Exploring the Impact of Health Expenditure and Its Allocation on Neonatal and Child Mortality at National Level Across 188 Countries from 2000 to 2019: Insights from the Global Burden of Disease Study

Ali Sheidaei, Negar Rezaei, Maryam Sharafkhah, Hossein Poustchi, Mohammadreza Mobinizadeh, Marita Mohammadshahi, Mohsen Naghavi, Alireza Olyaeemanesh, Reza Malekzadeh, Alireza Delavari, Sadaf G. Sepanlou
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Abstract

Background Exploring the impact of national health expenditure and its allocation on neonate and child mortality can help policy makers implement strategies aimed at achieving target 3.2 of Sustainable Development Goals (SDGs). The aim of the current study is to explore the impact of selected indicators of national health accounts on neonate and under-5 mortality across 188 countries from 2000 to 2019. Methods and findings This study has an ecological design. Data on health expenditure was obtained from the Global Health Expenditure Database (GHED) for 188 countries from 2000 to 2019. The Global Burden of Disease study (GBD) 2019 data on neonatal and under 5 mortality rates at national levels from 2000 to 2019 were obtained from the website of the Global Health Data Exchange (GHDx) supported by the Institute for Health Metrics and Evaluation. The income groups were stratified based on the World Bank classification. We employed a mixed-effects regression model to investigate the association of different health account indicators with changes in neonatal and under-5 mortality rates over time across countries. We used the Multiple Change Points model to determine the turning points in the association of health expenditure per capita with mortality across countries in 2019. And finally, we estimated the observed-to-expected ratio of mortality based on the segmented regression model for all 188 countries in 2019. Increase in the current health expenditure in International dollar Purchasing Power Parity (Int$ PPP) per capita was associated with lower mortality among both neonates and children in all strata of countries. Reductions were very minimal among high-income countries and were generally more prominent in low-income countries and decreased along with increase in income. Reductions were more noteworthy for under-5 mortality rates. The percentage of domestic general government health expenditure and the percentage of compulsory financing arrangements out of current health expenditure were inversely associated with mortality, while the association of percentage of domestic private health expenditure and out-of-pocket expenditure out of current health expenditure with mortality was positive. Results showed that the reduction in neonatal mortality associated with each ten-dollar increase in current health expenditure per capita is significantly more prominent for per capita expenditures less that the cut-point of 480 Int$ PPP per capita. The respective figure for under-5 mortality was 386 Int$ PPP per capita. Ultimately, a total of 110 countries had observed versus expected ratio less than one for neonatal mortality and 118 countries for child mortality. Conclusions Increase in health expenditure is significantly associated with decrease in neonate and under-5 mortality especially among low and low-middle income countries. However, the association fades among countries in which health expenditure per capita is higher than the threshold. In all countries, improvement in neonate and under-5 mortality requires modifying the health system infrastructure to move towards universal health coverage. However, the COVID-19 pandemic may have influenced the health spending at national levels.
探索 2000 至 2019 年期间 188 个国家在国家一级的卫生支出及其分配对新生儿和儿童死亡率的影响:全球疾病负担研究的启示
背景 探索国家卫生支出及其分配对新生儿和儿童死亡率的影响有助于政策制定者实施旨在实现可持续发展目标(SDGs)具体目标 3.2 的战略。本研究旨在探讨 2000 年至 2019 年期间,188 个国家的国家卫生账户中的部分指标对新生儿和 5 岁以下儿童死亡率的影响。从全球卫生支出数据库(GHED)中获取了 2000 年至 2019 年 188 个国家的卫生支出数据。全球疾病负担研究(GBD)2019年关于2000年至2019年各国新生儿和5岁以下儿童死亡率的数据来自卫生计量与评估研究所支持的全球卫生数据交换(GHDx)网站。收入组别根据世界银行的分类进行了分层。我们采用混合效应回归模型来研究不同健康账户指标与各国新生儿和 5 岁以下儿童死亡率随时间变化的关系。我们使用了多重变化点模型来确定 2019 年各国人均医疗支出与死亡率关系的转折点。最后,我们根据分段回归模型估算了 2019 年所有 188 个国家的观察死亡率与预期死亡率之比。以美元购买力平价(Int$ PPP)计算的当前人均医疗支出的增加与所有国家新生儿和儿童死亡率的降低相关。高收入国家的降低幅度非常小,而低收入国家的降低幅度普遍较大,并且随着收入的增加而降低。5 岁以下儿童死亡率的下降更为显著。国内一般政府卫生支出和强制性筹资安排占经常性卫生支出的百分比与死亡率成反比,而国内私人卫生支出和自付支出占经常性卫生支出的百分比与死亡率成正比。结果表明,人均经常保健支出每增加 10 美元,新生儿死亡率就会下降 10%,如果人均支出低于人均 480 购买力平价国际元的临界点,则下降幅度会更大。5 岁以下儿童死亡率的相应数字为人均 386 购买力平价国际元。最终,共有 110 个国家的新生儿死亡率观察值与预期值之比小于 1,118 个国家的儿童死亡率观察值与预期值之比小于 1。然而,在人均医疗支出高于临界值的国家,这种关联性逐渐减弱。在所有国家,要提高新生儿和 5 岁以下儿童的死亡率,就必须改变医疗系统的基础设施,以实现全民医保。不过,COVID-19 大流行可能影响了国家层面的卫生支出。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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