Is health care a luxury? The debate revisited with new evidence from emerging economies

This paper studies the long-run relationship between health care expenditure and income using a panel data set of emerging economies over the period 1995–2012. The results show that expenditure on health care and income are non-stationary and cointegrated. After controlling for cross-sectional dependence and unobserved heterogeneity among different countries, we find that the income elasticity of health care is less than 1, indicating that health care is a necessity and not a luxury. Government expenditure and out-of-pocket expenditure turn out to be important determinants of health care expenditure. Among non-monetary factors, results show that old age dependency and female education seem to have significant bearings on health care expenditures. Policy recommendations suggest that government should increase spending on health care in emerging economies since higher incomes may not automatically translate into higher health care spending by the people of these countries.     

Fiscal policy and economic activity in South Asia

This paper analyzes whether fiscal policy in South Asia amplifies or smoothens business cycle fluctuations. It estimates several econometric models to explore the cyclicality of government spending and tax buoyancy. In South Asia, tax revenue increases less than one to one with changes in gross domestic product (GDP), but public spending increases more than proportionally. For each percentage point change in GDP growth, government expenditure changes by 1.3 percentage points. While changes in tax revenue have no significant impact on economic activity, the government spending multiplier is positive and significant: each additional US dollar (USD) of spending leads to an immediate increase in GDP of 0.2 USD and to an increase of 0.4 USD in the medium run. The impact of public spending on economic activity is entirely due to capital expenditure, which is also more procyclical. Procyclical public spending and a positive expenditure multiplier imply that fiscal policy in South Asia amplifies boom‐and‐bust cycles. These results are in line with those of other emerging markets and developing economies and robust to different model specifications and estimation strategies.     

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.     

“When it rains,it pours”: Fiscal policy,credit constraints and business cycles in emerging and developed economies

Fiscal procyclicality, meaning co-movement between government expenditure and macroeconomic fundamentals, is an important feature of business cycle dynamics for emerging and poor economies. I estimate a panel SVAR to investigate the reasons for fiscal procyclicality. The analysis sheds light on the role of external financial constraints in shaping fiscal policy. My findings suggest that the response of emerging governments to output fluctuations is similar to that of developed governments. However, emerging governments curtail spending in response to increases in the sovereign borrowing rate, which forces their consumption expenditure to act more procyclically. Using counterfactual analysis, I show that the key forces behind fiscal procyclicality are the sensitivity of government spending to international borrowing costs and the procyclical nature of these costs for emerging economies.     

Ideology and redistribution through public spending

For a panel of OECD economies (1980–2013) we analyse the scope of government ideology to shape patterns of public expenditures. To address if public expenditures are used to channel redistributive outcomes, we adopt a flexible panel error correction model and proceed in two steps: Firstly, we analyse if ideological positions matter for the sizing of the public sector. Secondly, we address the actual impact of government ideology on two disjoint categories of public expenditure that are characterized by distinguished redistributive effects. Under both, left-wing and right-wing governments, public spending shows progressively redistributive effects which are indirectly channelled through their policy response to changing macroeconomic, fiscal and demographic fundamentals. While right-wing governments act progressively redistributive under favourable socio-economic conditions, their left-wing counterparts do so under unfavourable conditions. Comparing the two effects in terms of their explanatory content, we find that the latter is stronger than the former.     

Is Post-Communist Health Spending Unusual?

What factors determine a country's spending on health? And what factors determine the share of spending financed by the public sector? Taking these factors into account, is post-communist health spending unusual? For the OECD economies, we find that per capita health spending is strongly related to per capita income, with an elasticity of about 1.5. The elasticity for developing economies is close to one. Spending is also positively related to the elderly dependency rate, but the relationship is weaker than a static comparison of spending by the elderly and non-elderly would suggest. Even though health spending as a share of GDP in the post-communist countries of eastern and central Europe is below the OECD average, there is evidence of above normal health spending in most countries when we control for income and demographics. For Hungary, the ‘excess’ spending reached over three percentage points of GDP in 1994. For the OECD sample, four development indicators account for half the variation in the public sector share of total health spending. Political variables help explain the remainder. If the post-communist countries converge to the market economy pattern, the share of public financing will fall, yet still remain well above half.     

