Does government expenditure reduce inequalities in infant mortality rates in low- and middle-income countries? A time-series, ecological analysis of 48 countries from 1993-2013
File(s)
Author(s)
Baker, P
Hone, thomas
Reeves, Aaron
Avendano, Mauricio
Millett, Christopher
Type
Journal Article
Abstract
Introduction
Inequalities in infant mortality rates (IMR) are rising in some Low and Middle-Income Countries (LMICs) and falling in others, but the explanation for these divergent trends is unclear. We investigate whether government expenditures and redistribution are associated with reductions in inequalities in IMR.
Methods
We estimated country-level fixed-effects panel regressions for 48 LMICs (142 country-observations). Slope and Relative Indices of Inequality in IMR (SII and RII) were calculated from Demographic and Health Surveys between 1993-2013. RII and SII were regressed on government expenditure (total, health, and non-health) and redistribution, controlling for GDP, private health expenditures, a democracy indicator, country fixed effects, and time.
Results
Mean SII and RII was 39.12 and 0.69. In multivariate models, a one percentage-point increase in total government expenditure (% of GDP) was associated with a decrease in SII of -2.468 (95% CIs: -4.190, -0.746) and RII of -0.026 (95% CIs: -0.048, -0.004). Lower inequalities were associated with higher non-health government expenditure, but not higher government health expenditure. Associations with inequalities were nonsignificant for GDP, government redistribution, and private health
expenditure.
Discussion
Understanding how non-health government expenditure reduces inequalities in IMR, and why health expenditures may not, will accelerate progress towards the Sustainable Development Goals.
Inequalities in infant mortality rates (IMR) are rising in some Low and Middle-Income Countries (LMICs) and falling in others, but the explanation for these divergent trends is unclear. We investigate whether government expenditures and redistribution are associated with reductions in inequalities in IMR.
Methods
We estimated country-level fixed-effects panel regressions for 48 LMICs (142 country-observations). Slope and Relative Indices of Inequality in IMR (SII and RII) were calculated from Demographic and Health Surveys between 1993-2013. RII and SII were regressed on government expenditure (total, health, and non-health) and redistribution, controlling for GDP, private health expenditures, a democracy indicator, country fixed effects, and time.
Results
Mean SII and RII was 39.12 and 0.69. In multivariate models, a one percentage-point increase in total government expenditure (% of GDP) was associated with a decrease in SII of -2.468 (95% CIs: -4.190, -0.746) and RII of -0.026 (95% CIs: -0.048, -0.004). Lower inequalities were associated with higher non-health government expenditure, but not higher government health expenditure. Associations with inequalities were nonsignificant for GDP, government redistribution, and private health
expenditure.
Discussion
Understanding how non-health government expenditure reduces inequalities in IMR, and why health expenditures may not, will accelerate progress towards the Sustainable Development Goals.
Date Issued
2018-06-27
Date Acceptance
2018-05-08
Citation
Health Economics, Policy and Law, 2018, 14, pp.249-273
ISSN
1744-1331
Publisher
Cambridge University Press (CUP)
Start Page
249
End Page
273
Journal / Book Title
Health Economics, Policy and Law
Volume
14
Copyright Statement
© Cambridge University Press 2018. This paper has been accepted for publication and will appear in a revised form, subsequent to peer-review and/or editorial input by Cambridge University Press.
Sponsor
Research Trainees Coordinating Centre
Identifier
https://www.cambridge.org/core/journals/health-economics-policy-and-law/article/does-government-expenditure-reduce-inequalities-in-infant-mortality-rates-in-low-and-middleincome-countries-a-timeseries-ecological-analysis-of-48-countries-from-1993-to-2013/F0199BEA8AC26F32C4559C0D1F146227#fndtn-information
Subjects
Science & Technology
Life Sciences & Biomedicine
Health Policy & Services
Health Care Sciences & Services
SOCIOECONOMIC INEQUALITIES
HEALTH
DEMOCRACY
EUROPE
POOR
1402 Applied Economics
1605 Policy and Administration
1801 Law
Health Policy & Services
Publication Status
Published
Date Publish Online
2018-06-27