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The purpose of this paper, on Portugal, is to determine the economic effects of public and private capital spending on health.

The authors use a vector autoregressive model to estimate the elasticities and marginal products of health care investments in Portugal on investment, employment and output.

Every €1m invested in health care yields significant positive spillover effects, boosting investment and GDP by €24.74 and €20.45m, respectively, creating 188 net jobs. Adversely, net exports deteriorate, as new capital goods are imported. While only 28.2 percent of the total accumulated increase in GDP occurs within a year, investment is front loaded with a corresponding 73.8 percent. Over this period, 68 workers are displaced for every €1m invested. At a disaggregated level, real estate, construction, and transportation and storage are industries where output shares increase the most. Employment shares increase the most in professional services, construction and basic metals.

This paper adds to the empirical literature, corroborating, for example, Rivera and Currais (1999a) and McDonald and Roberts (2002) in that health care spending can have a very significant effect on macroeconomic aggregates. In addition to the analysis of the tradable/non-tradable divide, it adds two further novelties by discussing industry-specific effects on economic performance and the distinction between effects on impact and those over the longer term.

As policy implications, health investments have very significant long-term economic performance effects, but are unhelpful counter cyclically. Also, they will change the industry mix: construction and professional services are the non-traded industries that will benefit the most, while the traded industries of non-metallic minerals, basic metals, and machinery and equipment benefit much less.

Given that capital spending on health boosts economic performance, especially in the long run, it ought to be a part of Portugal’s medium-to-long-term growth strategy. Also, if these projects depress economic activity in the short run, and are thus unhelpful counter cyclically, the timing of when they are launched matters. Furthermore, following a health investment, policies that boost net exports will be required to ensure trade balance.

The originality of this paper is to estimate, in a dynamic framework, the aggregate and industry-specific elasticities and marginal products on investment, employment and output, allowing the identification of effects both on impact and over the long term. Although health care investments are expected to have important macroeconomic effects, they need not be evenly distributed across industries.

General medical practitioners (GPs) in the UK are working from increasingly sophisticated premises. UK Government consultations have highlighted that inadequate premises are currently a barrier to improvements in primary health care. Therefore the National Health Service (Primary Care) Act 1997 permits pilot schemes for primary health care which may encompass property improvements. Provision of quality buildings has implications for the willingness of patients to consult GPs, the range of services offered by family doctors and the cost‐effectiveness of primary health care delivery. The decentralized nature of primary health care raises issues about the evolution of building design knowledge to cater for technical and organizational innovations in health care. As primary health care facilities become more sophisticated, advances in construction management techniques need to be applied so that they are procured efficiently. Current real estate arrangements for the provision of primary health care facilities are causing concern. The capital investment involved is increasingly burdensome for GPs. Lack of Government finance is leading to pressures for the employment of private capital, with accompanying new opportunities for property managers.

This paper presents three models of funding health care in 130 developing countries, based upon a public system, a private system and personal remittances.

The authors trace the funding of health from foreign aid to health funding and health outcomes in the public system, foreign direct investment to health funding in the private system, and personal remittances to health outcomes. This is followed by panel data, fixed effects models subjected to 2-, 3- and 4-stage least squares regressions.

Findings from the first model were that aid in the form of Technical Cooperation Grants funded Infrastructure. Infrastructure Spending due to aid funds Government Health Plans, which reduced the Incidence of Tuberculosis, which in turn reduced Undernourishment and increases Life Expectancy. Other positive health outcomes included reduced Birth Rate and reduced Maternal Mortality. In the second model, Foreign Direct Investment increased Female Employment and GDP per Person, funding Private Health Plans, which increase Life Expectancy, reduced Undernourishment, increased Skilled Care at Birth, increased the Number of Hospital Beds, reduced Maternal Mortality and increased the Birth Rate. In the third model, Remittances influenced both Out-of-Pocket Medical Expenses and Private Plans.

Publicly funded programs may be directed to nutrition, increasing life expectancy. Private funding may be directed to improving maternal conditions, with remittances removing the liquidity constraints.

This paper is the first attempt to trace health funding from its sources of foreign aid, foreign direct investment and personal remittances using three separate paths.

This paper aims to critically analyze the empirical literature on health and human development in high-, middle- and low-income countries to develop a sustainable model for investing in human health. The model is critical in building a comprehensive health-care system that fosters the stakeholders’ financial stability, economic growth and high-quality education for the local community.

A comprehensive literature review was carried out on health, human development and sustainable health investment. After thoroughly examining theoretical frameworks underlying the strategies of successful human health systems, a summary of empirical articles is created. Summaries provided in this paper represent relevant health-care strategies for Kenya.

Based on the empirical review of literature, a Nexus Health Care model focusing on human development, social and cultural development, economic development and environmental development in high-, middle- and low-income countries is proposed. The goal of this model is to enhance sustainable development where wealth creation is accompanied with environmental uplifting and protection of social and material well-being.

This paper is limited to a comprehensive literature review presenting empirical evidence of human development and sustainability.

Kenya like other developing nations aspires to contribute significantly in improving health through development of health products but the approaches used have been limiting. In most cases, the use of Western theories, lack of empowering the community and dependence on donor support have hindered the country from achieving comprehensive health and human development. This papers seeks to develop a model for health-care investment and provide strategies, operations and structure of successful health systems and human development for a developing country, such as Kenya.

The COVID-19 pandemic educed extraordinary policy responses globally, including in India, to flatten the infection-growth curve. The trajectories of infections, recovery, and deaths vastly differed across Indian states. The purpose of this study is to investigate whether persistent investments by states in critical social sectors, such as health and education, explain their preparedness and hence better management of the pandemic.

