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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.

The empirical analysis dealt in this paper emphasizes on the impact of military expenditures on out of pocket (OOP) healthcare payments. A sizeable body of defence economics literature has investigated the trade-off between military and public health expenditure, by testing the crowding-out or growth-stimulating hypothesis; does military expenditure scaling up crowd-out or promote governmental resources for social and welfare programs, including also state health financing?

In this study, panel data from 2000 to 2018 for 129 countries is used to examine the impact of military expenditure on OOP healthcare payments. The dataset of countries is categorized into four income-groups based on World Bank's income-group classification. Dynamic panel data methodology is applied to meet study objectives.

The findings of this study indicate that military expenditure positively affects OOP payments in all the selected groups of countries, strongly supporting in this way the crowding-out hypothesis whereby increased military expenditure reduces the public financing on health. Study econometric results are robust since different and alternative changes in specifications and samples are applied in our analysis.

Under the economic downturn backdrop for several economies in the previous decade and on the foreground of a potential limited governmental fiscal space related to the Covid-19 pandemic adverse economic effects, this study provides evidence that policy-makers have to adjust their government policy initiatives and prioritize Universal Health Coverage objectives. Consequently, the findings of this study reflect the necessity of governments as far as possible to moderate military expenditures and increase public financing on health in order to strengthen health care systems efficiency against households OOP spending for necessary healthcare utilization.

Despite the fact that a sizeable body of defence economics literature has extensively examined the impact of military spending on total and public health expenditures, nevertheless to the best of our knowledge there is no empirical evidence of any direct effect of national defence spending on the main private financing component of health systems globally; the OOP healthcare payments.

The paper demonstrates prejudicial effects of the rising private participation and the lacuna of state in ensuring the accessibility and affordability of healthcare.

Secondary data analysis from national and international databases is employed to demonstrate the low government spending and the alternate healthcare financing mechanisms in the country. The company reports of six Indian pharma companies are examined to map the profits and revenues, and also taking into account the sales growth and return on investment.

The paper observes the pharmaceutical sector, via its spiralling drug prices, is the primary contributor to the huge out-of-pocket expenses borne by households. The study findings indicate that there is an increased divergence between the out-of-pocket expenses of households and exorbitant profits of the private drug companies in the country over the years.

Amidst debates on the importance of public health in the aftermath of the pandemic, the paper examines the rising hands of private sector in healthcare, and implores – who benefits? The authors study the implications via looking into the rise in the wealth of pharma giants; at the time of crisis when the lives of common citizens in the country were at stake.

The paper emphasises the repercussions of the higher markup of the pharma industry in raising the healthcare costs of households. The authors emphasise that the nonregulation of the pharma sector leads to high medical debts/poverty, in the wake of growing out-of-pocket expenditures of the citizens.

The purpose of this study was to see the impact of increased out-of-pocket expenditure oh health care exerting budget pressure on households, which leads to change in dietary consumption.

It was a hospital-based cross-sectional study comprising 414 patients with a chronic or major illness attending a large tertiary care public hospital at Delhi, India. Each patient represented a household with total number of family members of 2,550 in the study. Questionnaire was used to gather data on factors responsible for changes in consumption of 12 major food items.

Moderate decrease in food consumption of a household after major illness is associated with: rural residence (p < 0.001), decrease in savings (p < 0.001), more number of household items sold (p < 0.001), education of the children affected (p < 0.001), upper socio-economic status (SES) (p < 0.001) and children started working after illness in family (p = 0.043). In addition to decrease in food items, there was also deterioration in quality of food preparation. More than 80% of the families did not change the intake of cereals (rice and wheat), pulses and sugar. Food items that were decreased by most families were fruits, followed by milk and its products, vegetables, meat and egg, oils and ghee.

