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"Uses econometric techniques to estimate determinants of health expenditures in the region. Also includes useful review of the literature on regional health expenditures. Focuses particularly on estimates of private health care spending, for which data is generally inadequate"--Handbook of Latin American Studies, v. 57

Rapid growth in the share of the nation's gross national product devoted to health expenditure has heightened concern over the survival of government entitlement programs and has led to debate of the desirability of current methods of financing health care. In this article, the authors present the data at the heart of the issue, quantifying spending for various types of health care in 1982 and discussing the sources of funds for that spending.

Health inputs are critical in attaining a healthy nation and improving health outcomes. Kenya, like other developing countries, grapples with limited health expenditures and poor population health indicators. Specifically, Kenya is yet to achieve the allocation of least 15% of the government's annual budget to improve the health sector as enshrined in the Abuja Declaration. Though there is an improvement with regards to infant mortality rate decreasing from 96.6 per 1, 000 live birth in 1970 to 30.6 per 1, 000 live birth in 2018. This indicator of population health outcome is currently far below the Sustainable Development Goals (SDGs) target of reducing the under five mortality rate to as low as 12 deaths per 1,000 live births by 2030. The literature suggests that increase in government's budgetary allocation to the health sector can improve country's health outcomes. Evidence on the impact of health expenditures on health outcomes is mixed and limited in developing countries. This study aims to analyze the impact of public health expenditures on health outcomes, among other control variables in Kenya. The study uses time series data from 1970 to 2018. The variables are found to be integrated of different orders suggesting the choice of Autoregressive Distributed Lag (ARDL) model. ARDL provides a useful link between long run equilibrium relationships and short run disequilibrium dynamics is estimated. The ARDL bounds test suggests presence of cointegration thus leading to the estimation of Error Correction Model (ECM). The findings suggest that improvements in public health expenditures enhance health outcomes in Kenya. The control variablesthat are found to be important determinants of infant mortality rate in Kenya include the national income and number of hospital beds per 100, 000. The study recommends that Kenyan government should increase annual budgetary allocation to health sector. Such increase is likely to lead to investments in physical and human capital in the health sector thus translating to improved health outcomes in Kenya.

The United States spent an estimated $247 billion for health care in 1980 (Figure 1), an amount equal to 9.4 percent of the Gross National Product (GNP). Highlights of the figures that underlie this estimate include the following: Health care expenditures in 1980 accelerated at a time when the economy as a whole exhibited sluggish growth. The 9.4 percent share of the GNP was a dramatic increase from the 8.9 percent share in 1979.Health care expenditures amounted to $1,067 per person in 1980 (Table 1). Of that amount, $450, or 42.2 percent, came from public funds.Expenditures for health care included $64.9 billion in premiums to private health insurance, $70.9 billion in Federal payments, and $33.3 billion in State and local government funds (Table 2).Hospital care accounted for 40.3 percent of total health care spending in 1980 (Table 3). These expenditures increased 16.2 percent between 1979 and 1980, to a level of $99.6 billion.Spending for the services of physicians increased 14.5 percent to $46.6 billion, 18.9 percent of all health care spending.All third parties combined—private health insurers, governments, philanthropists, and industry—financed 67.6 percent of the $217.9 billion spent for personal health care in 1980 (Table 4), ranging from 90.9 percent of hospital care services to 62.7 percent of physicians' services and 38.5 percent of the remainder (Table 5).Direct payments by consumers reached $70.6 billion in 1980 (Table 6). This accounted for 32.4 percent of all personal health care expenses.Outlays for health care benefits by the Medicare and Medicaid programs totaled $60.6 billion, including $35.8 billion for hospital care. The two programs combined to pay for 27.8 percent of all personal health care in the nation (Table 7).