Functional components of public expenditure,fiscal consolidations,and economic activity

This paper analyses how the functional components of public expenditure and spending‐driven consolidations affect the economic growth, unemployment, and income inequality. A dynamic panel data least squares dummy variable estimator estimator is employed over a sample of 15 European Union countries during the period 1990–2012. The empirical results show that real GDP growth decreases when fiscal austerity measures are implemented, especially if they are spending‐driven. Cuts in public expenditure undermine economic growth, namely if they slash spending on public order, recreation, and education. Spending cuts on education, in particular, affect the investment in human capital, harming not only growth but also economic, social, and human development. The unemployment rate also proved to be significantly boosted when austerity measures restrict spending on education, whereas income inequality rises when social protection expenditures are cut.     

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.     

Institutional quality and public spending in Europe: A quantile regression approach

We appraise the effects of institutional quality on public spending for a set of 27 European countries and 18 Euro-area economies over the 1996–2017 period. While institutions play a weak role in affecting spending once the fixed-effects model is employed, the application of the quantile regression indicates that improved institutional quality mitigates public spending, although the effects crucially depend on the distribution of public expenditure and the sample examined. For both the Euro-area sample and the full sample, we show that better quality of institutions reduces public spending, although the effects become less significant the higher the levels of public spending. Further, for the Euro-area sample, institutions appear to have a stronger role in mitigating public spending. Several robustness tests confirm our findings.     

Health spending in Italy: The impact of immigrants

The welfare impact of immigration is a highly debated issue especially for countries on the external borders of the European Union. This paper studies how immigrants affect public health expenditure across Italian regions during the period 2003–2016 using NUTS II level data. Identification strategy is based on shift–share instruments, which are made robust to pull factors that might attract immigrants in Italy and to internal migration of natives. We find that a 1 percentage point increase in immigrants over total resident population leads to a decrease in public health expenditure per capita by about 3.8% (i.e. around 69 euro per capita). Among possible channels, we find no support for any crowding out effect from public to private health services by natives due to increasing immigration or for any role played by different levels of efficiency across regional health systems. Our results are driven by immigrants' demographic structure: they are mostly males and younger workers that call for less health spending, according to a positive selection mechanism. Moreover, linguistic barriers contribute to limiting the immigrants' reliance on public healthcare, which is confirmed also by the use of the European Health Interview Survey microdata.     

政府卫生支出绩效评价研究——以北京市为例

公共支出的绩效评价日益成为世界各国公共财政管理的重要内容。近年来,随着医药卫生体制改革的深化,各级政府在医疗卫生领域中的主导地位逐渐明确,医疗卫生领域的政府投入也日渐增加。在此背景下,政府卫生投入的效率和效果就非常值得深入探讨和评估。本文初步设计了政府卫生支出绩效评价体系,通过模糊层次分析法计算指标权重,利用北京市的统计数据对政府卫生支出绩效评价进行了实证分析并得出了相关结论。     

中国城市政府公共支出效率分析——基于四阶段DEA方法的实证研究

本文以2008年中国内地126个地级以上城市为样本数据,利用四阶段DEA方法,对中国城市公共支出效率进行了实证分析。结果显示:如果不对外部环境因素加以控制,则经典的DEA方法将会高估城市公共支出效率;在控制外部环境因素影响后,样本城市公共支出效率得分为0.353,表明在保持支出不变下,通过改善组织管理、优化支出规模及结构,公共服务供给水平可提高约64%,城市公共支出效率还有很大的提升空间;经济发达、较大的辖区面积是城市公共支出效率提升的有利条件,而人口增加对公共品供给产生的拥挤效应不利于城市公共支出效率提升。     

