The Relationship between government spending on health and mortality from Non-Communicable Diseases: a global level panel data analysis (2000-2016)
Njuguna, Benson Ng’ang’a
Non-communicable diseases (NCD) cause the most death and disability globally, posing a significant public health threat, with detrimental impact on productivity and economic growth. The United Nations Sustainable Development Goal 3.4 targets reducing NCD related mortality by one third by 2030. In order to accomplish this, domestic government expenditure on health (GEH) has been proposed as a key policy tool to expand access to quality healthcare and reduce premature NCD mortality. GEH as a percentage of gross domestic product (GDP) varies between countries at the global, regional and income group level, however the relationship between domestic GEH and premature mortality from NCDs is currently unknown. This study objectives were to investigate the relationship between domestic GEH and premature NCD mortality from the four major NCDs, the mediating role of access to quality healthcare on this relationship, and the moderating role of country income grouping on this relationship. The study used panel data regression analysis to analyse country level secondary data for the years 2000-2016 for countries which are signatory to the UN SDG. Both fixed and random effects estimations were conducted, with the Wu Hausman test used to identify the most appropriate model. This study found an inverse relationship between domestic GEH and premature NCD mortality, controlling for private expenditure on health, per capita GDP, tertiary education level, and government effectiveness, with a coefficient of -0.049 (p value < 0.01) under a fixed effects assumption, which was favoured by the Wu Hausman test. The study also found no role of access to quality healthcare, as measured using the health access and quality index (HAQI) metric as a mediator in the relationship between domestic GEH and premature NCD mortality. Finally, the study found that country income grouping was a strong moderator in the relationship, becoming stronger and more significant as country income grouping rose. The findings of this study are instructive to policy makers, particularly in ministries of health and ministries of finance on the inverse relationship between domestic GEH and mortality from NCD and provides data in support of the calls to increase public spending on health, particularly given the health and economic benefits attainable from reducing NCD morbidity and mortality and achieving SDG 3.4.
A Dissertation submitted in partial fulfilment of the requirements for the Degree of Masters in Public Policy and Management in Strathmore Business School
Health expenditure, NCD mortality, Health access, Health quality