The United States spent an estimated $287 billion for health care in 1981 (Figure 1), an amount equal to 9.8 percent of the Gross National Product (GNP). Highlights of the figures that underly this estimate include the following: Health care expenditures continued to grow at a rapid rate in 1981, at a time when the economy as a whole exhibited sluggish growth. The 9.8 percent share of the GNP was a dramatic increase from the 8.9 percent share seen just two years earlier.Health care expenditures amounted to $1,225 per person in 1981 (Table 1). Of that amount, $524, or 42.7 percent, came from public funds.Hospital care accounted for 41.2 percent of total health care spending in 1981 (Table 2). These expenditures increased 17.5 percent from 1980, to a level of $118 billion.Spending for the services of physicians increased 16.9 percent to $55 billion—19.1 percent of all health care spending.Public sources provided 42.7 percent of the money spent on health in 1981, including Federal payments of $84 billion and $39 billion in State and local government funds (Table 3).All third parties combined—private health insurers, governments, private charities, and Industry—financed 67.9 percent of the $255 billion in personal health care in 1981 (Table 4), covering 89.2 percent of hospital care services, 62.1 percent of physicians' services, and 41.3 percent of the remainder (Table 5).Direct patient payments for health care reached $82 billion in 1981, accounting for 32.1 percent of all personal health care expenses (Table 6). Consumers and their employers paid another $73 billion in premiums to private health insurers, $67 billion of which was returned in the form of benefits.Outlays for health care benefits by the Medicare and Medicaid programs totaled $73 billion, including $42 billion for hospital care. The two programs combined paid for 28.6 percent of all personal health care in the nation (Table 7).

This article presents data on health care spending for the United States, covering expenditures for various types of medical services and products and their sources of funding from 1960 to 1993. Although these statistics show a slowing in the growth of health care expenditures over the past few years, spending continues to increase faster than the overall economy. The share of the Nation's health care bill funded by the Federal Government through the Medicaid and Medicare programs steadily increased from 1991 to 1993. This significant change in the share of health expenditures funded by the public sector has caused Federal health expenditures as a share of all Federal spending to increase dramatically.

This report includes estimates of how much was spent on health between 2003–04 and 2013–14. This information contributes to understanding the performance and efficiency of Australia's health system and how changes arise over time. Summary Continued slow growth Health expenditure growth in 2013–14 was relatively slow according to most measures. Total expenditure on health was estimated at $154.6 billion in 2013–14, up by 3.1% on 2012–13 in real terms (after adjusting for inflation). This growth was higher than the 1.1% growth experienced in 2012–13 but 1.9 percentage points lower than the average annual growth over the past decade (5.0%). Growth was also relatively slow in expenditure per person. An estimated $6,639 was spent per person on health in 2013–14, which was $94 more in real terms than in the previous year. This growth of 1.4% was less than half the average annual growth over the decade (3.3%). Despite this relatively slow growth in health spending, the proportion of the economy that health represented increased from 9.7% of gross domestic product (GDP) in 2012–13 to 9.8% in 2013–14. This was a result of relatively low growth in GDP. When compared to taxation revenue, government health spending represented the same proportion of taxation revenue (24.7%) as the previous year.

