scholarly journals Determinants of increased health care spending: Colombia in the international context

2020 ◽  
Author(s):  
Juan José Espinal Piedrahita ◽  
Jairo Humberto Restrepo Zea ◽  
Daniel Alberto Grajales Gaviria
Keyword(s):  
Fixed Effects ◽  
Health Spending ◽  
Demographic Variables ◽  
Health Care Spending ◽  
Financial Sustainability ◽  
Panel Regression ◽  
Middle Income ◽  
International Context ◽  
Middle Income Countries ◽  
Fixed Effects Panel Regression

Abstract Financial sustainability in health refers to the balance over time between income and expenditure, so expenditure is a major fiscal challenge and its determinants require monitoring. The objective of this study is to define and measure the most important determinants that influence increases in health expenditure in 80 countries at different income levels, and to determine how the average level of increase compares with Colombia. A literature review was conducted to define the determinants. Then, a fixed-effects panel regression model was estimated to reveal the contribution of these determinants to the increase in spending. The results indicate that demographic variables and technological innovation have the greatest impact on the increase in health spending (45% and 43%, respectively). In conclusion, the study validates what is reported in the international literature with regard to upper-middle-income countries, where the evidence identifies that demographic and technological factors have the greatest impact on the increase in spending. There is also a need to include institutional and outcome variables to ensure that a fuller array of health spending determinants are considered, quantified, and explored.

scholarly journals Infant Mortality in Low- and Middle-income Countries: Does Government Health Spending Matter?

2020 ◽  
Vol 5 (1) ◽  
pp. 54-73
Author(s):  
Micheal Kofi Boachie ◽  
Tatjana Põlajeva ◽  
Albert Opoku Frimpong
Keyword(s):  
Infant Mortality ◽  
Health Outcomes ◽  
Health Expenditure ◽  
Fixed Effects ◽  
Health Sector ◽  
Health Spending ◽  
Middle Income ◽  
Government Health ◽  
Middle Income Countries ◽  
Low And Middle Income

The issue of whether government health spending improves health outcomes has been a matter of contention over the years. There have been calls for governments to reduce their financing role in the health sector since such funding do not produce better health. This article examines the effect of public (i.e., government) health expenditure on infant mortality, a proxy of health outcomes, in low- and middle-income countries. We use data from the World Bank’s World Development Indicators database and employ fixed effects estimation technique, with three-stage least squares as a robustness check. The data cover the period 1995–2014. We find that public health expenditure improves health outcomes significantly, as it reduces infant mortality. The results further show that rising income and access to safe water are some of the reasons for improved health outcomes in low- and middle-income countries. Based on these results and the expected redistributive impact of government spending, governments in low- and middle-income countries may consider increasing health spending for better healthcare systems and improved health.

scholarly journals Characteristics and circumstances of falls leading to severe fractures in elderly people in Rio de Janeiro, Brazil

2009 ◽  
Vol 25 (2) ◽  
pp. 455-459 ◽  
Author(s):  
Evandro Silva Freire Coutinho ◽  
Kátia Vergetti Bloch ◽  
Laura C. Rodrigues
Keyword(s):  
Risk Factors ◽  
Elderly People ◽  
Rio De Janeiro ◽  
Developed Countries ◽  
Case Control ◽  
Demographic Variables ◽  
Case Control Studies ◽  
Middle Income ◽  
Middle Income Countries ◽  
Gender And Age

The circumstances associated with falls among elderly people have been well described in some developed countries, but little is known about such accidents in middle-income countries. The aim of this paper is to report the circumstances and characteristics associated with falls leading to severe fractures among elderly people living in Rio de Janeiro, Brazil. Cases were obtained from two case-control studies on risk factors for severe fractures due to falls among individuals 60 years or older. Fallers were stratified according to clinical and socio-demographic variables and circumstances of the accident. Women comprised three-fourths of the sample. The femur was the most frequently fractured bone, more common among individuals over 70 years of age. Most falls occurred at home, between 6:00 AM and 6:00 PM, but the rooms where they occurred differed according to gender and age. Most individuals did not attribute their falls to tripping or slipping. This sample's data did not differ substantially from studies in developed countries.

scholarly journals Regulating the international surrogacy market:the ethics of commercial surrogacy in the Netherlands and India

2020 ◽  
Vol 23 (4) ◽  
pp. 621-630
Author(s):  
Jaden Blazier ◽  
Rien Janssens
Keyword(s):  
The Netherlands ◽  
Ethical Analysis ◽  
Middle Income ◽  
International Treaty ◽  
International Context ◽  
Case Examples ◽  
Safety Standards ◽  
Middle Income Countries ◽  
Commercial Surrogacy ◽  
Cross Border

