Асимметричное влияние расходов на здравоохранение, доходов нижнего дециля и открытости экономики на показатели здравоохранения в странах БРИКС
DOI:
https://doi.org/10.17059/ekon.reg.2025-2-10Ключевые слова:
показатели здравоохранения, государственные расходы на здравоохранение, уровень младенческой смертности, ожидаемая продолжительность жизни, общий коэффициент смертности, открытость торговлиАннотация
В условиях неравномерного доступа к медицинским услугам и воздействия различных социально-экономических факторов проблема повышения эффективности систем здравоохранения в странах с развивающейся экономикой, в частности в странах БРИКС, приобретает особую значимость. Настоящее исследование посвящено анализу того, как государственные расходы на здравоохранение, открытость экономики и распределение доходов влияют на ключевые показатели здоровья населения — уровень младенческой смертности (IMR), ожидаемую продолжительность жизни (LE) и общий коэффициент смертности (CDR) в Бразилии, России, Индии, Китае и Южной Африке. В качестве эмпирической базы использованы панельные данные за 2000–2023 гг. Для оценки асимметричных эффектов применяется модель кросс-секционного асимметричного авторегрессионного распределённого лага (CS-NARDL). Показано, что увеличение расходов на здравоохранение способствует снижению показателей смертности, тогда как их сокращение оказывает более выраженное негативное влияние на состояние здоровья населения. Кроме того, выявлено, что в более открытых экономиках наблюдается естественное улучшение показателей здравоохранения, обусловленное доступом к передовым медицинским технологиям и услугам. Повышение доходов среди наименее обеспеченных групп населения (нижний дециль) также способствует улучшению доступа к медицинской помощи и, соответственно, улучшению здоровья. Таким образом, данное исследование расширяет наши представления о влиянии расходов на здравоохранение и распределении доходов на здоровье населения в странах БРИКС. Подчеркивается необходимость внедрения механизмов мониторинга и оценки эффективности государственных расходов в данной сфере, что позволит повысить эффективность политики здравоохранения и приблизиться к целям устойчивого развития.
Библиографические ссылки
Acemoglu, D., & Restrepo, P. (2017). Secular stagnation? The effect of aging on economic growth in the age of automation. American Economic Review, 107(5), 174–179. http://dx.doi.org/10.1257/aer.p20171101
Ahmed, M. (2022). Unequal Access to Health Care Facilities and its Impact on Achieving Sustainable Development Goals: Bangladesh Perspective. Journal of Community Positive Practices, 22(2), 120–144. https://doi.org/10.35782/JCPP.2022.2.09
Amimo, F., Lambert, B., Magit, A., & Hashizume, M. (2021). A review of prospective pathways and impacts of COVID-19 on the accessibility, safety, quality, and affordability of essential medicines and vaccines for universal health coverage in Africa. Globalization and Health, 17(1), 42. https://doi.org/10.1186/s12992-021-00666-8
Ansmann, L., Vennedey, V., Hillen, H. A., Stock, S., Kuntz, L., Pfaff, H., Mannion, R., & Hower, K. I. (2021). Resource dependency and strategy in healthcare organizations during a time of scarce resources: evidence from the metropolitan area of cologne. Journal of Health Organization and Management, 35(9), 211–227. https://doi.org/10.1108/JHOM-12-2020-0478
Aydin, M., & Bozatli, O. (2023). The effects of green innovation, environmental taxes, and financial development on renewable energy consumption in OECD countries. Energy, 280, 128105. https://doi.org/10.1016/j.energy.2023.128105
Aziz, F., Tahir, F., & Qureshi, N. A. (2021). Millennium development goals (MDGs-2000-2015) to sustainable development goals (SDGs-2030): a chronological landscape of public sector health care segment of Pakistan. Journal of the Pakistan Medical Association, 71(2), 596-601. https://doi.org/10.47391/JPMA.394
Babones, S. J. (2008). Income inequality and population health: Correlation and causality. Social Science and Medicine, 66(7), 1614–1626. https://doi.org/10.1016/j.socscimed.2007.12.012
Bai, P., Tang, Y., Zhang, W., & Zeng, M. (2021). Does Economic Policy Uncertainty Matter for Healthcare Expenditure in China? A Spatial Econometric Analysis. Frontiers in Public Health, 9, 63778. https://doi.org/10.3389/fpubh.2021.673778
Baltagi, B. H., Lagravinese, R., Moscone, F., & Tosetti, E. (2017). Health care expenditure and income: A global perspective. Health Economics, 26(7), 863–874. https://doi.org/10.1002/hec.3424
Baltagi, B. H., & Moscone, F. (2010). Health care expenditure and income in the OECD reconsidered: Evidence from panel data. Economic Modelling, 27(4), 804–811. http://dx.doi.org/10.1016/j.econmod.2009.12.001
Barro, R. J. (1991). Economic growth in a cross section of countries. The Quarterly Journal of Economics, 106(2), 407–443.
