Spatial and economic patterns in life expectancy among US States

This study investigates the determinants of gender-specific life expectancy across US states over the period 1995–2007. We employ a production function specification where life expectancy depends on health expenditure, income, education and lifestyle variables, allowing for spatial effects. Empirical results suggest that education attainment and health expenditure are the main factors behind improving longevity, whereas smoking bears a strong negative influence. For robustness purposes, we also use health spending as well as education criteria, apart from geographical ones to model interstate spillovers. In the former case, states with similar health expenditure are ‘neighbors’ and affect positively the life expectancy process. If education is applied instead of health spending together with geographic proximity, the spatial correlation is insignificant, i.e. education ‘neighbors’ do not affect life expectancy. Our findings do not imply significant gender differences regarding health production. The results suggest that health care policy will have to focus on wider economic and social considerations, like education and lifestyle changes, except medical care provision in order to exploit the full potential for life expectancy improvements of the US population.     

Human development and decentralization: The importance of public health expenditure

In this article, we empirically analyze the impact of central and subnational government spending on human development in a sample of 57 developed and developing countries over the period 2000–18. Specifically, we focus on the effects of health and education public expenditure on the Human Development Index (HDI) and its dimensions (life expectancy, education, and income). Applying data panel analysis, our empirical evidence shows the importance of central and subnational government health expenditure positively impacting on HDI and each of its components, while in the case of the education expenditure, this positive effect is only confirmed on the educational dimension of HDI. Our study shows how governments can stimulate human development, improving the well-being of citizens, by allocating more resources to healthcare through the different administrative levels.     

Waste not,want not: The efficiency of health expenditure in emerging and developing economies

Public health spending is low in emerging and developing economies relative to advanced economies and health outputs and outcomes need to be substantially improved. Simply increasing public expenditure in the health sector, however, may not significantly affect health outcomes if the efficiency of this spending is low. This paper quantifies the inefficiency of public health expenditure and the associated potential gains for emerging and developing economies using a stochastic frontier model that controls for the socioeconomic determinants of health, and provides country‐specific estimates. The results suggest that African economies have the lowest efficiency. At 2009 spending levels, they could boost life expectancy up to about 5 years if they followed best practices.     

ENDOGENOUS HEALTH CARE, LIFE EXPECTANCY AND ECONOMIC GROWTH

We study the endogenous relationship between health care, life expectancy and output in a neoclassical growth model. Although health care directly diverts resources away from goods production, it prolongs life expectancy, which in turn leads to higher savings and, hence, capital formation through a private annuity market. We show that savings and health care are complements in equilibrium, with both rising with economic development. Our model is therefore consistent with several observed stylized development patterns across countries. Moreover, through the longevity-enhancing channel, health care and health production technology are found by simulation to be growth and welfare promoting.     

Democracy comes to Europe: Franchise extension and fiscal outcomes 1830-1938

This paper examines the relation between public spending and the spread of democracy in Western Europe during the period 1830-1938. Our data set includes measures of the size of the electorate, the election rule, and electoral participation, as well as measures of the size and composition of central government expenditures for 12 countries. We estimate panel regressions, and find that (1) the gradual lifting of socio-economic restrictions on the voting franchise contributed to growth in government spending mainly by increasing spending on infrastructure and internal security; (2) the female suffrage had a weak positive effect, through spending on health, education and welfare; (3) the change from majority to proportional rule, which took place in 10 of the countries, did not contribute to growth in government spending, and held back spending on health, education and welfare; (4) there exists (weak) complementarity between economic development and the spread of democracy.     

Decentralization and sectoral expenditures in Europe

This article presents an empirical analysis of the recent impact of fiscal decentralization in Europe on total expenditure for specific government functions as well as on total government size. A panel data set for the years 2000–2009 for European countries has been constructed from EUROSTAT data. The effects of decentralization interact with the degree of vertical imbalances and tend to be negative as predicted by the Leviathan view of government. Effects vary strongly across government functions and are strongest in relative terms for social spending and infrastructure. Moderate restraining effects are found for education, while health spending is not significantly affected. This is consistent with competition between subnational entities, which try to attract taxpayers and shift expenses away from policies that benefit neighbouring jurisdictions.     

Demographics and medical care spending: standard and non-standard effects

"In this paper, [the authors] examine the effects of likely demographic changes on medical spending for the elderly. Standard forecasts highlight the potential for greater life expectancy to increase costs: medical costs generally increase with age, and greater life expectancy means that more of the elderly will be in the older age groups. Two factors work in the other direction, however. First, increases in life expectancy mean that a smaller share of the elderly will be in the last year of life, when medical costs generally are very high.... Second, disability rates among the surviving population have been declining in recent years by 0.5 to 1.5 percent annually.... Thus, changes in disability and mortality should, on net, reduce average medical spending on the elderly. However, these effects are not as large as the projected increase in medical spending stemming from increases in overall medical costs."     