Abstract It is unclear what proper remuneration for surrogacy is, since countries disagree and both commercial and altruistic surrogacy have ethical drawbacks. In the presence of cross-border surrogacy, these ethical drawbacks are exacerbated. In this article, we explore what would be ethical remuneration for surrogacy, and suggest regulations for how to ensure this in the international context. A normative ethical analysis of commercial surrogacy is conducted. Various arguments against commercial surrogacy are explored, such as exploitation and commodification of surrogates, reproductive capacities, and the child. We argue that, although commodification and exploitation can occur, these problems are not specific to surrogacy but should be understood in the broader context of an unequal world. Moreover, at least some of these arguments are based on symbolic rhetoric or they lack knowledge of real-world experiences. In line with this critique we argue that commercial surrogacy can be justified, but how and under what circumstances depends on the context. Surrogates should be paid a sufficient amount and regulations should be in order. In this article, the Netherlands and India (where commercial surrogacy was legal until 2015) are case examples of contexts that differ in many respects. In both contexts, surrogacy can be seen as a legitimate form of work, which requires the same wage and safety standards as other forms of labor. Payments for surrogacy need to be high enough to avoid exploitation by underpayment, which can be established by the mechanisms of either minimum wage (in high income countries such as the Netherlands), or Fair-Trade guidelines (in lower-middle income countries such as India). An international treaty governing commercial surrogacy should be in place, and local professional bodies to protect the interests of surrogates should be required. Commercial surrogacy should be permitted across the globe, which would also reduce the need for intended parents to seek surrogacy services abroad.

scholarly journals Inequality and Fiscal Redistribution in Middle Income Countries: Brazil, Chile, Colombia, Indonesia, Mexico, Peru and South Africa

2016 ◽  
Vol 7 (1) ◽  
Author(s):  
Nora Lustig
Keyword(s):  
South Africa ◽  
Fiscal Policy ◽  
Health Spending ◽  
Social Spending ◽  
Income Poverty ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Rich ◽  
Incidence Analysis ◽  
Consumption Taxes

AbstractThis paper examines the redistributive impact of fiscal policy for Brazil, Chile, Colombia, Indonesia, Mexico, Peru and South Africa using comparable fiscal incidence analysis with data from around 2010. The largest redistributive effect is in South Africa and the smallest in Indonesia. Success in fiscal redistribution is driven primarily by redistributive effort (share of social spending to GDP in each country) and the extent to which transfers/subsidies are targeted to the poor and direct taxes targeted to the rich. While fiscal policy always reduces inequality, this is not the case with poverty. When pensions are not considered a transfer, fiscal policy increases poverty in Brazil (over and above market income poverty) due to high consumption taxes on basic goods. Total spending on education is pro-poor except for Indonesia, where it is neutral in absolute terms. Health spending is pro-poor in Brazil, Chile and South Africa, roughly neutral in absolute terms in Mexico, and not pro-poor in Indonesia and Peru.

scholarly journals Exposure to landscape fire smoke extremely reduced birthweight in low- and middle-income countries

2021 ◽  
Author(s):  
jiajianghui li ◽  
Tianjia Guan ◽  
Qian Guo ◽  
Guannan Geng ◽  
Huiyu Wang ◽  
...  
Keyword(s):  
Fixed Effects ◽  
Low Birthweight ◽  
Fine Particulate Matter ◽  
Binary Outcomes ◽  
Middle Income ◽  
Middle Income Countries ◽  
Gestational Exposure ◽  
Fire Smoke ◽  
Fixed Effects Regression ◽  
Low And Middle Income

Landscape fire smoke (LFS) has been associated with reduced birthweight, but evidence from low and middle income countries (LMICs) is rare. Here, we present a sibling matched case control study of 227,948 newborns to identify an association between fire sourced fine particulate matter (PM2.5) and birthweight in 54 LMICs from 2000 to 2014. We selected mothers from the geocoded Demographic and Health Survey with at least two children and valid birthweight records. Newborns affiliated with the same mother were defined as a family group. Gestational exposure to LFS was assessed in each newborn using the concentration of fire sourced PM2.5. We determined the associations of the within group variations in LFS exposure with birthweight differences between matched siblings using a fixed effects regression model. Additionally, we analyzed the binary outcomes of low birthweight (LBW) or very low birthweight (VLBW). According to fully adjusted models, a 1 ug/m3 increase in the concentration of fire sourced PM2.5 was significantly associated with a 2.17 g (95% confidence interval [CI]: 0.56, 3.77) reduction in birthweight, a 2.80% (95% CI: 0.97, 4.66) increase in LBW risk, and an 11.68% (95% CI: 3.59, 20.40) increase in VLBW risk. Our findings indicate that gestational exposure to LFS harms maternal health.