政府公共卫生支出行为影响因素的实证分析

公共卫生支出属于财政支出的重要组成部分。随着我国公共财政体制的建立,合理界定公共卫生支出占财政支出的比重显得尤为重要。本文使用31省、直辖市、自治区2000—2010年的面板数据,实证分析了我国地方政府公共卫生支出的影响因素。研究表明,人口规模、人口结构、城市化程度与政府公共卫生支出并没有必然的因果关系;经济发展水平和政府机构及人员的膨胀程度与政府公共卫生支出之间存在着正相关关系;财政分权也只是对公共卫生支出产生很小的正面影响。     

Public–private mix of health expenditure: A political economy and quantitative analysis

This paper constructs a simple model to examine decisions on public and private health spending under majority voting. In the model, agents with heterogeneous incomes choose how much to consume and spend on health care and vote for public health expenditure. The health status of an agent is determined by a CES composite of public and private health expenditure. The existence and uniqueness of the voting equilibrium are established. A quantitative exercise reveals the importance of the relative effectiveness of public and private health expenditure and their substitutability in determining the public‐private mix of health expenditure and in accounting for the observed differences across a sample of 22 advanced democratic countries.     

政府规模与宏观经济稳定性 ——来自新兴市场经济的证据和RBC模型的分析

本文研究的核心是政府支出和收入规模对于宏观经济稳定性的影响。对新兴市场国家的实证分析表明,政府消费规模对产出具有非稳定效应,一般性政府支出规模和产出波动率的负向关系可能并不存在。本文首先构建了包含累进型税收机制和需求扰动型政府支出的实际经济周期模型（RBC）,模型拟合出政府支出规模的非稳定效应和税收的稳定效应。当将政府支出视为生产性支出后,支出规模的稳定效应体现出来,虽然在规模进一步扩大后稳定效应会消失。     

The impact of economic and monetary uncertainty on the demand for money in emerging economies

By introducing uncertainty, monetary volatility and economic volatility are said to make the public cautious, hence increase their cash holdings or their demand for money. On the other hand, because of monetary and economic uncertainty if the public seek safer assets than money, they may hold less cash. In the absence of any paper testing for the impact of economic and monetary uncertainty on the demand for money in emerging economies, this article fills the gap by considering the experiences of six Central and Eastern European emerging economies and four other emerging economies. We found that the impact is transitory in most countries. Moreover, money demand is found correctly specified and stable in most countries, suggesting that policy based on monetary targeting could still be effective despite significant output and monetary uncertainty.     

Infrastructure Investment and Maintenance Expenditure: Optimal Allocation Rules in a Growing Economy

This paper studies the allocation of public expenditure between infrastructure investment and maintenance in an endogenous growth framework. In the basic model, maintenance spending affects both the durability and efficiency of public capital. The balanced growth path is derived and transitional dynamics associated with a revenue-neutral increase in expenditure on maintenance are analyzed. The model is then extended to account for the possibility that public spending on maintenance affects also the durability of private capital. The growth-maximizing tax rate and share of infrastructure investment are calculated in both cases. First- and second-best welfare-maximizing solutions are also discussed.     

民生支出的公平正义性分析——基于浙江各县教育和卫生支出的分析

文章基于1997～2008年浙江省教育支出和卫生支出的受益归宿分析表明,民生支出的最大受益者为人均收入最高地区居民,最大受损者为人均收入次低地区居民,民生支出具有累进性,距离公平正义的政策初衷仍有一定差距。但是,如果考虑不同收入组别生活成本、支出需求的差异,民生支出的公平程度将有所提高。通过建立因素法转移支付制度,提高民生支出比重,可以进一步提高民生支出的公平正义水平。     

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.     

关于公共支出与经济增长的国内外研究综述

公共支出与经济增长的关系一直以来为经济学家们所争论。持公共支出促进经济增长观点认为,政府公共支出在经济增长中发挥着重要作用,因为它为经济发展提供了大量的公共品和其他具有外部效应的公共福利或服务,从而鼓励和便利了私人投资,形成了一个较好的投资环境,促进了经济增长。而持反对意见的认为,公共支出往往是生产率较低的,为融通政府支出而形成的高税收又会对私人部门的消费和投资造成很大的负面影响,因此,必须缩减政府支出,才能保证经济增长。当然也有人持两者根本就没有关系的观点。