Bergh, A., & Nilsson, T. (2010). Good for Living? On the Relationship between Globalization and Life Expectancy. World Development, 38(9), 1191–1203. https://doi.org/10.1016/j.worlddev.2010.02.020
Breitung, J. (2000). The local power of some unit root tests for panel data. In Baltagi, B. H., Fomby, T. B. and Carter Hill, R. (Ed.), Nonstationary Panels, Panel Cointegration, and Dynamic Panels (Advances in Econometrics, Vol. 15) (pp. 161–177). Emerald Group Publishing Limited. https://doi.org/10.1016/S0731-9053(00)15006-6
Bussmann, M. (2009). The Effect of Trade Openness on Women’s Welfare and Work Life. World Development, 37(6), 1027–1038. https://doi.org/10.1016/j.worlddev.2008.10.007
Canbay, Ş., & Kırca, M. (2022). Health expenditures (total, public and private) and per capita income in the BRICS+ T: panel bootstrap causality analysis. Journal of Economics, Finance and Administrative Science, 27(53), 52–67. http://dx.doi.org/10.1108/JEFAS-06-2021-0105
Coe, D. T., & Helpman, E. (1995). International R&D spillovers. European Economic Review, 39(5), 859–887. https://doi.org/10.1016/0014-2921(94)00100-E
Cornia, G. A. (2001). Globalization and health: results and options. Bulletin of the World Health Organization, 79(9), 834–841. http://dx.doi.org/10.1590/S0042-96862001000900008
Culyer, A. J. (1988). Health care expenditures in Canada: Myth and reality; past and future. Canadian Tax Foundation.
Cutler, D. M., Rosen, A. B., & Vijan, S. (2006). The value of medical spending in the United States, 1960–2000. New England Journal of Medicine, 355(9), 920–927. http://dx.doi.org/10.1056/NEJMsa054744
Deaton, A. (2004). Health in the age of globalizatoin. NBER Working Paper, (10669).
Di Matteo, L. (2003). The income elasticity of health care spending. The European Journal of Health Economics, 4(1), 20–29. https://doi.org/10.1007/s10198-002-0141-6
Esily, R. R., Ibrahiem, D. M., Sameh, R., & Houssam, N. (2022). Assessing environmental concern and its association with carbon trade balances in N11 Do financial development and urban growth matter? Journal of Environmental Management, 320, 115869. https://doi.org/10.1016/j.jenvman.2022.115869
Farooq, F., Yusop, Z., & Chaudhry, I. S. (2019). How do trade openness and public expenditures affect health status in OIC member countries? An empirical analysis. Pakistan Journal of Commerce and Social Science, 13(4), 1041–1056.
Frankel, J. A., & Romer, D. (1999). Does trade cause growth? American Economic Review, 89(3), 379–399. https://doi.org/10.1257/aer.89.3.379
Grigoli, F., & Kapsoli, J. (2018). Waste not, want not: The efficiency of health expenditure in emerging and developing economies. Review of Development Economics, 22(1), 384–403. http://dx.doi.org/10.1111/rode.12346
Gu, L., Wang, M.-C., & Li, F. (2022). The correlation between economic fluctuation, workforce employment and health expenditure in the BRICS countries. Frontiers in Public Health, 10, 933728https://doi.org/10.3389/fpubh.2022.933728
Gupta, P., & Bhatia, P. (2022). An empirical investigation of N-11 countries as successors of BRICS using panel data modeling. International Journal of Emerging Markets, 17(8), 2024–2051. https://doi.org/10.1108/IJOEM-07-2020-0809
Hall, R. E., & Jones, C. I. (2007). The value of life and the rise in health spending. The Quarterly Journal of Economics, 122(1), 39–72.