scholarly journals Impact of contact tracing on COVID-19 mortality: An impact evaluation using surveillance data from Colombia

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0246987
Author(s):  
Andres I. Vecino-Ortiz ◽  
Juliana Villanueva Congote ◽  
Silvana Zapata Bedoya ◽  
Zulma M. Cucunuba
Keyword(s):  
Fixed Effects ◽  
Contact Tracing ◽  
Supply Side ◽  
Fixed Effects Model ◽  
Surveillance Strategy ◽  
Middle Income ◽  
The Public ◽  
Middle Income Countries ◽  
The Impact ◽  
Crucial Part

Background Contact tracing is a crucial part of the public health surveillance toolkit. However, it is labor-intensive and costly to carry it out. Some countries have faced challenges implementing contact tracing, and no impact evaluations using empirical data have assessed its impact on COVID-19 mortality. This study assesses the impact of contact tracing in a middle-income country, providing data to support the expansion and optimization of contact tracing strategies to improve infection control. Methods We obtained publicly available data on all confirmed COVID-19 cases in Colombia between March 2 and June 16, 2020. (N = 54,931 cases over 135 days of observation). As suggested by WHO guidelines, we proxied contact tracing performance as the proportion of cases identified through contact tracing out of all cases identified. We calculated the daily proportion of cases identified through contact tracing across 37 geographical units (32 departments and five districts). Further, we used a sequential log-log fixed-effects model to estimate the 21-days, 28-days, 42-days, and 56-days lagged impact of the proportion of cases identified through contact tracing on daily COVID-19 mortality. Both the proportion of cases identified through contact tracing and the daily number of COVID-19 deaths are smoothed using 7-day moving averages. Models control for the prevalence of active cases, second-degree polynomials, and mobility indices. Robustness checks to include supply-side variables were performed. Results We found that a 10 percent increase in the proportion of cases identified through contact tracing is related to COVID-19 mortality reductions between 0.8% and 3.4%. Our models explain between 47%-70% of the variance in mortality. Results are robust to changes of specification and inclusion of supply-side variables. Conclusion Contact tracing is instrumental in containing infectious diseases. Its prioritization as a surveillance strategy will substantially impact reducing deaths while minimizing the impact on the fragile economic systems of lower and middle-income countries. This study provides lessons for other LMIC.

Autonomy, health expenditures and development

2019 ◽  
Vol 18 (2) ◽  
pp. 138-159
Author(s):  
Jamie Sommer
Keyword(s):  
Child Mortality ◽  
Fixed Effects ◽  
Theoretical Perspective ◽  
Health Spending ◽  
Health Expenditures ◽  
State Autonomy ◽  
Extrinsic Factors ◽  
Middle Income ◽  
Content Type ◽  
Infant And Child Mortality

Purpose State capacity for development is decomposed into two broad dimensions, intrinsic and extrinsic. The former concerns the state’s cohesiveness as a strategic actor, which encompasses the ability of the state to formulate and implement policy in a coherent fashion, and the latter is the state’s ability to extract and redistribute resources. Diverging from previous studies, this paper aims to consider how these intrinsic and extrinsic factors interact to increase health cross-nationally. Design/methodology/approach This study provides a framework for understanding how domestic and international state autonomy in policy decisions improves the effectiveness of health spending at achieving its intended outcomes. Using two-way fixed effects regression models for a sample of 89 low and middle-income nations from 1996-2012, the author tests the claim that health expenditures reduce infant and child mortality more in nations with higher levels of international and domestic autonomy rather than those with lower levels. Findings The author finds evidence that supports the theoretical perspective that state autonomy in international and domestic policy, through cohesion, legitimacy and local insight, improves the effectiveness of health expenditures at reducing infant and child mortality. Research limitations/implications The data only exist for 89 nations and from 1996 to 2012. In addition, the independent variables of interest that measure autonomy are not direct measures but instead indices. Originality/value The health and development of a nation’s citizenry largely depends on prioritizing expenditures in health. This research considers under what conditions nations can better prioritize health expenditures.

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