Department of Government, University of Essex, Colchester, UK.
Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City, Taiwan, 40447.
BMC Public Health. 2020 May 11;20(1):649. doi: 10.1186/s12889-020-08821-3.
A country's spending on healthcare significantly improves its population health status. No comparative study has examined how the threat perceived by leaders influences health expenditure and cross-national analyses of authoritarian regimes. The objectives of this study are to examine how time horizons of autocrats influence health expenditure.
We designed a mixed methods research approach. First, the study used panel data from 1995 to 2010 covering 95 countries (n = 1208) and applied fixed effects regression models. As a proxy for time horizons, the study generated the predicted survival time for each regime-year using parametric survival analysis and the predictors to model regime failure. Second, we chose Chad, Rwanda and Ivory Coast to apply synthetic control methods for comparative case studies. Armed conflict had significant effects on regime duration and was used for an intervention. We constructed a synthetic version of each country, combining counties that did not or did experience armed conflict to resemble the values of health expenditure predictors for the actual country prior to the intervention.
We found that an increase in the natural log form of survival time by 1 resulted in a 1.14 percentage point increase in health expenditure (% of GDP) (1.14, 95% CI = 0.60-1.69). Furthermore, we found that the difference in health expenditure between the actual Chad and its synthetic version starts to grow following the civil war in 2004 (in 2004, actual: 5.72%, synthetic: 5.91%; in 2005, actual: 3.91%, synthetic: 6.74%). Similarly, a large health expenditure gap between the actual Rwanda and its synthetic control resulted after the peace deal was signed in 2002 (in 2002, actual: 4.18%, synthetic: 4.77%; in 2003, actual: 6.34%, synthetic: 5.03%). In Ivory Coast, the two series diverge substantially during the civil war from 1999 to 2005 (in 1998, actual: 7.30%, synthetic: 7.11%; in 2002, actual: 4.47%, synthetic: 7.43%; in 2007, actual: 6.35%, synthetic: 6.50%).
The findings suggest that health expenditure decreases as regime time horizons shrink, and reducing armed conflict is a way to promote regime stability.
一个国家在医疗保健上的支出显著改善了其人口健康状况。没有比较研究考察过领导人感知到的威胁如何影响医疗支出，以及对威权政权的跨国分析。本研究的目的是考察独裁者的时间视野如何影响医疗支出。
我们设计了一个混合方法研究方法。首先，该研究使用了 1995 年至 2010 年涵盖 95 个国家（n=1208）的面板数据，并应用固定效应回归模型。作为时间视野的代理，该研究使用参数生存分析生成了每个政权年的预测生存时间，并使用预测政权失败的指标来建模。其次，我们选择乍得、卢旺达和科特迪瓦应用综合控制方法进行比较案例研究。武装冲突对政权持续时间有重大影响，并被用作干预措施。我们为每个国家构建了一个综合版本，将没有或经历过武装冲突的县组合起来，以类似于实际国家在干预前卫生支出预测指标的值。
我们发现，生存时间的自然对数增加 1 个单位，卫生支出（占 GDP 的百分比）增加 1.14 个百分点（1.14，95%置信区间=0.60-1.69）。此外，我们发现，实际乍得与其综合版本之间的卫生支出差异自 2004 年内战以来开始扩大（2004 年，实际：5.72%，综合：5.91%；2005 年，实际：3.91%，综合：6.74%）。同样，2002 年签署和平协议后，卢旺达实际与其综合控制之间的卫生支出差距也很大（2002 年，实际：4.18%，综合：4.77%；2003 年，实际：6.34%，综合：5.03%）。在科特迪瓦，1999 年至 2005 年内战期间，两个系列之间的差距明显扩大（1998 年，实际：7.30%，综合：7.11%；2002 年，实际：4.47%，综合：7.43%；2007 年，实际：6.35%，综合：6.50%）。
研究结果表明，医疗支出随着政权时间视野的缩小而减少，减少武装冲突是促进政权稳定的一种方式。
