Health expenditure, governance and SDG3 nexus: a longitudinal analysis in BRICS economies.

IF 5.9 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Md Mominur Rahman, Tasneem Islam Dyuti, Mohammad Tareque, Mohammed Alnour
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引用次数: 0

Abstract

Background: Achieving Sustainable Development Goal 3 (SDG3): good health and well-being, requires significant health investments and effective governance. While many studies explored the influence of health expenditure and governance, little is known about how different levels of governance affect the relationship between health expenditure and SDG3 in a globalised world. Thus, this study aims to fill that gap by examining the marginal effects of health expenditure on SDG3 under varying levels of governance in BRICS economies.

Methods: This study uses quantitative data spanning a panel of 2000-2023 years. Governance is measured using worldwide governance indicators, while health spending is represented by current health costs, government health costs, and private health costs from the World Development Indicators. Data on SDG3 comes from the SDG Index. Cross-sectional dependency, stationarity and cointegration tests are employed to choose appropriate panel data models. The final results are obtained using Fully Modified OLS, while System GMM is used to address issues like endogeneity, autocorrelation, instrumentation, and causality. To ensure the results are reliable, the study also tests alternative measures of governance.

Results: 1% increase in current and government health spending improves SDG3 by 3.92% and 2.86%, respectively, while a 1% rise in private health spending reduces it by 0.677%. This negative impact in BRICS nations is likely due to market failures in private healthcare, where profit-driven models limit access and efficiency. The positive impact of current and government health expenditure on health outcomes is comparatively weaker at lower levels of governance but private health expenditure and SDG3 are weakening by governance at different levels which is indicative of inefficiencies in resource allocation and implementation. This study supports institutional theory, which states that strong governance improves the effectiveness of public health spending, leading to better health outcomes. The study highlights how the geopolitical prominence of governance frameworks interacts to optimise the benefits of health investments, demonstrating their role as leaders in advancing global health initiatives. Thus, policymakers need an integrated approach in health investments with institutional reforms in achieving health outcomes more effectively as good governance significantly amplifies the relationship.

Conclusions: This study highlights that governance plays a key role in improving the impact of health spending on SDG3. Strong governance boosts the benefits of public health expenditure and limits the negative effects of private health expenditure. Thus, the findings stress the importance of effective governance in enhancing health outcomes in BRICS economies.

卫生支出、治理和可持续发展目标3的联系:金砖国家经济体的纵向分析。
背景:实现可持续发展目标3(可持续发展目标g3):良好健康和福祉,需要大量卫生投资和有效治理。虽然许多研究探讨了卫生支出和治理的影响,但在全球化的世界中,不同的治理水平如何影响卫生支出与可持续发展目标3之间的关系,我们知之甚少。因此,本研究旨在通过考察金砖国家经济体不同治理水平下卫生支出对可持续发展目标g3的边际效应来填补这一空白。方法:本研究采用2000-2023年的定量数据。治理是使用全球治理指标来衡量的,而卫生支出则由世界发展指标中的当前卫生成本、政府卫生成本和私人卫生成本来表示。关于可持续发展目标3的数据来自可持续发展目标指数。采用横截面相关性、平稳性和协整检验来选择合适的面板数据模型。使用完全修正的OLS获得最终结果,而系统GMM用于解决内生性、自相关、仪器和因果关系等问题。为了确保结果是可靠的,该研究还测试了治理的替代措施。结果:当前和政府卫生支出增加1%分别使SDG3提高3.92%和2.86%,而私人卫生支出增加1%使SDG3降低0.677%。这种对金砖国家的负面影响可能是由于私营医疗保健的市场失灵,利润驱动的模式限制了获取和效率。当前和政府卫生支出对卫生成果的积极影响在较低的治理水平上相对较弱,但私人卫生支出和可持续发展目标3正在因各级治理而减弱,这表明资源分配和执行效率低下。这项研究支持制度理论,该理论指出,强有力的治理可以提高公共卫生支出的有效性,从而带来更好的健康结果。该研究强调了治理框架的地缘政治重要性如何相互作用,以优化卫生投资的效益,展示了它们作为推动全球卫生倡议的领导者的作用。因此,决策者需要在卫生投资方面采取综合办法,同时进行体制改革,以更有效地实现卫生成果,因为善治会大大扩大两者之间的关系。结论:本研究强调,治理在改善卫生支出对可持续发展目标g3的影响方面发挥着关键作用。强有力的治理可提高公共卫生支出的效益,并限制私人卫生支出的负面影响。因此,研究结果强调了有效治理对提高金砖国家经济健康成果的重要性。
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来源期刊
Globalization and Health
Globalization and Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
18.40
自引率
1.90%
发文量
93
期刊介绍: "Globalization and Health" is a pioneering transdisciplinary journal dedicated to situating public health and well-being within the dynamic forces of global development. The journal is committed to publishing high-quality, original research that explores the impact of globalization processes on global public health. This includes examining how globalization influences health systems and the social, economic, commercial, and political determinants of health. The journal welcomes contributions from various disciplines, including policy, health systems, political economy, international relations, and community perspectives. While single-country studies are accepted, they must emphasize global/globalization mechanisms and their relevance to global-level policy discourse and decision-making.
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