Kiross Girmay Tsegay, Chojenta Catherine, Barker Daniel, Loxton Deborah
Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.
Health Econ Rev. 2020 Mar 6;10(1):5. doi: 10.1186/s13561-020-00262-3.
Although health expenditure in sub-Saharan African countries is the lowest compared with other regions in the world, most African countries have improved their budget allocations to health care over the past 15 years. The majority of health care sources in sub-Saharan Africa are private and largely involve out-of-pocket expenditure, which may prevent healthcare access. Access to healthcare is a known predictor of infant mortality. Therefore the objective of this study is to determine the impact of health care expenditure on infant mortality in sub-Saharan Africa.
The study used panel data from World Bank Development Indictors (WDI) from 2000 to 2015 covering 46 countries in sub-Saharan Africa. The random effects model was selected over the fixed effects model based on the Hausman test to assess the effect of health care expenditure on infant and neonatal mortality.
Both public and external health care spending showed a significant negative association with infant and neonatal mortality. However, private health expenditure was not significantly associated with either infant or neonatal mortality. In this study, private expenditure includes funds from households, corporations and non-profit organizations. Public expenditure include domestic revenue as internal transfers and grants, transfers, subsidies to voluntary health insurance beneficiaries, non-profit institutions serving households or enterprise financing schemes as well as compulsory prepayment and social health insurance contributions. External health expenditure is composed of direct foreign transfers and foreign transfers distributed by government encompassing all financial inflows into the national health system from outside the country.
Health care expenditure remains a crucial component of reducing infant and neonatal mortality in sub-Saharan African countries. In the region, where health infrastructure is largely underdeveloped, increasing health expenditure will contribute to progress towards reducing infant and neonatal mortality during the Sustainable Development Goals (SDGs) era. Therefore, governments in the region need to increase amounts allocated to health care service delivery in order to reduce infant mortality.
尽管撒哈拉以南非洲国家的卫生支出与世界其他地区相比是最低的，但在过去15年里，大多数非洲国家增加了对医疗保健的预算分配。撒哈拉以南非洲的大多数医疗保健资金来源是私人的，并且在很大程度上涉及自付费用，这可能会阻碍获得医疗保健服务。获得医疗保健服务是已知的婴儿死亡率预测指标。因此，本研究的目的是确定卫生支出对撒哈拉以南非洲婴儿死亡率的影响。
该研究使用了世界银行发展指标（WDI）2000年至2015年的面板数据，涵盖撒哈拉以南非洲的46个国家。基于豪斯曼检验，选择随机效应模型而非固定效应模型来评估卫生支出对婴儿和新生儿死亡率的影响。
公共和外部卫生支出均与婴儿和新生儿死亡率呈显著负相关。然而，私人卫生支出与婴儿或新生儿死亡率均无显著关联。在本研究中，私人支出包括来自家庭、企业和非营利组织的资金。公共支出包括作为内部转移和赠款的国内收入、转移支付、对自愿医疗保险受益人的补贴、为家庭服务的非营利机构或企业融资计划以及强制预付款和社会医疗保险缴款。外部卫生支出由直接外国转移和政府分配的外国转移组成,包括从国外流入国家卫生系统的所有资金。
卫生支出仍然是撒哈拉以南非洲国家降低婴儿和新生儿死亡率的关键组成部分。在该地区，卫生基础设施在很大程度上不发达,增加卫生支出将有助于在可持续发展目标（SDGs）时代朝着降低婴儿和新生儿死亡率取得进展。因此，该地区各国政府需要增加分配给医疗保健服务提供的金额，以降低婴儿死亡率。
