From income inequality to social corrosion: impact on health levels in an international efficiency comparison panel

Capita Health Expenditure

Abstract Background Health equity, although addressed in several publications dealing with health efficiency analysis, usually does not usually remain as a relevant result in empirical studies, due to the difficulty in its operationalization. Some studies provide evidence that it does not influence health outcomes; others demonstrate that its effect is an indirect one, with the hegemony of material living conditions over its social connotation. The aim of this article is to evaluate the role of health equity in determining health outcomes, in an international comparative analysis of the effectiveness and efficiency of health systems. Method Fixed Effects Model Panel and Data Envelopment Analysis, a dynamic and network model, in addition to comparative analysis between methods and health impacts. The effect variables considered in the study were life expectancy at birth and infant mortality, in 2010 and 2015, according to the sociocultural regions of the selected countries. Inequality was assessed both economically and socially. The following dimensions were considered: physical and financial resources, health production (access, coverage and prevention) and intersectoral variables: demographic, socioeconomic, governance and health risks. Results Both methods demonstrated that countries with higher inequality levels (regarding income, education and health dimensions), associated or not with poverty, are the least efficient, not reaching the potential for effective health outcomes. The outcome life expectancy at birth showed inequality and per capita health expenditure in the final model. The variable linfant mortality comprehended education, in association with care seeking due to diarrhea, births attended by skilled health professionals and the reduction in the incidence of HIV. Conclusion The dissociation between the distribution of health outcomes and the overall level of health of the population characterizes a devastating political choice for society, as it increases the levels of segregation, disrespect and violence from within. Countries should prioritize health equity, adding value to its resources, since health inequalities affect society altogether, generating mistrust and reduced social cohesion.

From income inequality to social inequity: impact on health levels in an international efficiency comparison panel

BMC Public Health ◽

10.1186/s12889-021-10395-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Simone Schenkman ◽

Aylene Bousquat

Keyword(s):

Comparative Analysis ◽

Infant Mortality ◽

Life Expectancy ◽

Health Outcomes ◽

Health Equity ◽

Fixed Effects ◽

Health Production ◽

Social Inequity ◽

Capita Health Expenditure

Abstract Background Health equity, although addressed in several publications dealing with health efficiency analysis, is not easily translated into the operationalization of variables, mainly due to technical difficulties. Some studies provide evidence that it does not influence health outcomes; others demonstrate that its effect is an indirect one, with the hegemony of material living conditions over its social connotation. The aim of this article is to evaluate the role of health equity in determining health outcomes, in an international comparative analysis of the effectiveness and efficiency of health systems. Method Fixed Effects Model Panel and Data Envelopment Analysis, a dynamic and network model, in addition to comparative analysis between methods and health impacts. The effect variables considered in the study were life expectancy at birth and infant mortality, in 2010 and 2015, according to the sociocultural regions of the selected countries. Inequity was assessed both economically and socially. The following dimensions were considered: physical and financial resources, health production (access, coverage and prevention) and intersectoral variables: demographic, socioeconomic, governance and health risks. Results Both methods demonstrated that countries with higher inequity levels (regarding income, education and health dimensions), associated or not with poverty, are the least efficient, not reaching the potential for effective health outcomes. The outcome life expectancy at birth exhibited, in the final model, the following variables: social inequity and per capita health expenditure. The outcome infant mortality comprehended the level of education variable, in association with the following healthcare variabels: care seeking due to diarrhea in children under five, births attended by skilled health professionals and the reduction in the incidence of HIV. Conclusion The dissociation between the distribution of health outcomes and the overall level of health of the population characterizes a devastating political choice for society, as it is associated with high levels of segregation, disrespect and violence from within. Countries should prioritize health equity, adding value to its resources, since health inequties affect society altogether, generating mistrust and reduced social cohesion.

Globalization and women’s and girls’ health in 192 UN-member countries

International Journal of Social Economics ◽

10.1108/ijse-07-2014-0139 ◽

2016 ◽

Vol 43 (7) ◽

pp. 692-721 ◽

Cited By ~ 2

Author(s):

Deniz Gevrek ◽

Karen Middleton

Keyword(s):

