Raeesi Pouran, Harati-Khalilabad Touraj, Rezapour Aziz, Azari Samad, Javan-Noughabi Javad
Department of Health Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Department of Health Economics, School of Health Management and Information Science, Iran University of Medical Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2018 May 1;32:35. doi: 10.14196/mjiri.32.35. eCollection 2018.
In the recent decades, most studies have paid more attention to community expenditures in health sector and health outcomes. This study provides econometric evidence linking countries' health expenditures to 3 health outcomes: (1) infant mortality, (2) under 5 mortality and (3) life expectancy within 4 different health care systems. In this study, we used the econometric method to estimate the effect of health expenditure on health status. Panel data were collected and grouped for 25 countries according to the health care system over 15 years (2000-2015). The random effects model was selected over the fixed effects model based on the Hausman test to assess the effect of different factors on the 3 mentioned health outcomes. A significant relationship was found between health expenditures and health indicators. The effect of private health expenditures on health outcomes in countries with mixed health financing system and traditional sickness fund insurance was higher than public expenditures. Also, after comparing the results between different health care systems, we found that the effect of health expenditure on the health outcome in countries with national health system (NHS) was more than other health care systems. To improve health status, health policymakers should focus on the factors that lie inside the health care system. Therefore, since private and public health expenditures have different effects on health outcomes in each health care system, countries should choose an optimal combination of private and public health expenditures.
在最近几十年里，大多数研究都更加关注卫生部门的社区支出和健康结果。本研究提供了计量经济学证据，将各国的卫生支出与三种健康结果联系起来：（1）婴儿死亡率，（2）五岁以下儿童死亡率，以及（3）四种不同医疗体系下的预期寿命。在本研究中，我们使用计量经济学方法来估计卫生支出对健康状况的影响。根据15年（2000 - 2015年）间的医疗体系，收集了25个国家的面板数据并进行分组。基于豪斯曼检验，在固定效应模型和随机效应模型中选择了随机效应模型，以评估不同因素对上述三种健康结果的影响。研究发现卫生支出与健康指标之间存在显著关系。在混合卫生筹资体系和传统疾病基金保险的国家，私人卫生支出对健康结果的影响高于公共支出。此外，在比较不同医疗体系的结果后，我们发现国家卫生体系（NHS）国家的卫生支出对健康结果的影响大于其他医疗体系。为了改善健康状况，卫生政策制定者应关注医疗体系内部的因素。因此，由于私人和公共卫生支出在每个医疗体系中对健康结果有不同影响，各国应选择私人和公共卫生支出的最佳组合。