Public spending and outcomes: Does governance matter?

This paper studies the links between public spending, governance, and outcomes. We examine the role of governance–measured by the level of corruption and the quality of bureaucracy–in determining the efficacy of public spending in improving human development outcomes. Our analysis contributes to our understanding of the relationship between public spending, governance and outcomes, and helps explain the surprising result that public spending often does not yield the expected improvement in outcomes. We show empirically that the differences in the efficacy of public spending can be largely explained by the quality of governance. Public health spending lowers child mortality rates more in countries with good governance. Similarly, public spending on primary education becomes more effective in increasing primary education attainment in countries with good governance. More generally, public spending has virtually no impact on health and education outcomes in poorly governed countries. These findings have important implications for enhancing the development effectiveness of public spending. The lessons are particularly relevant for developing countries, where public spending on education and health is relatively low, and the state of governance is often poor.     

New evidence on factors affecting the level and growth of US health care spending

The dual problems of high and rising medical care expenditures and substantial differences in spending across geographic regions have long plagued the US health care system. We provide new evidence to explain why some states and regions of the country spend much more on medical care than others, and why health care spending for the nation as a whole has been growing rapidly over the last several decades. To do this, we estimate a health care spending panel data model using annual data on all 50 states for the period 1993–2009. Our model includes a number of socio-economic, health care provider, lifestyle and environmental variables that past studies indicate may affect the level or growth of aggregate health care spending. We exploit the time effect component of our model to obtain an upper-bound estimate of the effect of advances in medical technology. Our findings indicate that the most important factors influencing the level of spending are availability of providers, income, excessive alcohol consumption, Medicaid coverage, HMO health plans and the proportion of the population elderly and African-American. The principal drivers of growth have been the continual introduction of new medical technologies, and the growth of providers and income.     

The influence of remittances on education and health outcomes: a cross country study

We study the effect of international remittances on aggregate educational and health outcomes using a sample of 69 low- and middle-income countries. We find that remittances play an important role in improving primary and secondary school attainment, increasing life expectancy and reducing infant mortality. Our results suggest that as migration laws continue to support greater emigration and remittances, policies should be enacted to facilitate the flow of remittances as they represent a significant source for economic development.     

Who benefits from big government? A life satisfaction approach

Which impact does government size have on life satisfaction, and how do effects of bigger government differ between income groups in society? Previous studies typically employed country averages and thus neglected possibly heterogeneous happiness effects between income groups. This paper addresses empirically the effects of government spending on subjective well-being of individuals belonging to different income groups. Our analysis is based on individual data from 25 European countries participating in the European Social Survey. In contrast to most previous studies we take account of the endogeneity between relative income position and reported life satisfaction by an instrumental variable approach. Our results suggest, first, that most government spending categories, including social protection, are on average negatively related to individual well-being. Secondly, estimated marginal effects of health, education and social protection spending at different income levels show that spending increases always have a stronger negative effect on high income groups’ well-being than on low income groups’ life satisfaction. For all government spending categories, marginal happiness effects of higher public spending are clearly negative for income groups at the top.     

Health expenditure and socio-economic determinants of life expectancy in the OECD Asia/Pacific area countries

Recent economic research is focused on the study of the relationship between socio-economic factors and health outcomes. In this study, the relationship in the OECD Asia/Pacific area countries regarding life expectancy is explored. Data from the World Bank and OECD Health Statistics (2015) have been used to build a panel data during the period 1995–2013. On the one hand, it was found that per capita income, unemployment and exchange rates improve health outcomes. On the other hand, poor performance, in terms of government expenditures for the countries-sample, comes across. Empirical results highlight the importance of cost-effectiveness analysis.     

The effectiveness of government spending on education and health care in developing and transition economies

Recent studies show that corruption is associated with higher military spending [Eur. J. Polit. Econ. 17 (2001) 794] and lower government spending on education and health care [J. Publ. Econ. 69 (1998) 263]. This suggests that policies aimed at reducing corruption may lead to changes in the composition of government outlays toward more productive spending. However, little empirical evidence has been presented to support the claim that public spending improves education and health indicators in developing and transition countries. This paper uses cross-sectional data for 50 such countries to show that increased public expenditure on education and health care is associated with improvements in both access to and attainment in schools, and reduces mortality rates for infants and children. The education regressions are robust to different specifications, but the relationship between health care spending and mortality rates is weaker.     

