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Health can be influenced by many factors. One of the factors is the political context of the country and democracy. The purpose of this paper is to examine the effects of freedom in press and polity index in overall, public, private and out of pocket health expenditures.

A long-term panel data approach has been used to examine the relationship between democracy and health expenditures. The authors inserted polity and freedom into press indexes in the health expenditure model.

Increase in freedom of the press and democracy will increase the overall, public and private health expenditures while they decrease out of pocket health expenditures.

Polity and freedom index has a significant impact on all the health expenditure models.

The search for more effective policies, choice of optimal implementation strategies for achieving defined policy targets (e.g., cost-containment, improved access, and quality healthcare outcomes), and selection among the metrics relevant for assessing health system policy change performance simultaneously pose continuing healthcare sector challenges for many countries of the world. Meanwhile, research on the core drivers of healthcare costs across the health systems of the many countries continues to gain increased momentum as these countries learn among themselves. Consequently, cross-country comparison studies largely focus their interests on the relationship among health expenditures (HCE), GDP, aging demographics, and technology. Using more recent 1980–2014 annual data panel on 34 OECD countries and the panel ARDL (Autoregressive Distributed Lag) framework, this study investigates the long- and short-run relationships among aggregate healthcare expenditure, income (GDP per capita or per capita GDP^_HCE), age dependency ratio, and “international co-operation patents” (for capturing the technology effects). Results from the panel ARDL approach and Granger causality tests suggest a long-run relationship among healthcare expenditure and the three major determinants. Findings from the Westerlund test with bootstrapping further corroborate the existence of a long-run relationship among healthcare expenditure and the three core determinants. Interestingly, GDP less health expenditure (GDP^_HCE) is the only short-run driver of HCE. The income elasticity estimates, falling in the 1.16–1.46 range, suggest that the behavior of aggregate healthcare in the 34 OECD countries tends toward those for luxury goods. Finally, through cross-country technology spillover effects, these OECD countries benefit significantly from international investments through technology cooperations resulting in jointly owned patents.

This chapter provides an assessment of the sustainability of Ireland's health care system. It starts by describing the historical development of the Irish system and identifying key features of the current system that raise potential challenges for sustainability. It then provides an analysis of recently compiled and up-to-date data on trends in health care expenditures. A number of specific demand and supply side challenges to sustainability are then described and discussed. This is followed by an examination of recent and current reforms to the health care system, focussing on their likely impact on sustainability, as well as a discussion of how health economics has and can inform policy, practice and debate. We also discuss the potential implications of the COVID-19 pandemic for the Irish system.

Little is known about perceptions of medical expenditure risks despite their presumed relevance to the demand for health insurance. This is the first study to examine households’ beliefs about their future spending on health care. The study made a unique elicitation of subjective probabilities of medical expenditures from rural Ethiopians participating in a panel survey and offered the opportunity to enrol in a health insurance programme. The vast majority of respondents give logically consistent responses to the subjective probability questions. The data indicate that the cross-sectional variance of realized expenditures, which is often used to proxy risk exposure, greatly overestimate the risk faced by any single household. Consistent with the serial correlation observed in realized expenditures, expectations are positively correlated with past expenses. They are revised upward in response to an increase in realized expenditure and, to some extent, they predict expenditure incurred in the year ahead. Despite containing information on future medical expenditures, there is no evidence that expectations influence the decision to take out health insurance, although plans to insure are positively related to the perceived volatility of expenses.

These results suggest that adverse selection may not threaten the viability of voluntary health insurance. A caveat is that measurement error in the reported probabilities may weaken the test for adverse selection. Notwithstanding this limitation, measurement of household-specific distributions of future medical expenses is feasible and avoids relying on the cross-sectional variance, which provides an upwardly biased estimate of medical expenditure risk.

The purpose of this paper is to examine the determinants of catastrophic household health expenditure in Nigeria, with particular focus on Out-of-Pocket (OOP) health expenditure. Payments for healthcare through OOP are the major means of channeling funds to healthcare providers in many developing countries including Nigeria. It has great consequence on household well-being, especially when it is difficult for household to meet up with spending on other necessity goods.

The demand for health theory provided the theoretical framework. The study used data from 2018/2019 Nigeria Living Standard Survey (NLSS) with catastrophic thresholds of 10 and 25%. A logistic regression model was used, while Pearson chi-squared test was used for models' goodness of fit.

Based on the obtained result using Pearson chi-squared, at 10% threshold of total non-food expenditure, the likelihood of experiencing catastrophic health expenditure increased with secondary education, for those without health insurance and for severely ill or injured by 1.48, 2.57 and 8.70, respectively. It fell for those who consulted patent medicine vendors/chemists for illness or injury by 0.63 compared to orthodox practitioners. Enhancement of post-secondary education and widening the coverage of the available social health insurance would minimise the financial burden on many households.

This paper fulfills the need to examine the determinants of catastrophic household health expenditure on two catastrophic thresholds and two forms of household expenditure.

This study investigates the impact of total health expenditure on life expectancy in a panel of 43 African countries from 2000 to 2018.

The dynamic panel generalized method of moments (GMM) estimation method developed by Arellano and Bond (1991) is used in this study. This approach generates estimates that are heteroskedasticity and autocorrelation consistent, as well as controls for unobserved time-invariant country-specific effects and eliminates any endogeneity in the panel model.

The results reveal that health expenditure on its own has a positive significant influence on life expectancy. However, health expenditure via the moderating effect of government effectiveness reduces life expectancy. The authors also observe that school enrollment and the level of economic activity significantly drive life expectancy.

