Impact of macro-fiscal determinants on health financing:empirical evidence from low-and middle-income countries

Background:Health financing is a major challenge in low-and middle-income counties(LMICs)for achieving Universal Health Coverage(UHC).Past studies have argued that the budgetary allocation on health financing depends on macrofiscal policies of an economy such as sustained economic growth and higher revenue mobilization.While the global financial crisis of late 2008 observed a shortage of financial resources in richer countries and adversely affected the health sector.Therefore,this study has examined the impact of macro-fiscal policies on health financing by adopting socioeconomic factors in 85 LMICs for the period 2000 to 2013.Methods:The study has employed the panel System Generalized Method of Moment model that captures the endogeneity problem in the regression estimation by adopting appropriate instrumental variables.Results:The elasticity of public health expenditure(PHE)with respect to macro-fiscal factors varies across LMICs.Tax revenue shows a positive and statistically significant relationship with PHE in full sample,pre-global financial crisis,middle-income,and coefficient value varies from 0.040 to 0.141%.Fiscal deficit and debt services payment shows a negative effect on PHE in full sample,as well as sub-samples and coefficient value,varies from 0.001 to 0.032%.Aging and per capita income show an expected positive relationship with PHE in LIMI countries.Conclusions:Favorable macro-fiscal policies would necessarily raise finance for the health sector development but the prioritization of health budget allocation during the crisis period depends on the nature of tax revenue mobilization and demand for health services.Therefore,the generation of health-specific revenues and effective usage of health budget would probably accelerate the progress towards the achievement of UHC.

Does disability increase households’health financial risk:evidence from the Uganda demographic and health survey

Background:In the last few years,there has been a worldwide commitment to protect the vulnerable individuals from higher financial risk through out-of-pocket(OOP)health expenditure.This study examines the influence of disability and socio-demographic factors on households’health financial risks in Uganda.Methods:We used nationally representative cross-sectional data from the Uganda Demographic and Health Survey(UDHS)collected in 2016 by the Uganda Bureau of Statistics(UBOS)in Uganda.We measured financial risk(households’health expenditure)by money paid for health care services.We estimated the“probit”model to investigate the effect of disability on health financial risk.Results:A total of 19,305 households were included in this study.Almost 32%of households paid money for health care services access,among which 32%paid through out-of-pocket.Almost 41%of household heads were affected by disability.The majority(73%)of families went to the public sector for health care services.The mean age was 45 years(SD±15).We find that disability is significantly associated with the household financial risk(p<0.01).The private sector’s choice for health care services is likely to positively affect the financial risk compared to the public sector(p<0.01).The wealthier the household was,the more money paid for health service was(p<0.01).Conclusion:Our results indicated that disability and household socio-demographic characteristics were associated with health financial risk in Uganda.Identifying families with disability and experiencing difficult living conditions constitute an entry point for health authorities to enhance health coverage progress in low and middle-income countries.