Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Health Econ. 2014 Feb;23(2):129-40. doi: 10.1002/hec.3016. Epub 2013 Dec 11.
Research assessing the relationship between government health expenditure and development assistance for health channeled to governments (DAHG) has not considered that this relationship may depend on whether DAHG is increasing or decreasing. We explore this issue using general method of moments estimation and a panel of financial flows data spanning 119 countries and 16 years. Our primary concern is how DAHG affects government health expenditure as source (GHES). We disaggregate the average effect of DAHG and separately identify the effects of increases versus decreases in DAHG. We find that a $1 year-over-year increase in DAHG leads to a $0.62 (90% confidence interval (CI): 0.15, 1.09) decrease in GHES, whereas a $1 year-over-year decrease in DAHG does not have an effect on GHES that is statistically different from zero (CI: -0.67, 1.17). Simulation shows that the displacement of GHES between 1995 and 2010 reduced total government health expenditure by $152.8 billion (CI: 46.9, 277.6). Moreover, the irregular disbursement of DAHG reduced total government expenditure by $96.9 billion (CI: 0.5, 212.4). Thus, this research shows that health aid is fungible and highlights the cost of displacement and erratic aid disbursement.
研究评估政府卫生支出与政府渠道的卫生发展援助（DAHG）之间的关系时，尚未考虑到这种关系可能取决于 DAHG 是增加还是减少。我们使用矩估计的一般方法和跨越 119 个国家和 16 年的资金流动数据面板来探讨这个问题。我们主要关注的是 DAHG 如何影响政府卫生支出（GHES）。我们细分了 DAHG 的平均影响，并分别确定了 DAHG 增加和减少的影响。我们发现，DAHG 每年增加 1 美元，会导致 GHES 减少 0.62 美元（90%置信区间（CI）：0.15，1.09），而 DAHG 每年减少 1 美元，对 GHES 没有影响，与零（CI：-0.67，1.17）在统计学上没有显著差异。模拟显示，1995 年至 2010 年间 GHES 的置换减少了 1528 亿美元的政府卫生总支出（CI：469 亿美元，2776 亿美元）。此外，DAHG 的不规则支付减少了 969 亿美元的政府总支出（CI：0.5 亿美元，212.4 亿美元）。因此，这项研究表明卫生援助是可替代的，并强调了置换和不稳定援助支付的成本。