This study uses secondary data on the number of infected, recovered and deceased due to COVID-19, along with data on population and income across 302 districts in 11 major states in India. Data on health and education indices are collected at the state-level. Linear regression models that also control for heteroskedasticity are applied.

This study finds that higher investments in health care and education reduce the propensity of the infection spread. Further, states with persistent investments in health care and education exhibit a higher rate of recovery. This study also finds that death rates are significantly lower in states with higher investments in education.

The findings support the conjecture that states that have consistently invested in social sectors benefited from the associated positive externalities during the crisis that helped them manage the pandemic better.

This study will help policymakers understand the underlying social forces critical to the success in the fight against pandemics. Apart from improving preparedness for future pandemics, the evidence provided in the paper may help give better direction and purpose to tax-financed public spending in states where social sector development has hitherto received low priority.

The long-term financial stability of hospital systems represents a “grand challenge” in health care. New ownership forms, such as private equity (PE), promise to achieve better financial performance than nonprofit or for-profit systems. In this study, we compare two systems with many similarities, but radically different ownership structures, missions, governance, and merger and acquisition (M&A) strategies. Both were nonprofit, religious systems serving low-income communities – Montefiore Health System and Caritas Christi Health Care.

Montefiore's M&A strategy was to invest in local hospitals and create an integrated regional system, increasing revenues by adding primary doctors and community hospitals as feeders into the system and achieving efficiencies through effective resource allocation across specialized units. Slow and steady timing of acquisitions allowed for organizational learning and balancing of debt and equity. By 2019, it owned 11 hospitals with 40,000 employees and had strong positive financials and low reliance on debt.

By contrast, in 2010, PE firm Cerberus Capital bought out Caritas (renamed Steward Health Care System) and took control of the Board of Directors, who set the system's strategic direction. Cerberus used Steward as a platform for a massive debt-driven acquisition strategy. In 2016, it sold off most of its hospitals’ property for $1.25 billion, leaving hospitals saddled with long-term inflated leases; paid itself almost $500 million in dividends; and used the rest for leveraged buyouts of 27 hospitals in 9 states in 3 years. The rapid, scattershot M&A strategy was designed to create a large corporation that could be sold off in five years for financial gain – not for health care integration. Its debt load exploded, and by 2019, its financials were deeply in the red. Its Massachusetts hospitals were the worst financial performers of any system in the state. Cerberus exited Steward in 2020 in a deal that left its physicians, the new owners, holding the debt.

Collaborative product commerce (CPC) techniques are being applied with greater frequency in the health care sector. The purpose of this paper is to explore the potential barriers to their success in influencing cost and quality.

The health care supply chain (SC) is analyzed and five national health initiatives attempting to apply CPC techniques are described.

Five national‐level programs designed to improve health care quality and control costs use a variety of CPC techniques to create incentives and/or disincentives to influence suppliers’ behavior. Six barriers to success are identified that threaten healthcare CPC initiatives. They include: widespread resistance to change; information system limitations; the Health Insurance Portability and Accountability Act (HIPAA); the required time investment; lack of commitment to CPC principles; and the sustainability of the CPC business model.

Investigation into the barriers to success is warranted to develop evidence‐based solutions to improve effectiveness of CPC approaches in health care.

No national health care initiative to date can be described as an unqualified success in terms of its ability to align the SC. Nevertheless, individually, and to some extent collectively, the aforementioned programs are making some headway.

This work is one of the first to present information on how collective CPC efforts are taking shape in health care and to describe key national‐level projects currently underway in the field. Such information can offer policymakers and employers insight into how CPC techniques might improve effectiveness in health benefit contracting.

The spiraling cost of health care is emerging as one of the country's most urgent problems and a major domestic political issue. In the 1940s, prepaid medical care provided by groups of health‐care professionals began to take hold and finally emerged as a serious prospect for cost‐effective health care with the passage of the Health Maintenance Organization Act of 1973 (42 U.S.C. 300e). Although still not widespread, interest in HMOs is growing and government incentives to private investment in such organizations should prompt inquiries to libraries from citizens groups, businesspeople, and potential customers of these services. Here is a sampling of items on the subject.

The purpose of this study is to examine how servicescapes impact well-being and satisfaction of both hospital customers (patients) and health care professional service providers.

The study investigates how a hospital servicescape impacts two critical outcomes – well-being and satisfaction – of both hospital patients (customers) and health care professionals, who are immersed in that environment.

The hospital servicescape had a greater impact on physical, psychological and existential well-being for professionals than for patients. However, the reverse was true for satisfaction. The new servicescape enhanced the satisfaction and physical and psychological well-being of professionals but only the satisfaction of customers.

The study implications for health care policy suggest that investment in health care-built environments should balance the needs of health care professionals with those of customers to benefit their collective well-being and satisfaction.

Based on the findings, the authors propose that servicescape investments should focus on satisfying the physical needs of patients while also placing emphasis on the psychological needs of professionals.

Health care spending on physical facilities should incorporate careful cost-benefit analysis, ensuring that beneficial features for both user groups are included in new hospital designs, omitting features that are less supportive of well-being.

To the best of the authors’ knowledge, this study is the first to compare the impact of the same real-life servicescape on the satisfaction of both customers and service providers (professionals) and considers the critical health outcome of well-being.

Norman Daniels has presented a concept of health care need which he proposes as the basis for the distribution of health care resources, plausibly to define and provide a philosophical justification for a decent minimum of health care. Daniels′ construction is reconsidered and criticisms both from the literature and those new to this discussion are investigated.