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Health policies seek to achieve conflicting objectives. We argue that the objective of saving lives is best served by a careful balancing of fairness and efficiency considerations. Open, fair, and equitable access to health care for all citizens will lower overall mortality rates by enabling the very poor and chronically ill to satisfy their demand for necessary health care. But it will also result in higher costs, not least by also increasing demand for irrelevant, unnecessary, and inefficient health care. This undesirable demand and its associated costs can be reduced by increasing out-of-pocket contributions paid for by patients. Such payments are unpopular, though, as they are regarded as regressive and damaging to health of the relatively poor. We argue that properly enacted, no such apparent trade-offs exist. If the freed-up resources are used for more life-saving measures, then higher out-of-pocket contributions will lower overall mortality rates. However, this beneficial effect is conditional on what happens to total health spending. Ironically, out-of-pocket payments are most effective as health policies if they are not or only hardly used as a means of reducing total health expenditures. Our theoretical arguments are confirmed by an econometric analysis of aggregate mortality rates in OECD countries over the period 1984 to 2007. Adapted from the source document.

There is a paucity of research analysing the influence of fiscal decentralisation on health outcomes. Colombia is an interesting case study, as health expenditure there has been decentralising since 1993, leading to an improvement in health care insurance. However, it is unclear whether fiscal decentralisation has improved population health. We assess the effect of fiscal decentralisation of health expenditure on infant mortality rates in Colombia. Infant mortality rates for 1080 municipalities over a 10-year period (1998-2007) were related to fiscal decentralisation by using an unbalanced fixed-effect regression model with robust errors. Fiscal decentralisation was measured as the locally controlled health expenditure as a proportion of total health expenditure. We also evaluated the effect of transfers from central government and municipal institutional capacity. In addition, we compared the effect of fiscal decentralisation at different levels of municipal poverty. Fiscal decentralisation decreased infant mortality rates (the elasticity was equal to -0.06). However, this effect was stronger in non-poor municipalities (-0.12) than poor ones (-0.081). We conclude that decentralising the fiscal allocation of responsibilities to municipalities decreased infant mortality rates. However, this improved health outcome effect depended greatly on the socio-economic conditions of the localities. The policy instrument used by the Health Minister to evaluate municipal institutional capacity in the health sector needs to be revised.

There is a paucity of research analysing the influence of fiscal decentralisation on health outcomes. Colombia is an interesting case study, as health expenditure there has been decentralising since 1993, leading to an improvement in health care insurance. However, it is unclear whether fiscal decentralisation has improved population health. We assess the effect of fiscal decentralisation of health expenditure on infant mortality rates in Colombia. Infant mortality rates for 1080 municipalities over a 10-year period (1998-2007) were related to fiscal decentralisation by using an unbalanced fixed-effect regression model with robust errors. Fiscal decentralisation was measured as the locally controlled health expenditure as a proportion of total health expenditure. We also evaluated the effect of transfers from central government and municipal institutional capacity. In addition, we compared the effect of fiscal decentralisation at different levels of municipal poverty. Fiscal decentralisation decreased infant mortality rates (the elasticity was equal to -0.06). However, this effect was stronger in non-poor municipalities (-0.12) than poor ones (-0.081). We conclude that decentralising the fiscal allocation of responsibilities to municipalities decreased infant mortality rates. However, this improved health outcome effect depended greatly on the socio-economic conditions of the localities. The policy instrument used by the Health Minister to evaluate municipal institutional capacity in the health sector needs to be revised.

Development can be understood from many perspectives. Among those, the one proposed by Amartya Sen states that a development policy should aim at expanding the freedom of individuals, and this goal can be achieved by the expansion of capabilities. With this conceptual framework in mind, health, more specifically infant mortality, is chosen as a measure of development and as the object of study. The Government should guarantee the provision of health services, as they consist in meritory goods. Mosley and Chen (1984) propose a theoretical framework to study infant mortality based on the proximal determinants, in which the socioeconomic factors affect the result observed indirectly. In Brazil there has been a substantial reduction of the average levels of infant mortality rates in the last decades. However, there is still a significant regional inequality. Econometric models for 1980, 1991 and 2000 are estimated including a spatial filter in order to account for the spatial dependency observed in the data. The study concludes that health infrastructure lost its explanative power for the differences in infant mortality rate among the localities. On the other hand, socioeconomic variables have become more relevant and significant. It means that future public policies must try to improve the access of the families to public facilities, reduce poverty and inequality and improve educational levels. Therefore, the family-based prevention against health problems should be stimulated, helping to avoid premature death.

Life-table data from feral ferret populations in New Zealand were analysed to estimate their mortality rates, and to test for any additive effect of Mycobacterium bovis infection on observed mortality rates. The observed instantaneous mortality rate was best estimated by modelling mortality as a 2-phase step model with different rates for juveniles (μ1 = 1.45 year–1, 95% C.I. 1.2–1.7 year–1) and adults (μ2 = 0.55 year–1, 95% C.I. 0.4–0.9 year–1). This corresponds to a survival probability of 0.25 during the first year of life, rising to 0.55 year–1 thereafter, and a life expectancy of 0.95 years. At a population level, no additional mortality due to M. bovis infection was observed, suggesting either that the rate of disease-induced mortality was negligible, or that it was compensatory with natural mortality.

The aim of this paper is to examine empirically the impact of the demographic structure and socio-economic environment on the Covid-19 mortality rate across 29 European countries. The analysis is based on empirical data recorded cumulatively from the start of the Covid-19 disease until 26th May 2020 covering 'the first wave of the pandemic'. Results indicate that, although countries with a higher degree of ageing structure are anticipated to be more vulnerable to Covid-19, this study provides evidence that population ageing contributes only marginally to Covid-19 death rates across Europe. Urbanization, the level of economic development and health care systems, seem to better explain patterns of interstate mortality rates. The analysis provides important policy implications since it underlines the importance of urbanization and socio-economic conditions in the accelerating incidence of casualties and signifies the importance of health care systems for the protection of people and places from the pandemic.