Globalization has brought health concerns to the forefront. Moreover, governments, policymakers, and health officials are paying more attention to these health concerns. With the increased cross-national interaction, diseases have more pathways to spread than ever. As countries attempt to ensure access to care and control health expenditure, monitoring and improving the quality of health care is a pressing issue. This paper uses linear regressions to analyze the relationship between prevention and public health expenditure and the rate of measles immunizations in member countries of the Organisation of Economic Co-operation and Development (OECD). There is a weak negative relationship between the expenditure and rates of measles immunizations for both private and public expenditure data, suggesting that the higher the expenditure the lower the rates of measles immunizations. Several possible reasons for this phenomenon is discussed in conjunction with the role of health educators as it relates to the use of theory based interventions to improve rates of measles immunizations.

The relationship between health and globalization may be constructed on improving public health through the flow of personnel, the import of medication, the quality improvement of drinking water, the utility of new medical technology, and the use of new medication on patients. Some scholars have pointed out that globalization may affect life expectancy from four aspects as income, education, nutrition, and public health. Unlike the existing literature primarily focuses on the correlation between health expenditure and GDP (gross domestic product), we examine to see whether a cointegration relationship between GDP and health expenditure exists under the impact of globalization by applying the panel cointegration test of Pedroni (1999, 2004) which allows heterogeneous data analysis and the Fully Modified OLS test. This paper mainly conducts a cross-continental comparison by using the data in the period from 1995 to 2004 of an estimate sample of 87 developing countries which consists of 12 European countries, 21 Central and South American countries, 20 Asian countries, and 34 African countries. The result shows that the existence of a cointegration relationship between GDP and health expenditure in both the overall developing countries and the cross-continental sample countries. Generally, investment of health and a fast pace of globalization progress boost GDP; especially in Europe and Asia, globalization is a very important factor in influencing the effectiveness of health expenditure upon GDP. In central and south America, the effect of globalization on the effectiveness of GDP to health expenditure is the most significant. The findings of this paper offer future researchers a different aspect for viewing and studying the correlation between health expenditure and GDP.

Globalization has brought health concerns to the forefront. Moreover, governments, policymakers, and health officials are paying more attention to these health concerns. With the increased cross-national interaction, diseases have more pathways to spread than ever. As countries attempt to ensure access to care and control health expenditure, monitoring and improving the quality of health care is a pressing issue. This paper uses linear regressions to analyze the relationship between prevention and public health expenditure and the rate of measles immunizations in member countries of the Organisation of Economic Co-operation and Development (OECD). There is a weak negative relationship between the expenditure and rates of measles immunizations for both private and public expenditure data, suggesting that the higher the expenditure the lower the rates of measles immunizations. Several possible reasons for this phenomenon is discussed in conjunction with the role of health educators as it relates to the use of theory based interventions to improve rates of measles immunizations.

This thesis serves to investigate the varying effects of public health-care expenditure and private health-care expenditure on economic growth in developed and developing countries. I have contributed to the literature by using an expansive geographical dataset, lagged variables to address endogeneity, and model averaging techniques. I do so by first addressing the issue of model uncertainty, which is inherent in growth studies, by using Bayesian Model Averaging as the method of analysis in the thesis. Examination of 126 countries (32 developed and 94 developing) in the period 2000-2018 reveals that there is no variation in the impact of public health expenditure on economic growth between developed and developing countries. Contrary to public health expenditure, private health expenditure has a varying impact on both developed and developing countries. My analysis also reveals that the results hold when lagged variables are used in the model. Public health expenditure has unanimously a negative effect on economic growth in both developed and developing countries. Private health expenditure, on the other hand, has a positive impact on economic growth in developed and developing countries. Furthermore, I found that the results are robust to different model specifications. JEL Classification I15, O11,...

Introduction The International Monetary Fund (IMF) is an international financial institution that acts as a lender of the last resort for countries experiencing balance of payments problems. Its loans to national authorities come with conditions, which typically include tighter control of public spending, though the nature and extent of conditions as well as the emphasis on social protection may vary according to the type of lending agreement. A subject of intense debate has been the effects of these loans on the capacity of health systems to meet health need. This study investigates the effects of IMF agreements on one crucial determinant of that capacity: government health expenditure (GHE). To do so, it evaluates: (i) the effects of IMF agreements on GHE across low- and middle-income countries; (ii) how these effects vary across different country income groups; and (iii) how these effects vary according to the type of agreement. Methods The study employs a dataset that includes GHE for 127 countries for the years 1995-2012, estimates the effects of IMF agreements using the Fixed Effects estimator, controls for determinants of GHE and accounts for endogeneity using a Heckman-style selection model. Results When controlling for endogeneity and important determinants of government health expenditure, the results suggest that, across all countries, agreements do not have a statistically significant effect on GHE. However, the effect differs according to country income group, with low-income countries experiencing increases in spending during agreement, lower-middle income countries seeing decreases in expenditure, for upper-middle income countries no effect on spending are observed. In addition, the effect differs according to agreement type: agreements with a social protection component are associated with increases in spending in low-income countries but have no statistically significant effects among middle-income countries. Agreement types with no social protection component are associated with decreases in spending among lower-middle income countries; and there is no statistically significant effect among low-income and upper-middle income countries. Conclusions The results indicate that, contrary to claims in the existing literature, IMF agreements do not have a statistically significant effect on GHE (positive or negative). However, this aggregate finding obscures the effect of particular agreement types in particular contexts. In low-income countries, agreements with an emphasis on social protection are associated with increases in GHE. When agreements have no social protection component they are associated with decreases in GHE for lower-middle-income countries, but not in other countries. In such contexts, IMF agreements either fail to enhance, or actually reduce, the capacity of health systems to meet health need.

