-2018, com maior impacto nos homens. Foi encontrada uma relação negativa entre desigualdade de renda e desfechos de Doenças Não Transmissíveis, mas nenhuma associação significativa com o número de médicos do Sistema Único de Saúde foi identificada.

The effect of government spending on population's health has received attention over the past decades. This study re-examines the link between government health expenditures and health outcomes to establish whether government intervention in the health sector improves outcomes. The study uses annual data for the period 1980-2014 on Ghana. The ordinary least squares (OLS) and the two-stage least squares (2SLS) estimators are employed for analyses; the regression estimates are then used to conduct cost-effectiveness analysis. The results show that, aside from income, public health expenditure contributed to the improvements in health outcomes in Ghana for the period. We find that, overall, increasing public health expenditure by 10% averts 0.102-4.4 infant and under-five deaths in every 1000 live births while increasing life expectancy at birth by 0.77-47 days in a year. For each health outcome indicator, the effect of income dominates that of public spending. The cost per childhood mortality averted ranged from US$0.20 to US$16, whereas the cost per extra life year gained ranged from US$7 to US$593.33 (2005 US$) during the period. Although the health effect of income outweighs that of public health spending, high (and rising) income inequality makes government intervention necessary. In this respect, development policy should consider raising health sector investment inter alia to improve health conditions.

Under the dual challenges of global downward economic pressure and the COVID-19 pandemic, studying the impact of local government fiscal pressure on public health is a meaningful endeavor. First, this paper analyzes the impact of local government fiscal pressure on public health and clarifies its impact mechanisms. Second, by utilizing panel data of 31 Chinese provinces from 2000 to 2020, two-way fixed-effects and mediating-effects models are developed to identify the effects and impact mechanisms of local government fiscal pressure on public health. The results show that local government fiscal pressure can be detrimental to public health through three main mechanisms: reducing public health fiscal expenditures, hindering industrial structure upgrading, and exacerbating environmental pollution. Heterogeneity analysis finds that the negative effects of local government fiscal pressure on public health mainly exist in Central and Western China. Accordingly, three policy implications are proposed: optimizing the fiscal system, accelerating industrial upgrading, and improving the appraisal system of local officers.

The rapid economic growth over recent years and the resulting environmental pollution in OECD countries are a serious concern for the health of the general public. A comprehensive analysis of environmental pollutants, economic growth, and public health is done using data from 28 OECD economies from 2002 to 2018. Panel fully modified least squares and the panel vector error correction model are used. The results show that there is long-run causality from renewable energy and carbon dioxide (CO 2 ) emissions to healthcare spending. Renewable energy and healthcare spending are positively and significantly related. It is concluded that investment in renewable energy leads to a reduction in air pollution, improvements in healthcare, and the promotion of economic growth.

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.

The United Nations 2030 Sustainable Development Goals (SDGs) involve society, economy, and environment, and the Belt and Road Initiative (BRI) is an important path to implement the SDGs. Moreover, the BRI is a vision for economic development of countries along the route. Although many studies documented the effect of the BRI on environment and economic performance, few studies have discussed the effect of the BRI on social and economic benefits. Therefore, we introduce the public health expenditure to explore the relationship between the BRI and the public health and economic growth of countries along the route from the dual perspective of social development and economic growth. Based on a panel data from 171 countries from 2010 to 2018, the current research explores whether the BRI can boost public health and promote economic growth in the belt-road countries. As a result, we found that the BRI boosted the expenditure of public health and effectively spurred economic growth in the belt-road countries. Furthermore, the effect of the BRI on the economic growth in the countries along the route depends on the level of public health expenditure in each country; the positive effect of the BRI on economic growth is significant when the public health expenditure level is moderate instead of low or high. The findings provide theoretical and practical insights into the SDGs of the BRI.

Health holds an important position in maintaining economic development since it is both a prerequisite for and an outcome of economic development. This means that health contributes greatly to the attainment of sustainable development and health outcomes. The importance of health is demonstrated in the Millennium Development Goals (MDGs) where three of the eight goals are aimed at improving health outcomes. Despite progress made by other middle-income countries in achieving health-related MDGs, South Africa is still worse off in respect of health outcomes and experiences a challenge in attaining positive outcomes for these goals. This study’s main focus was to identify the association between public health expenditure and health outcomes in South Africa’s nine provinces from 2002 to 2016. The study implemented fixed effects and a random effects panel data estimation technique to control for time effects and individual provincial heterogeneity. This was followed by employing the Hausman specification test to identify the fixed effects model as the appropriate estimator for the study. The study also employed the seemingly unrelated regression (SUR) model and the least squares dummy variable (LSDV) model to examine the impact of public health expenditure on each province separately. The findings elucidated that the relationship between public health expenditure and health outcomes in South Africa varied across provinces depending on provincial management and infrastructure availability.