How the Ageing Population Contributes to UK Economic Activity: A Microsimulation Analysis

In the United Kingdom, as in several other countries, increasing life expectancy is leading to a shift in the age distribution of the population. Meanwhile, at the level of individuals, spending patterns change as people age. This paper investigates the extent to which demographic change is likely to affect household spending patterns by combining the techniques of dynamic microsimulation with an imputation method known as random assignment. While there has been significant concern about the economic cost of the ageing population, this paper finds a potentially beneficial effect in the form of an increase in total spending for most expenditure categories.     

Effects of longevity and dependency rates on saving and growth: Evidence from a panel of cross countries

While earlier empirical studies found a negative saving effect of old-age dependency rates without considering longevity, recent studies have found that longevity has a positive effect on growth without considering old-age dependency rates. In this paper, we first justify the related yet independent roles of longevity and old-age dependency rates in determining saving and growth by using a growth model that encompasses both neoclassical and endogenous growth models as special cases. Using panel data from a recent World Bank data set, we then find that the longevity effect is positive and the dependency effect is negative in savings and investment regressions. The estimates indicate that the differences in the demographic variables across countries or over time can well explain the differences in aggregate savings rates. We also find that both population age structure and life expectancy are important contributing factors to growth.     

Optimal Social Insurance and Health Inequality

This paper integrates into public economics a biologically founded, stochastic process of individual aging. The novel approach enables us to quantitatively characterize the optimal joint design of health and retirement policy behind the veil of ignorance for today and in response to future medical progress. Calibrating our model to Germany, our analysis suggests that the current social insurance policy instruments are set close to the (constrained) socially optimal levels, given proportional contribution rates for health and pension finance, the equivalence principle in the pension system, and a common statutory retirement age. Future progress in medical technology calls for a potentially drastic increase in health spending and a higher retirement age without lowering the pension contribution rate. Interestingly, from an ex ante point of view, medical progress and higher health spending are in conflict with the goal to reduce health inequality.     

Health spending and public pension: evidence from panel data

This article empirically investigates the determinants of aggregate health expenditure in a panel of OECD countries from 1980 to 2005. We differ from most existing studies by testing some new determinants motivated by recent theoretical advances in the literature. We find that a one percentage increase in public pension payments per elderly person leads to approximately a one third percentage increase in aggregate health spending, and this effect is significant and robust across a variety of model specifications. A back of the envelope calculation based on this estimate suggests that the expansion of the public pension programme on average accounts for approximately over one fifth of the rise in aggregate health expenditure as a share of GDP in the set of OECD countries during 1980–2005. In addition, we find that the estimated effect of GDP per capita in our model ranges from 0.66 to 0.80, which is consistent with the results from some recent studies, and thus further reinforces the finding in the literature that health care is not a luxury good.     

Life expectancy and human capital: long-run evidence from a panel of countries

This article examines the long-run impact of life expectancy on human capital investment for a panel of 14 countries over the period 1870–2010. Using recently developed panel time series techniques, we find (i) that life expectancy at birth has a statistically significant long-run effect on schooling and (ii) that long-run causality is unidirectional from life expectancy to schooling.     

The Impact of Power Equality,Income, and the Environment on Human Health: Some Inter‐Country Comparisons

Economic studies on environmental degradation generally have a narrow focus on per capita income as an explanatory variable, and often fail to distinguish among the various types of environmental quality or damage. This paper addresses both problems by examining the effect of relative equality in the distribution of power on environmental outcomes, and making a clear distinction between health‐related environmental outcomes and so‐called ‘environmental amenities,’ only the latter of which should correlate strongly with income. This paper introduces a national index of power equality that is derived from related socioeconomic variables, and studies its effects on individual country achievement in addressing environmental quality and population health. This model is applied to a data set of 180 countries, as well as to subgroups of the entire country set. Employing disability‐adjusted life expectancy and the population child mortality rate as two health proxies, this paper finds that power equality in most cases positively influences population health, and that power equality is in every case no worse and in some cases better than per capita income at explaining population health.     

Determinants of healthcare spending: a state level analysis

Within the high and rising level of healthcare spending for the US as a whole is substantial variation in spending across states. Yet relatively little attention has been given to the empirical analysis of interstate differences in aggregate healthcare expenditures, and therefore little empirical evidence exists at the state level to guide policymakers. Using data for all 50 states for the year 1998, we estimate an empirical model that includes structural and reduced-form healthcare spending equations and a health production function to assess the significance, size and relative importance of factors that prior research indicates, may play an important role in explaining interstate variation in medical care expenditures, and the main pathways through which they operate. Our results indicate higher levels of healthcare spending for state populations with higher income, less education, fewer uninsured residents, less healthy lifestyles, larger proportion of elderly residents, greater availability of medical care providers and less urbanization. Our findings suggest that the most effective cost containment measures may be those that increase education and promote healthy lifestyles. Not only do these actions lead to reductions in healthcare spending, they also improve the health status of the population, and may help to achieve other important social policy goals.