Mortality Rate ◽

Infant Mortality ◽

Life Expectancy ◽

Health Outcomes ◽

Fixed Effects ◽

Content Type ◽

Adolescent Fertility ◽

The Impact ◽

The Relationship

Purpose – The purpose of this paper is to explore the relationship between the ratification of the United Nations’ (UN’s) Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and women’s and girls’ health outcomes using a unique longitudinal data set of 192 UN-member countries that encompasses the years from 1980 to 2011. Design/methodology/approach – The authors focus on the impact of CEDAW ratification, number of reports submitted after ratification, years passed since ratification, and the dynamic impact of CEDAW ratification by utilizing ordinary least squares (OLS) and panel fixed effects methods. The study investigates the following women’s and girls’ health outcomes: total fertility rate, adolescent fertility rate, infant mortality rate, maternal mortality ratio, neonatal mortality rate, female life expectancy at birth (FLEB), and female to male life expectancy at birth. Findings – The OLS and panel country and year fixed effects models provide evidence that the impact of CEDAW ratification on women’s and girls’ health outcomes varies by global regions. While the authors find no significant gains in health outcomes in European and North-American countries, the countries in the Northern Africa, sub-Saharan Africa, Southern Africa, Caribbean and Central America, South America, Middle-East, Eastern Asia, and Oceania regions experienced the biggest gains from CEDAW ratification, exhibiting reductions in total fertility, adolescent fertility, infant mortality, maternal mortality, and neonatal mortality while also showing improvements in FLEB. The results provide evidence that both early commitment to CEDAW as measured by the total number of years of engagement after the UN’s 1980 ratification and the timely submission of mandatory CEDAW reports have positive impacts on women’ and girls’ health outcomes. Several sensitivity tests confirm the robustness of main findings. Originality/value – This study is the first comprehensive attempt to explore the multifaceted relationships between CEDAW ratification and female health outcomes. The study significantly expands on the methods of earlier research and presents novel methods and findings on the relationship between CEDAW ratification and women’s health outcomes. The findings suggest that the impact of CEDAW ratification significantly depends on the country’s region. Furthermore, stronger engagement with CEDAW (as indicated by the total number of years following country ratification) and the submission of the required CEDAW reports (as outlined in the Convention’s guidelines) have positive impacts on women’s and girls’ health outcomes.

Analysis of Determinant of Life Expectancy in East Java Province

Economics Development Analysis Journal ◽

10.15294/edaj.v8i1.25447 ◽

2019 ◽

Vol 8 (1) ◽

pp. 30-41

Author(s):

Nurnas Kavila Elnung ◽

Yozi Aulia Rahman

Keyword(s):

Life Expectancy ◽

Research Methods ◽

Fixed Effects ◽

Revenue Sharing ◽

Fixed Effects Model ◽

Tobacco Products ◽

Quantitative Research Methods ◽

Improve Life Expectancy ◽

Per Capita ◽

Economic development in East Java Province increases each year, can be seen from the Gross Regional Domestic Product (GRDP) Per Capita is increasing. The increase in GRDP Per Capita, cigarette consumption can increase so that the impact on tax receipts and an increase in life expectancy is low. Tax receipts made as the Province of East Java with revenue sharing fund of tobacco products excise highest. The purpose of this study was to analyze the influence of revenue sharing fund of tobacco products excise, betel leaves and tobacco expenditures and GRDP Per capita against life expectancy in East Java Province. Research methods used in this research is quantitative research methods with processing and data analysis technique used is Panel regression analysis with Fixed Effects Model (FEM). The results showed that only the GRDP Per Capita affects life expectancy while revenue sharing fund of tobacco products excise and expenditure of tobacco and betel leaves don't effect on life expectancy in East Java province. Based on those results, so in an attempt to improve life expectancy in East Java province by improving the use of programme revenue sharing fund of tobacco products excise that can provide direct benefits to society such as examination health routine.

OP134 Predictors Of Public Health Outcomes: A Case Study From Turkey

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462317001933 ◽

2017 ◽

Vol 33 (S1) ◽

pp. 62-63

Author(s):

Songul Cinaroglu ◽

Onur Baser

Keyword(s):

Public Health ◽

Health Outcome ◽

Life Expectancy ◽

Health Outcomes ◽

Outcome Indicators ◽

Random Forest Classification ◽

Forest Classification ◽

Province Level ◽

Public Health Outcome

INTRODUCTION:In Turkey, there is a scarcity of knowledge about the predictors of health outcomes at a national level, and it is well known that there is a gap between rural and urban parts of developing countries in terms of the level of health outcomes. This study aims to find out predictor factors of the public health outcomes at a province level in Turkey.METHODS:Life expectancy at birth and mortality are used as public health outcome indicators. Logistic regression and Random Forest classification generated by using 50, 100, and 150 trees were used to compare prediction performance of health outcomes. The results of different prediction methods were recorded changing the “k” parameter from 3 to 20 in k-fold cross validation. The Area Under the ROC Curve (AUC) was used as a measure of prediction accuracy. Prediction performance differences were tested using Kruskall-Wallis analysis and visualized on a heatmap. Finally, predictor variables of public health outcomes were shown on a decision tree.RESULTS:Study results revealed that Logistic regression outperformed Random Forest classification. The difference between all prediction methods to predict public health outcome indicators was statistically significant (p<.000). The heatmap shows that AUC values to predict mortality have superior performance when compared with life expectancy at birth. Decision tree graphs present that the most important predictor variables were total number of beds for mortality and percentage of higher education graduates for life expectancy at birth.CONCLUSIONS:The results of this study represent a preliminary attempt to determine public health outcome indicators. It is hoped that the results of this study serve as a basis to understand the determinants of health care outcomes at province level with focus on a developing country. This study illustrates that there is a need to spend extra effort for future studies to analyze public health outcomes to improve social welfare functions in health systems.

