Gabani, Jacopo, Mazumdar, Sumit and Suhrcke, Marc (2022) The effect of health financing systems on health system outcomes:A cross-country panel analysis. Health Economics. ISSN 1057-9230
Abstract
Several low- and middle-income countries are considering health financing system reforms to accelerate progress toward universal health coverage (UHC). However, empirical evidence of the effect of health financing systems on health system outcomes is scarce, partly because it is difficult to quantitatively capture the ‘health financing system’. We assign country-year observations to one of three health financing systems (i.e., predominantly out-of-pocket, social health insurance (SHI) or government-financed), using clustering based on out-of-pocket, contributory SHI and non-contributory government expenditure, as a percentage of total health expenditures. We then estimate the effect of these different systems on health system outcomes, using fixed effects regressions. We find that transitions from OOP-dominant to government-financed systems improved most outcomes more than did transitions to SHI systems. Transitions to government financing increases life expectancy (+1.3 years, p < 0.05) and reduces under-5 mortality (−8.7%, p < 0.05) and catastrophic health expenditure incidence (−3.3 percentage points, p < 0.05). Results are robust to several sensitivity tests. It is more likely that increases in non-contributory government financing rather than SHI financing improve health system outcomes. Notable reasons include SHI's higher implementation costs and more limited coverage. These results may raise a warning for policymakers considering SHI reforms to reach UHC.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2022 The Authors |
Dates: |
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Institution: | The University of York |
Academic Units: | The University of York > Faculty of Social Sciences (York) > Centre for Health Economics (York) The University of York > Faculty of Social Sciences (York) > Economics and Related Studies (York) |
Depositing User: | Pure (York) |
Date Deposited: | 15 Dec 2022 09:50 |
Last Modified: | 29 Oct 2024 01:07 |
Published Version: | https://doi.org/10.1002/hec.4635 |
Status: | Published online |
Refereed: | Yes |
Identification Number: | 10.1002/hec.4635 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:194465 |
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Description: Health Economics - 2022 - Gabani - The effect of health financing systems on health system outcomes A cross‐country panel
Licence: CC-BY 2.5