Background: In Vietnam, problems of high out-of-pocket payments for health, leading to catastrophic health expenditure and resulting impoverishment for vulnerable groups, has been at focus in the past decades. Since the beginning of the 1990’s, the Vietnamese government has launched a series of social health insurance reforms to increase prepayment in the health sector and thereby better protect the population from the financial consequences of health problems. Objective: The objective of this thesis is to contribute to the discussion in Vietnam on how large the problems of catastrophic health expenditure are in the population as a whole and in a special subgroup; the elderly households, and to assess important aspects on health insurance as a means to reduce the problems. Methods: Catastrophic health expenditure has been estimated, using an established and common method, from two different data sources; the Epidemiological Field Laboratory for Health Systems Research (FilaBavi) in the Bavi district, and Vietnam Household Living Standards Survey (VHLSS) 2010. Results from two cross-sectional analyses and a panel study have been compared, to gain information on whether the estimates of catastrophic health spending may be overestimated when using cross-sectional data. Then, the size of the problem for one group, the elderly households; hypothesized to be particularly vulnerable in this context, has been estimated. The question of to what extent a health insurance reform; the Health Care Funds for the Poor (HCFP), has offered protection for the insured against health spending is being assessed in another study over the period 2001 – 2007, using propensity score matching. The value that households attach to health insurance has also been explored through a willingness to pay (WTP) study. Results: Comparing results from two cross-sectional studies with a panel study over a full year in which the respondents were interviewed once every month, the estimates of catastrophic spending vary largely. The monthly estimates in the panels study are half as large as the cross-sectional estimates; the latter also having a recall period of one month. Among the elderly households, catastrophic health spending and impoverishment are found to be problems three times as large as for the whole population. However, household health care expenditure as a percentage of total household expenditure was affected by the HCFP, and significantly reduced for the insured. In the study of household WTP for health insurance, it was iiifound that households attach a low value to this insurance form; WTP being only half of household health expenditure. Conclusions: Cross-sectional studies of catastrophic spending with a monthly recall period are likely to be affected by recall bias leading to overestimations through respondents including expenditure in the period preceding the recall period. However, such problems should not deter researchers form studying this phenomenon. If using the same method, estimates of catastrophic spending and impoverishment can be compared between different groups – as for the elderly households – and over time; e.g. studying the protective capacity of health insurance. It should be used more, not less. The VHLSS rounds offer the Vietnamese a possibility to regularly study this. The HCFP were found to be partly protective but important problems remain to be solved, e.g. the fact that people are reluctant to use their health insurance because of e.g. quality problems and possible discrimination of the insured. The findings of a low WTP for health insurance may be another reflection of this.

Background: Peru has increased substantially its domestic public expenditure in maternal and child health. Peruvian departments are heterogeneous in contextual and geographic factors, underlining the importance of disaggregated expenditure analysis up to the district level. We aimed to assess possible district level factors influencing public expenditure on reproductive, maternal, neonatal and child health (RMNCH) in Peru. Methods: We performed an ecological study in 24 departments, with specific RMNCH expenditure indicators as outcomes, and covariates of different hierarchical dimensions as predictors. To account for the influence of variables included in the different dimensions over time and across departments, we chose a stepwise multilevel mixed-effects regression model, with department-year as the unit of analysis. Results: Public expenditure increased in all departments, particularly for maternal-neonatal and child health activities, with a different pace across departments. The multilevel analysis did not reveal consistently influential factors, except for previous year expenditure on reproductive and maternal-neonatal health. Our findings may be explained by a combination of inertial expenditure, a results-based budgeting approach to increase expenditure efficiency and effectiveness, and by a mixed-effects decentralization process. Sample size, interactions and collinearity cannot be ruled out completely. Conclusions: Public district-level RMNCH expenditure has increased remarkably in Peru. Evidence on underlying factors influencing such trends warrants further research, most likely through a combination of quantitative and qualitative approaches. / This work was funded through a sub-grant from the U.S. Fund for UNICEF under the Countdown to 2015 for Maternal, Newborn and Child Survival grant from the Bill & Melinda Gates Foundation, and through a sub-grant from the Partnership for Maternal, Newborn & Child Health. / Revisión por pares / Revisión por pares

No / Though Bangladesh has made tremendous strides forward in health and other socio-economic indicators in the recent past, basic needs of health still remain largely unmet and only less than half of the population has access to basic healthcare. The health spending is far below the optimum level which is needed to scale up essential health intervention. Bangladesh is also experiencing a critical and chronic shortage and imbalance of skill mix and deployment of health workforce. The important achievements in health indicators include life expectancy, infant mortality, and vaccinations. However, overall burden of mortality and morbidity in most of the key health indicators is higher compared to other regional countries. Despite remarkable progress, except child mortality, targets are not expected to be met by 2015 if the prevailing trends persist in several areas. Major reforms are needed in health and medical education to ensure quality healthcare for the population of Bangladesh.

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The thesis analyzes the determinants of pharmaceutical expenditures on cardiovascular diseases with particular focus on Central Europe. We show how the pharmaceutical expenditure varies across the countries. We try to empirically verify that factors such as age, GDP, total health expenditure, education and prevalence of a particular disease cause the variation. Applying the fixed effect model on selected countries in the period 2000-2009, we find that the increase in pharmaceutical expenditures on cardiovascular diseases is explained mainly by aging population and prevalence of the diseases. Additionally, countries with higher GDP tend to also have somewhat higher pharmaceutical expenditures on cardiovascular diseases. Key words Pharmaceutical expenditures, cardiovascular diseases, GDP, health expenditure, fixed effect model, prevalence of a disease, aging of population.