TY - CHAP
T1 - Assessing the impact of health care expenditures on mortality using cross-country data
AU - Nakamura, Ryota
AU - Lomas, James
AU - Claxton, Karl Philip
AU - Bokhari, Farasat
AU - Moreno Serra, Rodrigo
AU - Suhrcke, Marc
PY - 2020/6
Y1 - 2020/6
N2 - A significant body of literature has examined the impact of public health expenditure on mortality, using a global cross-section or panel of country-level data. However, while a number of studies do confirm such a relationship, the magnitude of the impact varies considerably between studies, and several studies show statistically insignificant effects. In this chapter, we re-examine the literature that identifies this effect using cross-country data. Our analysis builds on the two instrumental variable (IV) approaches applied by key publications in the field — Bokhari et al. (2007) and Moreno-Serra and Smith (2015). Using exactly the same data and econometric specifications as the published studies, we start by successfully replicating their findings. However, further analyses using updated data and “streamlined” econometric specifications, plus statistical data imputation and extensive robustness checks, reveal highly sensitive results. In particular, the relevance of the IVs is seriously compromised in the updated data, leading to imprecise estimations of the relationship. While our results should not be taken to imply that there is no true mortality-reducing impact of public health care expenditures, the findings do call for further methodological work, for instance, in terms of identifying more suitable IVs or by applying other estimation strategies, in an effort to derive more robust estimates of the marginal productivity of public health care funding.
AB - A significant body of literature has examined the impact of public health expenditure on mortality, using a global cross-section or panel of country-level data. However, while a number of studies do confirm such a relationship, the magnitude of the impact varies considerably between studies, and several studies show statistically insignificant effects. In this chapter, we re-examine the literature that identifies this effect using cross-country data. Our analysis builds on the two instrumental variable (IV) approaches applied by key publications in the field — Bokhari et al. (2007) and Moreno-Serra and Smith (2015). Using exactly the same data and econometric specifications as the published studies, we start by successfully replicating their findings. However, further analyses using updated data and “streamlined” econometric specifications, plus statistical data imputation and extensive robustness checks, reveal highly sensitive results. In particular, the relevance of the IVs is seriously compromised in the updated data, leading to imprecise estimations of the relationship. While our results should not be taken to imply that there is no true mortality-reducing impact of public health care expenditures, the findings do call for further methodological work, for instance, in terms of identifying more suitable IVs or by applying other estimation strategies, in an effort to derive more robust estimates of the marginal productivity of public health care funding.
KW - Health care provision
KW - Health
UR - https://www.mendeley.com/catalogue/8bd0928e-bfc9-32e3-996a-7f7d8a3006eb/
U2 - 10.1142/9789813272378_0001
DO - 10.1142/9789813272378_0001
M3 - Chapter
SN - 978-981-3272-36-1
T3 - World Scientific Global Health Economics and Public Policy
SP - 3
EP - 49
BT - Global Health Economics - Shaping Healthcare Policy in Low- and Middle-Income Countries
A2 - Revill, Paul
A2 - Suhrcke, Marc
A2 - Moreno Serra, Rodrigo
A2 - Sculpher, Mark
PB - World Scientific Publishing Co. Pte Ltd
ER -