Harrison, A. (1996). Openness and growth: A time-series, cross-country analysis for developing countries. Journal of Development Economics, 48(2), 419–447. https://doi.org/10.1016/0304-3878(95)00042-9
Hartwig, J., & Sturm, J.-E. (2014). Robust determinants of health care expenditure growth. Applied Economics, 46(36), 4455–4474. https://doi.org/10.1080/00036846.2014.964829
Hitiris, T., & Posnett, J. (1992). The determinants and effects of health expenditure in developed countries. Journal of Health Economics, 11(2), 173–181. https://doi.org/10.1016/0167-6296(92)90033-w
Hone, T., Macinko, J., & Millett, C. (2018). Revisiting Alma-Ata: what is the role of primary health care in achieving the Sustainable Development Goals? The Lancet, 392(10156), 1461–1472. https://doi.org/10.1016/S0140-6736(18)31829-4
Hosoya, K. (2014). Determinants of health expenditures: Stylized facts and a new signal. Modern Economy, 5(13), 1171–1180. http://dx.doi.org/10.4236/me.2014.513109
Im, K. S., Pesaran, M. H., & Shin, Y. (2003). Testing for unit roots in heterogeneous panels. Journal of Econometrics, 115(1), 53–74. https://doi.org/10.1016/S0304-4076(03)00092-7
Jakovljevic, M., Lamnisos, D., Westerman, R., Chattu, V. K., & Cerda, A. (2022). Future health spending forecast in leading emerging BRICS markets in 2030: health policy implications. Health Research Policy and Systems, 20(1), 23. https://doi.org/10.1186/s12961-022-00822-5
Jani, V. J., Joshi, N. A., & Mehta, D. J. (2019). Globalization and health: An empirical investigation. Global Social Policy, 19(3), 207–224. https://doi.org/10.1177/1468018119827475
Jawadi, F., El Gouddi, S., Ftiti, Z., & Kacem, A. (2018). Assessing the Effect of Trade Openness on Health in the MENA Region: a Panel Data Analysis. Open Economies Review, 29(2), 469–479. https://doi.org/10.1007/s11079-017-9450-3
Kawachi, I., & Kennedy, B. P. (1999). Income inequality and health: pathways and mechanisms. Health Services Research, 34(1 Pt 2), 215–227.
Khoshnevis Yazdi, S., & Khanalizadeh, B. (2017). Air pollution, economic growth and health care expenditure. Economic Research-Ekonomska Istraživanja, 30(1), 1181–1190. http://dx.doi.org/10.1080/1331677X.2017.1314823
Kleiman, E. (1974). The Determinants of National Outlay on Health. In The Economics of Health and Medical Care (pp. 66–88). Palgrave Macmillan. https://doi.org/10.1007/978-1-349-63660-0_5
Lamnisos, D., Giannakou, K., & Jakovljevic, M. (2021). Demographic forecasting of population aging in Greece and Cyprus: one big challenge for the Mediterranean health and social system long-term sustainability. Health Research Policy and Systems, 19(1), 21. https://doi.org/10.1186/s12961-020-00666-x
Levin, A., Lin, C.-F., & James Chu, C.-S. (2002). Unit root tests in panel data: asymptotic and finite-sample properties. Journal of Econometrics, 108(1), 1–24. https://doi.org/10.1016/S0304-4076(01)00098-7
Levine, D. I., & Rothman, D. (2006). Does trade affect child health? Journal of Health Economics, 25(3), 538–554. https://doi.org/10.1016/j.jhealeco.2005.10.001
Mehta, D., & Derbeneva, V. (2024). Impact of environmental fiscal reforms on carbon emissions of EURO-4 countries: CS-NARDL approach. International Journal of Thermofluids, 21, 100550. https://doi.org/10.1016/j.ijft.2023.100550
Mehta, D., & Derbeneva, V. V. (2023). Asymmetry Effect of Tax and Public Debt on Private Consumption Spending in Russia. Journal of Tax Reform, 9(3), 359–375. https://doi.org/10.15826/jtr.2023.9.3.147
Mehta, D., & Prajapati, P. (2024). Asymmetric effect of environment tax and spending on CO2 emissions of European Union. Environmental Science and Pollution Research, 31(18), 27416–27431. https://doi.org/10.1007/s11356-024-32990-y
Murphy, K. M., & Topel, R. H. (2006). The value of health and longevity. Journal of Political Economy, 114(5), 871–904.