Following decentralization in Indonesia there is evidence of a mismatch between spending responsibilities at the local level and local government's ability to effectively manage resources. This research investigates the relationship between institutional arrangements for public expenditure management (PEM) and inequalities in health outcomes in selected districts of Bengkulu Province, Indonesia. The primary aims of this study are to identify factors contributing to health outcome attainment differences and efficiency determinants. The role of the central government and the own-source capacity of district-level governments in financing health resources are also explained. This research differs from previous works by focusing on the inefficiency of the district-level health sector that is associated with weak PEM systems in order to explain the significant disparity in health outcome attainment within a country, using the new institutional economics (NIE) perspective as a guideline. Mixed methods procedures were adopted: quantitative and qualitative data were collected concurrently. The quantitative study utilized secondary data from data sets of government institutions. A correlational analysis, using the software package SPSS, was applied to assess the relationship between public health expenditure and other determinants with health outcomes at the provincial level. The qualitative study used primary data from in-depth face-to-face interviews with 20 key actors involved in the budget process for the health sector in four district governments of Bengkulu Province. Qualitative data were analysed using the QSR NVivo software program. This study reveals that changes in public health expenditure as a percentage of GRDP and real public health expenditure per capita and other determinants can be important factors behind observed declines in infant and child mortality and increases in life expectancy in Bengkulu Province. Other determinants of health outcomes comprise real GRDP per capita, the percentage of population participation in managed care, the percentage of delivering mothers assisted by health personnel, the ratio of midwives per 100,000 population, and the female literacy rate. The role of central government in financing health resources in the districts studied is also very prominent. These districts rely heavily on the central government and have limited financial capacity. Consequently, district governments have difficulty in performing their functions in the health sector properly because of frequently insufficient and reduced public health spending that originates from the central budget. This study also finds that the inability of institutional arrangements to adopt PEM principles has undermined the efficiency of government intervention in the health sector at district level. Weak institutional arrangements in PEM have had harmful effects on the size, allocation and use of public health expenditure, which contributes to inequalities in health outcome attainment in Bengkulu Province. Such weaknesses include the absence of constructive political engagement, lack of policy clarity, consistency and affordability, the presence of poor predictability, lack of transparency, the presence of poor comprehensiveness and integration and a lack of accountability. District governments also face severe inefficiencies in PEM that are created by delays in the budget approval processes. The introduction of market-based practices in PEM of the district governments studied has been unable to prevent potential opportunistic political behaviour. This has led to failure in reducing or eliminating the costs of negotiating and enforcing political agreements in allocating public resources by policy makers, since the budget can be viewed as a contract. These findings reinforce the criticism that the applicability of the PEM technique is country-specific. Proper institutional arrangements that address an Indonesia-specific context are required for the success of PEM. Using the NIE perspective, the findings support the view that hierarchies as an alternative mode of governance are more appropriate than markets, which cannot reduce transaction costs. Results-oriented cultures of the PEM approach cause difficulty in implementing this approach due to serious measurement problems in the health service.

We examine how political institutions influence health expenditure by using a panel of 151 developing and developed countries for the years 2000 to 2015 and four measures of democracy. Our pooled OLS analysis shows that democracies have 20-30% higher government health expenditure relative to GDP than their autocratic counterparts. An instrumental variable approach which exploits the regional diffusion of democracy confirms the positive effect of democracy on government health expenditure. Panel fixed effects and event study models also suggest a positive within-country effect of democratization on government health expenditure within a short period after regime transition. Democratic rule, however, does not turn out to significantly influence private health expenditure compared to autocracies. We conclude that democracies may care more for their citizens and strive to decrease inequalities in the access to health care.

This report focuses on expenditures for personal health care, since these goods and services constitute most spending on health-related activities.

Analysed in this paper are national health accounts estimates for 191 WHO Member States for 1997, using simple comparisons and linear regressions to describe spending on health and how it is financed. The data cover all sources - out-of-pocket spending, social insurance contributions, financing from government general revenues and voluntary and employment-related private insurance - classified according to their completeness and reliability. Total health spending rises from around 2-3% of gross domestic product (GDP) at low incomes ( 7000 US dollars). Surprisingly, there is as much relative variation in the share for poor countries as for rich ones, and even more relative variation in amounts in US dollars. Poor countries and poor people that most need protection from financial catastrophe are the least protected by any form of prepayment or risk-sharing. At low incomes, out-of-pocket spending is high on average and varies from 20-80% of the total; at high incomes that share drops sharply and the variation narrows. Absolute out-of-pocket expenditure nonetheless increases with income. Public financing increases faster, and as a share of GDP, and converges at high incomes. Health takes an increasing share of total public expenditure as income rises, from 5-6% to around 10%. This is arguably the opposite of the relation between total health needs and need for public spending, for any given combination of services. Within public spending, there is no convergence in the type of finance - general revenue versus social insurance. Private insurance is usually insignificant except in some rich countries.