This study is a subset of other two studies previously published. The authors had not been able to cover this aspect fully in those two studies but understood the importance of impact of expenditure on illness on food consumption. The authors studied change in food consumption pattern (not amount) in subjects after illness. The impact of weather changes in food consumption on the impacted nutritional status of family has not been studied. The authors only collected cross-sectional, observational data and recall bias cannot be completely ruled out and corrected. With such data, only associations could be concluded, not causality. The illness condition of a household was measured by presence of chronic disease and inpatient treatment. Such measures did not take into account the types of illness and number of episodes. Data of this study cannot capture whether food intake of family prior to illness was sufficient/in excess/deficient. The Kuppuswamy scale, mostly used in urban and peri-urban settings, was also used for rural subjects in the study, which might have resulted in impaired capture of rural SES. The authors did not assess whether families were allocated food grains by schemes like public distribution system, which might have resulted in biased decrease in food consumption. Questionnaire used was not validated.

This study demonstrates the various factors that act as barriers to proper food consumption, including non-financial factors. The policy of user fee in government is hitting poorer section, and equity and access to health are compromised. Health expenditure should be increased by public sector policies to implement uniform healthcare. There is need for more studies to identify measures that could be put in place when designing policies and interventions for the uniform distribution of benefits.

The policy of user fee in government is hitting poorer section, and equity and access to health are compromised. Health expenditure should be increased by public-sector policies to implement uniform healthcare.

Major or chronic illness affects money acquisition and priorities of expenditure, resulting in deterioration in quality of food consumption and by a household.

The author studies the determinants of public trust in government doctors and hospitals (DH) – a crucial indicator of the quality of a country's healthcare system – in India by analyzing the India Human Development Survey (IHDS) 2011–2012.

The author uses descriptive statistics and a set of ordered probit regression models controlling for a set of individual-specific, household-level and other covariates and analyze across heterogeneous contexts (national/rural/urban/male heads/female heads/social groups).

Across contexts, people reporting a great deal of trust in private DH (PDH) are significantly more likely to report a great deal of trust in government DH. Those people with a great deal of trust in government schools to provide good education (vis-à-vis people with only some trust in government school) have significantly higher likelihood of reporting a great deal of trust in government DH. Visiting a private doctor last time (vis-à-vis a government doctor) makes reporting higher trust levels in government DH less likely.

India's healthcare system is afflicted with several resource allocation problems and low public trust issues are indicative of misgovernance. In presence of limited state capacity, ubiquitous corruption and underwhelming institutional trust, understanding the factors influencing public trust in healthcare providers is critical to designing appropriate trust-enhancing public health policies.

Given the sparse empirical literature on public trust in healthcare systems in the developing countries such as India, this study is a pertinent contribution as the study explains the determinants of public trust in DH using a comprehensive unit-recorded household survey dataset.

Healthcare is indispensable for any civilisation to attain a good quality of life and well-being on both mental and physical levels. The healthcare domain primarily falls under pharma, medical, biotechnology, and nursing. Also, other fields may be aligned with these primary fields. Healthcare amasses the contemporary trends and knowledge of upcoming techniques to improve healthcare processes. The practitioners are primarily doctors, nurses, specialists and health professionals, hospital administrators, and health insurance.

It is a fundamental attribute needed for any society to attain good quality of life and well-being in mental and physical health. It is a fundamental right of people to receive good healthcare where drug treatment and hospitalization are available at a nominal cost, as a requirement of today’s modern era. There appears to be a significant disparity in the availability of good healthcare in rural areas compared to urban in India. Even though we enter the digital era with the facilities offered in Industry 4.0 and other advanced technologies brings about a significant change of overall processing within healthcare systems. During the pandemic of COVID-19, there has been digital transformation with success globally. Healthcare cooperatives are a new norm to support the healthcare systems globally. The chapter discusses Gampaha healthcare cooperative and reviews Ayushman Sahakar scheme in India. The reforms require time to evolve.

Healthcare property has become an important alternate property sector in recent years for many international institutional investors. The purpose of this paper is to assess the risk-adjusted performance, portfolio diversification benefits and performance dynamics of French healthcare property in a French property portfolio and mixed-asset portfolio over 1999–2020. French healthcare property is seen to have different performance dynamics to the traditional French property sectors of office, retail and industrial property. Drivers and risk factors for the ongoing development of the direct healthcare property sector in France are also identified, as well as the strategic property investment implications for institutional investors.