Access to sanitary toilets and health outcomes: A panel data analysis using two-way fixed effects model

Mathematical Biosciences and Engineering ◽

10.3934/mbe.2021435 ◽

2021 ◽

Vol 18 (6) ◽

pp. 8815-8830

Author(s):

Wanli Zhou ◽

◽

Yingwen Gu ◽

Xiulin Wang

Keyword(s):

Infectious Diseases ◽

Health Outcomes ◽

Child Mortality ◽

Fixed Effects ◽

Hepatitis A ◽

Rural China ◽

Panel Data Analysis ◽

Supporting Evidence ◽

Fixed Effects Model ◽

<abstract> <p>Based on the data regarding the renovation of the toilets of 30 provinces (municipalities) in rural China from 2005 to 2017, this study utilized a two-way fixed effect model to empirically test the impact of access to sanitary toilets on health, which include intestinal infectious diseases (consisting of hepatitis A, dysentery, and typhoid) and child mortality (consisting of perinatal mortality, infant mortality, and the mortality rate of children under 5). This study attempted to assess the health outcomes of the "toilet revolution" in rural China. The results showed that: (1) Access to sanitary toilets effectively reduced the incidence of hepatitis A and dysentery. For every 1% increase in the rate of access to sanitary toilets, the incidence of hepatitis A was reduced by 5.6%, and the incidence of dysentery was reduced by 36.5%. (2) Access to sanitary toilets does not significantly reduce child mortality. (3) There are obviously regional differences in the impact of access to sanitary toilets on the health outcomes. The renovation of sanitary toilets has shown the most significant effect on reducing the incidence of intestinal infectious diseases in the central region as well as the effect on reducing child mortality in the western region. It is implied that the health outcomes of China's "toilet revolution" may provide supporting evidence and experience for other developing countries and regions in implementing toilet renovation projects.</p> </abstract>

A Panel Data Approach to the Measurement of Health Technical Efficiency of Sub-Saharan Africa

Zagreb International Review of Economics and Business ◽

10.1515/zireb-2015-0001 ◽

2015 ◽

Vol 18 (1) ◽

pp. 1-15 ◽

Cited By ~ 1

Author(s):

Elham Torkian

Keyword(s):

Panel Data ◽

Environmental Factors ◽

Life Expectancy ◽

Technical Efficiency ◽

Fixed Effects ◽

Sub Saharan Africa ◽

Stochastic Production Frontier ◽

Sub Saharan ◽

Abstract This study investigates technical efficiency of health production function in Sub-Saharan Africa. For this purpose, a stochastic production frontier model is estimated using fixed-effects panel data method over the period of 2000-2007. More specifically the impact of economic, social, and environmental factors in determining life expectancy at birth, as the dependent variable, is measured and evaluated. Overall, the results justify the important role of policymakers, who their proactive approaches should be given to activities that go beyond the health system to influence the main determinants of health i.e. socioeconomic and environmental factors in preventing infectious diseases, improving life expectancy and aid populations to access available resources.

Socioeconomic and Environmental Determinants of Health Outcomes: The Case of Transition Economies

Problemy Ekorozwoju ◽

10.35784/pe.2021.2.10 ◽

2021 ◽

Vol 16 (2) ◽

pp. 94-107

Author(s):

Ebru Çağlayan-Akay ◽

◽

Zamira Oskonbaeva ◽

Keyword(s):

Health Status ◽

Life Expectancy ◽

Health Outcomes ◽

Transition Economies ◽

Annual Data ◽

Men And Women ◽

Factors Affecting ◽

Environmental Determinants Of Health ◽

Socio Demographic Factors

This study examines the effects of economic and socio-demographic factors on the health status of men and women separately. The annual data of 16 selected transition countries for the period 2000-2016 were used. Life expectancy at birth was used as an indicator of health status in the study. Economic and environmental variables such as GDP per capita, health expenditures, unemployment, carbon emissions, access to safe water, and urbanization are considered as factors affecting life expectancy at birth. In the study, the Autoregressive Distributed Lags (ARDL) model was used. The findings show that the effects of socioeconomic and environmental factors on life expectancy differ according to men and women. It has been found that above-mentioned factors are more effective on life expectancy of men than women in selected transition economies. Therefore, it can be recommended to prioritize economic and environmental targets in improving the health outcomes of countries.

