Institute of Hospital and Health Care Administration, National Yang-Ming University, No. 155, Sec. 2, Linong St., Beitou District, Taipei 112, Taiwan.
Department of International Health, Johns Hopkins School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA.
Soc Sci Med. 2014 Aug;114:161-8. doi: 10.1016/j.socscimed.2014.05.044. Epub 2014 May 29.
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 DAH to government is higher in countries where corruption or ethnic tensions are widespread. However, DAH to non-governmental organizations is not fungible with DGHE.
人们普遍认为，收入水平的提高和技术的发展是医疗总支出的主要驱动因素。相比之下，公共部门卫生支出的决定因素就不那么为人所理解了。本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。我们采用固定效应两阶段最小二乘法对 1995 年至 2010 年期间涵盖 120 个国家的面板数据进行了分析。我们的结果表明，民主问责制与 GHE 的正相关关系逐渐减弱，政府越稳定，GHE 的水平就越高。腐败与发展中国家的 GHE 较低有关，但与发达国家的 GHE 较高有关。我们还发现，卫生发展援助（DAH）与国内政府卫生支出（DGHE）具有可替代性。对于一个平均国家来说，政府获得的 DAH 增加 1%，与 DGHE 减少 0.03-0.04%相关。此外，在腐败或族裔紧张局势普遍存在的国家，DAH 对政府的可替代性程度更高。然而，DAH 与非政府组织之间没有可替代性。
