Hadipour Alireza, Delavari Sajad, Bayati Mohsen
Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
Heliyon. 2023 Sep 17;9(9):e20251. doi: 10.1016/j.heliyon.2023.e20251. eCollection 2023 Sep.
Our study investigated the impact of institutional quality on health system outcomes, utilizing worldwide governance indicators and analyzing data from 158 countries between 2001 and 2020. We employed Principal Component Analysis (PCA) to create a composite index of institutional quality and conducted various tests to select the appropriate econometric model. The role of institutional quality, along with other variables, in health outcomes was estimated using fixed effects and generalized method of moments (GMM) models. High-income and low-income countries were analyzed separately. The results of our study revealed that institutional quality, as measured by Control of Corruption, Voice and Accountability, Political Stability, Rule of Law, Regulatory Quality, and Government Effectiveness, had a negative impact on infant mortality rates and a positive impact on life expectancy. Similarly, variables such as GDP, mean years of schooling, total health expenditure, and urbanization rate showed a negative association with infant mortality rates and a positive association with life expectancy. Conversely, the logarithm of CO2 emissions exhibited a positive effect on infant mortality rates and a negative effect on life expectancy. These findings highlight the crucial role of institutional quality in determining health outcomes. Improving institutional quality contributes to the development of democratic and meritocratic systems, infrastructure enhancement, efficient tax and subsidy systems, optimal budget allocation, improved public education, and enhanced access to primary healthcare services. The influence of institutional quality is particularly significant in high-income countries compared to low-income countries. In conclusion, our study emphasizes the importance of institutional quality in shaping health system outcomes. Enhancing institutional quality is essential for the overall advancement of healthcare systems, encompassing governance, infrastructure, education, and access to healthcare services. It is crucial to prioritize efforts to improve institutional quality, especially in high-income countries, to achieve better health outcomes for populations worldwide.
我们的研究利用全球治理指标，调查了制度质量对卫生系统成果的影响，并分析了2001年至2020年期间158个国家的数据。我们采用主成分分析（PCA）来创建制度质量的综合指数，并进行了各种测试以选择合适的计量经济学模型。使用固定效应和广义矩估计法（GMM）模型估计了制度质量以及其他变量在健康结果中的作用。对高收入国家和低收入国家分别进行了分析。我们的研究结果表明，以腐败控制、发言权和问责制、政治稳定性、法治、监管质量和政府效能衡量的制度质量对婴儿死亡率有负面影响，对预期寿命有正面影响。同样，国内生产总值、平均受教育年限、卫生总支出和城市化率等变量与婴儿死亡率呈负相关，与预期寿命呈正相关。相反，二氧化碳排放量的对数对婴儿死亡率有正面影响，对预期寿命有负面影响。这些发现凸显了制度质量在决定健康结果方面的关键作用。提高制度质量有助于发展民主和择优制度、加强基础设施、建立高效的税收和补贴制度、优化预算分配、改善公共教育以及增加获得初级医疗服务的机会。与低收入国家相比，制度质量在高收入国家的影响尤为显著。总之，我们的研究强调了制度质量在塑造卫生系统成果方面的重要性。提高制度质量对于医疗保健系统的全面发展至关重要，包括治理、基础设施、教育以及获得医疗服务的机会。必须优先努力提高制度质量，特别是在高收入国家，以便为全球人口实现更好的健康结果。
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