Naidu, S., & Chand, A. (2013). Does central government health expenditure and medical technology advancement determine economic growth rates in the Pacific island countries? Asia-Pacific Journal of Business Administration, 5(3), 234–245. https://doi.org/10.1108/APJBA-01-2013-0005
Newhouse, J. P. (1977). Medical-care expenditure: a cross-national survey. The Journal of Human Resources, 12(1), 115–125. http://dx.doi.org/10.2307/145602
Nordhaus, W. D. (2002). The health of nations: the contribution of improved health to living standards. Cambridge: National Bureau of Economic Research..
Odagiri, M., Azhar, K., Cronin, A. A., Gressando, Y., Hidayat, I., Utami, W., Widowati, K., Roshita, A., Soeharno, R., Warouw, S. P., & Ardhiantie. (2018). Water, Sanitation, and Hygiene Services in Public Health-Care Facilities in Indonesia: Adoption of World Health Organization/United Nations Children’s Fund Service Ladders to National Data Sets for a Sustainable Development Goal Baseline Assessment. The American Journal of Tropical Medicine and Hygiene, 99(2), 546–551. https://doi.org/10.4269/ajtmh.18-0044
Owen, A. L., & Wu, S. (2007). Is Trade Good for Your Health?. Review of International Economics, 15(4), 660–682. https://doi.org/10.1111/j.1467-9396.2007.00677.x
Pampel Jr., F. C., & Pillai, V. K. (1986). Patterns and determinants of infant mortality in developed nations, 1950–1975. Demography, 23(4), 525–542. https://doi.org/10.2307/2061349
Patel, N., & Mehta, D. (2023). The asymmetry effect of industrialization, financial development and globalization on CO2 emissions in India. International Journal of Thermofluids, 20, 100397. https://doi.org/10.1016/j.ijft.2023.100397
Pedroni, P. (1999). Critical Values for Cointegration Tests in Heterogeneous Panels with Multiple Regressors. Oxford Bulletin of Economics and Statistics, 61(s1), 653–670. https://doi.org/10.1111/1468-0084.0610s1653
Pedroni, P. (2004). Panel cointegration: asymptotic and finite sample properties of pooled time series tests with an application to the PPP hypothesis. Econometric Theory, 20(3), 597-625. https://doi.org/10.1017/S0266466604203073
Piabuo, S. M., & Tieguhong, J. C. (2017). Health expenditure and economic growth-a review of the literature and an analysis between the economic community for central African states (CEMAC) and selected African countries. Health Economics Review, 7(1), 23. https://doi.org/10.1186/s13561-017-0159-1
Pickett, K. E., & Wilkinson, R. G. (2015). Income inequality and health: A causal review. Social Science and Medicine, 128, 316–326. https://doi.org/10.1016/j.socscimed.2014.12.031
Rana, R. H., Alam, K., & Gow, J. (2021). Financial development and health expenditure nexus: A global perspective. International Journal of Finance & Economics, 26(1), 1050–1063. https://doi.org/10.1002/ijfe.1835
Rebolledo, E. S., & Giatti, L. L. (2022). Convergences between primary health care planning and the Sustainable Development Goals: an evaluation of municipal health plans in Brazil and Chile. Saúde e Sociedade, 31(4), e191006pt. https://doi.org/10.1590/s0104-12902022191006en
Rodgers, G. B. (2002). Income and inequality as determinants of mortality: an international cross-section analysis. International Journal of Epidemiology, 31(3), 533–538. https://doi.org/10.1093/ije/31.3.533