The study is limited to 43 out of 54 African countries, and it covers a period of 18 years: 2000 to 2018.

The authors argue that larger health expenditure will aid in improving the life expectancy rate in Africa. However, in practice, this would be difficult given the needs of other priority sectors.

Since most developing countries' health expenditures are small, a policy option is that healthcare services should be subsidized such that the poorest people can also access them.

The study differs from the previous attempts, and with this, the authors contribute significantly to the literature. First, to the best of the authors’ knowledge, the authors are unaware of any study considering the role of government effectiveness as a moderating factor in investigating the effect of health expenditure on life expectancy in the African context. Thus, the authors fill a yawning gap in the literature. Second, the authors employ a recent dataset with larger sample size. Finally, to address the problem of endogeneity and simultaneity bias, the authors use the system GMM technique.

The study aims to compare India's public health expenditure at the international and state levels. The paper also empirically examines the regional disparities in NRHM spending across the 21 selected states of India.

The tools of absolute β-and σ-convergence are used in the analysis to test the regional convergence. The average annual growth rate across the states is the dependent variable for β-convergence, and time is the second dependent variable but is used for s-convergence. In contrast, the initial value of NRHM expenditure and the coefficient of variation of NRHM expenditure are used as independent variables, respectively. Descriptive statistics are also used for the study. The data are annual and cover the panel from 2007 to 2020.

The study attests to the hypothesis of β-and σ-convergence for the selected states in the period mentioned. The observed convergence in NRHM expenditure is due to the shift in the government's attention from the non-high focus high focus states to high states through the national rural health mission policy. The coefficient of variation across the states also shows a declining trend and provides the robustness of the σ-convergence.

As far as the literature is concerned, none of the existing studies examines the convergence of a public health expenditure scheme like the National Rural Health Mission across the Indian states by applying the techniques of β-and σ-convergence. The novelty of the study is using the newly updated dataset and validating the convergence hypotheses in the National Rural Health Mission expenditure case.

This paper examines the long-run and dynamic causal relationship among air pollution, health expenditure and economic growth in Mexico, Indonesia, Nigeria and Turkey (MINT countries).

The bounds test approach to cointegration and causality test was employed on data covering 1995–2018.

The study shows evidence of a long-run relationship among the variables in MINT countries and the causality test confirms the existence of a bidirectional causal nexus between health expenditure and economic growth in the four countries. It also confirms that there is a bidirectional causal relationship between carbon dioxide (CO₂) emission and economic growth, except in Nigeria where a unidirectional causal relationship was found running from CO₂ emissions to economic growth. In addition, a bidirectional causal relationship was found between air pollution and health expenditure in Turkey, while no causal relationship was found among these variables in Nigeria.

This study is limited by available data and it only focuses on four emerging economies. To address this, future studies can expand this scope to more emerging economies with severe air pollution and also extend the scope when more recent data becomes available.

This study suggests that pollution standards in MINT countries should be monitored and enforced with transparency so as to mitigate its health implications and ensure the sustainability of economic growth.

The study confirms the importance of keeping air pollution as low as possible because of its negative effect on health and economic output.

The study accounts for the complexity of each MINT country instead of providing a general discussion on the relationship between air pollution, health expenditure and economic growth in MINT countries.

Bangladesh is applauded for its achievement in various health and social outcomes though criticized for its failure in properly dealing with governance issues. The purpose of this paper is intends to see how the health outcomes (in case of life expectancy, under-five mortality and adolescent fertility) are impacted by health expenditure (both public and private), per capita income in presence of overall governance and female education. This paper assumes that rapid progress in female education reflects the Bangladeshis’ social responsiveness to change.

This paper uses autoregressive distributed lag technique to estimate the models with data ranges from 1990 to 2016 under two different scenarios.

This study has found that all the explanatory variables exert significant impact on health outcomes. Furthermore, public health expenditure is augmented with a composite governance issue, and this enhances robustness as well as statistical significance of the models. These suggest that the governance issues play a very crucial role to achieve the expected health outcomes. Female secondary enrolment ratio appears with improved coefficients in terms of sign and magnitude for all the health indicators.

This paper contributes to the existing literature showing econometric evidence that highlights the importance of governance and female education in improving health outcomes of Bangladesh apart from health expenditure and per capita gross domestic product.

Despite the global attempt at achieving goal 3 of the Sustainable Development Goals by improving health outcomes, some countries (West African countries inclusive) still do not spend a significant proportion of their income on health and they exhibit health outcomes that are still far below that of developed countries. Besides countries like Nigeria, Chad and Guinea-Bissau are experiencing worsening insecurity and political instability. This study, therefore, examines the effect of health expenditure on three health outcomes in the West African sub-region, while investigating the effect of the quality of governance in this nexus.

This study conducts an instrumental variable approach (two-stage least squares regression) on a panel of 15 West African countries over the period 2000–2018. This study uses three proxies to measure health outcomes and six measures of the quality of governance were also considered.

The result of this study shows that all forms of health expenditures significantly influenced health outcomes. That is, there is a negative relationship between health expenditure, infant mortality and under-five mortality, but a positive relationship between health expenditure and life expectancy at birth. Besides, the general effect of the same quantity of public health spending is subject to the quality of governance because countries with a higher quality of governance benefit better from their public health spending.

This study, to the authors' knowledge, is the first empirical attempt to examine the role of governance in the health expenditure-health outcomes nexus in 15 ECOWAS countries, using different measures of health outcomes and governance.