Do public health expenditures affect maternal and child health in Madagascar?

IF 2.7 3区经济学 Q1 ECONOMICS

Health Economics Review Pub Date : 2023-10-18 DOI:10.1186/s13561-023-00462-7

Marilys Victoire Razakamanana, Voahirana Tantely Andrianatoandro, Tiarinisaina Olivier Ramiandrisoa

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Abstract

Background: Previous studies have argued that the relationship between health expenditures and health outcomes is more significant among the poor than the non-poor. However, public spending alone does not improve health status. Quality of governance is considered not only as an important determinant of health outcomes but also of the efficiency of public expenditure on health. In low-income countries, barriers to quality service provision can be observed, which may explain the effects of health expenditures. Therefore, this paper aims to identify the relationship between health expenditures and maternal and child mortality in Madagascar and the potential bottlenecks in the flow of funds for maternal and child health.

Methods: Using panel data, fixed and random effect models for the 22 regions of Madagascar over the period 2010 to 2017 were used. Then bottlenecks related to the flow of funds for maternal and child health were identified.

Results: The results reveal that, on the one hand, funding for maternal health, mainly constituted by equipment endowments for health facilities, significantly contributes to the improvement of maternal health (-0.35; p-value = 0.00). On the other hand, child health financing, often realized through transfers of funds to the health system, does not affect children's health (0.22; p-value = 0.88). The bottleneck analysis illustrates that the transferred funds can suffer from delay or misappropriation and only few parts reach beneficiaries.

Conclusions: Equipment endowments contributed more to health improvement and would be more effective than monetary financing.

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公共卫生支出是否影响马达加斯加的孕产妇和儿童健康？

背景：先前的研究表明，穷人的医疗支出与医疗结果之间的关系比非穷人更为显著。然而，仅靠公共支出并不能改善健康状况。治理质量不仅被视为卫生成果的重要决定因素，而且被视为公共卫生支出效率的一个重要决定因素。在低收入国家，可以观察到提供优质服务的障碍，这可以解释卫生支出的影响。因此，本文旨在确定马达加斯加卫生支出与孕产妇和儿童死亡率之间的关系，以及孕产妇和儿童卫生资金流动的潜在瓶颈。方法：使用面板数据，使用2010年至2017年期间马达加斯加22个地区的固定和随机效应模型。然后确定了与妇幼保健资金流动有关的瓶颈。结果：研究结果表明，一方面，主要由卫生设施设备捐赠构成的孕产妇健康资金对改善孕产妇健康有显著贡献（-0.35；p值 = 0.00）。另一方面，儿童健康融资通常通过向卫生系统转移资金来实现，并不影响儿童的健康（0.22；p值 = 0.88）。瓶颈分析表明，转移的资金可能会受到延误或挪用，只有少数部分到达受益人手中。结论：设备捐赠对改善健康的贡献更大，比货币融资更有效。

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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来源期刊

Health Economics Review Multiple-

CiteScore

3.90

自引率

4.20%

发文量

审稿时长

13 weeks

期刊介绍： Health Economics Review is an international high-quality journal covering all fields of Health Economics. A broad range of theoretical contributions, empirical studies and analyses of health policy with a health economic focus will be considered for publication. Its scope includes macro- and microeconomics of health care financing, health insurance and reimbursement as well as health economic evaluation, health services research and health policy analysis. Further research topics are the individual and institutional aspects of health care management and the growing importance of health care in developing countries.