Rodrik, D., Subramanian, A., & Trebbi, F. (2004). Institutions Rule: The Primacy of Institutions Over Geography and Integration in Economic Development. Journal of Economic Growth, 9(2), 131–165. https://doi.org/10.1023/B:JOEG.0000031425.72248.85
Sahoo, P. M., Rout, H. S., & Jakovljevic, M. (2023). Future health expenditure in the BRICS countries: a forecasting analysis for 2035. Globalization and Health, 19(1), 49. https://doi.org/10.1186/s12992-023-00947-4
Sandholtz, W., & Gray, M. M. (2003). International Integration and National Corruption. International Organization, 57(4), 761–800. https://doi.org/10.1017/S0020818303574045
Sharma, M. G., & Popli, H. (2023). India on the Path to Universal Health Coverage-Progress Compared with Other Emerging Economies of BRICS and ASEAN-5. Journal of Young Pharmacists, 15(2), 326–333. https://doi.org/10.5530/jyp.2023.15.43
Sharma, R., Kautish, P., & Mehta, D. (2024). Determining Energy Consumption Function under Nonlinearity and Structural Break in India: An Empirical Investigation. Journal of Quantitative Economics, 22(2), 339–363. https://doi.org/10.1007/s40953-024-00391-0
Sheikh, U. A., Tabash, M. I., & Asad, M. (2020). Global Financial Crisis in Effecting Asymmetrical Co-integration between Exchange Rate and Stock Indexes of South Asian Region: Application of Panel Data NARDL and ARDL Modelling Approach with Asymmetrical Granger Causility. Cogent Business & Management, 7(1), 1843309. https://doi.org/10.1080/23311975.2020.1843309
Shin, Y., Yu, B., & Greenwood-Nimmo, M. (2014). Modelling Asymmetric Cointegration and Dynamic Multipliers in a Nonlinear ARDL Framework. In Festschrift in Honor of Peter Schmidt (pp. 281–314). Springer New York. https://doi.org/10.1007/978-1-4899-8008-3_9
Subramanian, S. V., & Kawachi, I. (2004). Income Inequality and Health: What Have We Learned So Far?. Epidemiologic Reviews, 26(1), 78–91. https://doi.org/10.1093/epirev/mxh003
Wang, F., Gillani, S., Nazir, R., & Razzaq, A. (2023). Environmental regulations, fiscal decentralization, and health outcomes. Energy & Environment, 35(6), 0958305X2311646. http://dx.doi.org/10.1177/0958305X231164680
Wang, K. M., & Lee, Y. M. (2018). The impacts of life insurance asymmetrically on health expenditure and economic growth: dynamic panel threshold approach. Economic Research-Ekonomska Istraživanja, 31(1), 440–460. https://doi.org/10.1080/1331677X.2018.1429943
WHO. (2021). Global expenditure on health: public spending on the rise? World Health Organization.
Wilkinson, R. G. (1992). Income distribution and life expectancy. British Medical Journal, 304(6820), 165. https://doi.org/10.1136/bmj.304.6820.165
Wolf Jr., C., Dalal, S., DaVanzo, J., Larson, E. V, Akhmedjanov, Al., Dogo, H., Huang, M., & Montoya, Si. (2011). China and India, 2025 - A Comparative Assessment. RAND Corporation.
Yan, F., Li, H., Wang, W., & Zhang, J. (2023). The trend in density of skilled health personnel in BRICS countries: Implication for China and India. The International Journal of Health Planning and Management, 38(3), 759–772. https://doi.org/10.1002/hpm.3623
Yuelan, P., Akbar, M. W., Zia, Z., & Arshad, M. I. (2022). Exploring the nexus between tax revenues, government expenditures, and climate change: empirical evidence from Belt and Road Initiative countries. Economic Change and Restructuring, 55(3), 1365–1395. https://doi.org/10.1007/s10644-021-09349-1
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