The Impact of Public Health Expenditure on Health Outcomes in South Africa

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16162993 ◽

2019 ◽

Vol 16 (16) ◽

pp. 2993

Author(s):

Besuthu Hlafa ◽

Kin Sibanda ◽

Dumisani MacDonald Hompashe

Keyword(s):

Public Health ◽

South Africa ◽

Economic Development ◽

Health Outcomes ◽

Health Expenditure ◽

Fixed Effects ◽

Seemingly Unrelated Regression ◽

Fixed Effects Model ◽

Public Health Expenditure ◽

Health holds an important position in maintaining economic development since it is both a prerequisite for and an outcome of economic development. This means that health contributes greatly to the attainment of sustainable development and health outcomes. The importance of health is demonstrated in the Millennium Development Goals (MDGs) where three of the eight goals are aimed at improving health outcomes. Despite progress made by other middle-income countries in achieving health-related MDGs, South Africa is still worse off in respect of health outcomes and experiences a challenge in attaining positive outcomes for these goals. This study’s main focus was to identify the association between public health expenditure and health outcomes in South Africa’s nine provinces from 2002 to 2016. The study implemented fixed effects and a random effects panel data estimation technique to control for time effects and individual provincial heterogeneity. This was followed by employing the Hausman specification test to identify the fixed effects model as the appropriate estimator for the study. The study also employed the seemingly unrelated regression (SUR) model and the least squares dummy variable (LSDV) model to examine the impact of public health expenditure on each province separately. The findings elucidated that the relationship between public health expenditure and health outcomes in South Africa varied across provinces depending on provincial management and infrastructure availability.

OP49 Restrictive Versus Non-Restrictive Drug Reimbursement Systems

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462317001404 ◽

2017 ◽

Vol 33 (S1) ◽

pp. 22-23

Author(s):

Laia Maynou

Keyword(s):

Life Expectancy ◽

Health Outcomes ◽

Fixed Effects ◽

Mortality Rates ◽

Healthy Life ◽

Drug Reimbursement ◽

Healthy Life Years ◽

Life Years ◽

The Impact ◽

Rejection Rates

INTRODUCTION:Existing literature shows evidence on the differences in drug reimbursement decisions across countries. These differences are the reason for this study. The main aim of this research is to model the impact of drug reimbursement decisions on health outcomes (that is, life expectancy, healthy life years and mortality rates). In particular, this study is looking at countries that have different acceptance, restriction and rejection rates for drug reimbursement decisions.METHODS:The current study is based on a longitudinal dataset with data from nine European countries from 2002 to 2014. This dataset is formed of primary data on drug reimbursement decisions (that is, cancer drugs) collected in the Advancing and strengthening the methodological tools and practices relating to the application and implementation of Health Technology Assessment (ADVANCE-HTA) project and secondary data on life tables and indicators of health and socioeconomic status (from Eurostat and World Bank). Following the longevity model defined by Lichtenberg (1), a panel data model with country and year fixed-effects is run on this dataset in order to model the impact of the level of access to drugs on health outcomes.RESULTS:The results show that the rate of adoption of new drugs into a national health system does not have any significant effect on life expectancy. However, more restrictive systems are positively and significantly related with healthy life years. Finally, for mortality rates, higher rejection rates are associated with lower deaths.CONCLUSIONS:To conclude, contrary to the public opinion, results show that a more restrictive drug reimbursement system is not related with a worse health outcome, it is either associated with a positive outcome or it is not related.

Healthcare Financing and Health Outcomes: Analysis of Oil-Producing Countries in Africa

Management & Economics Research Journal ◽

10.48100/merj.2021.158 ◽

2021 ◽

Author(s):

Olaide Sekinat Opeloyeru ◽

Nurudeen Abiodun Lawal ◽

Kehinde Kabir Agbatogun

Keyword(s):

Life Expectancy ◽

Health Outcomes ◽

Health Expenditure ◽

Negative Impact ◽

Environmental Variable ◽

Healthcare Financing ◽

Development Indicators ◽

Out Of Pocket Payments ◽

External Sources

The major concern of the study is on healthcare financing and health outcomes in the major oil-producing countries in Africa. We used the data sorted from World Development Indicators (WDI) to identify the effect of four different health expenditures on the rate of mortalities on maternal, under-five, infant, neonatal and life expectancy at birth through random and fixed effect models. This paper also takes cognizance of the environmental variable (pollution) that is common to the top 10 oil-producing countries in Africa. Our findings showed that high health expenditure from government, private and external sources improved health outcomes, while health expenditure from out of pocket is detrimental to health outcomes. Also, the environmental variable has a negative impact on life expectancy. The outcome of the paper indicated that there is a need to reduce environmental pollution, increase health expenditure from government, private, external sources and reduce out of pocket payments in the selected areas.