Using annual total returns, the risk-adjusted performance, portfolio diversification benefits and performance dynamics of French direct healthcare property over 1999–2020 are assessed. Asset allocation diagrams are used to assess the role of direct healthcare property in a French property portfolio and in a French mixed-asset portfolio. The role of specific drivers for French healthcare property performance is also assessed. Robustness checks are also done to assess the potential impact of COVID-19 on the performance of French healthcare property.

French healthcare property is shown to have different performance dynamics to the traditional French property sectors of office, retail and industrial property. French direct healthcare property delivered strong risk-adjusted returns compared to French stocks, listed healthcare and listed property over 1999–2020, only exceeded by direct property. Portfolio diversification benefits in the fuller mixed-asset portfolio context were also evident, but to a much lesser extent in a narrower property portfolio context. Importantly, this sees French direct healthcare property as strongly contributing to the French property and mixed-asset portfolios across the entire portfolio risk spectrum and validating the property industry perspective of healthcare property being low risk and providing diversification benefits in a mixed-asset portfolio. However, this was to some degree to the loss or substitution of traditional direct property exposure via this replacement effect. French direct healthcare property and listed healthcare are clearly shown to be different channels in delivering different aspects of French healthcare performance to investors. Drivers of French healthcare property performance are also shown to be both economic and healthcare-specific factors. The performance of French healthcare property is also shown to be different to that seen for healthcare property in the UK and Australia. During COVID-19, French healthcare property was able to show more resilience than French office and retail property.

Healthcare property is an alternate property sector that has become increasingly important in recent years. The results highlight the important role of direct healthcare property in a French property portfolio and in a French mixed-asset portfolio, with French healthcare property having different investment dynamics to the other traditional French property sectors. The strong risk-adjusted performance of French direct healthcare property compared to French stocks, listed healthcare and listed property sees French direct healthcare property contributing to the mixed-asset portfolio across the entire portfolio risk spectrum. French healthcare property’s resilience during COVID-19 was also an attractive investment feature. This is particularly important, as many institutional investors now see healthcare property as an important property sector in their overall portfolio; particularly with the ageing population dynamics in most countries and the need for effective social infrastructure. The importance of French direct healthcare property sees direct healthcare property exposure accessible to investors as an important alternate real estate sector for their portfolios going forward via both non-listed healthcare property funds and the further future establishment of more healthcare REITs to accommodate both large and small institutional investors respectively. The resilience of French healthcare property during COVID-19 is also an attractive feature for future-proofing an investor’s portfolio.

This paper is the first published empirical research analysis of the risk-adjusted performance, diversification benefits and performance dynamics of French direct healthcare property, and the role of direct healthcare property in a French property portfolio and in a French mixed-asset portfolio. This research enables empirically validated, more informed and practical property investment decision-making regarding the strategic role of French direct healthcare property in a portfolio; particularly where the strategic role of direct healthcare property in France is seen to be different to that in the UK and Australia via portfolio replacement effects. Clear evidence is also seen of the drivers of French healthcare property performance being strongly influenced by healthcare-specific factors, as well as economic factors.

Estimation of (in)efficiency became a popular practice that witnessed applications in virtually any sector of the economy over the last few decades. Many different models were deployed for such endeavors, with Stochastic Frontier Analysis (SFA) models dominating the econometric literature. Among the most popular variants of SFA are Aigner, Lovell, and Schmidt (1977), which launched the literature, and Kumbhakar, Ghosh, and McGuckin (1991), which pioneered the branch taking account of the (in)efficiency term via the so-called environmental variables or determinants of inefficiency. Focusing on these two prominent approaches in SFA, the goal of this chapter is to try to understand the production inefficiency of public hospitals in Queensland. While doing so, a recognized yet often overlooked phenomenon emerges where possible dramatic differences (and consequently very different policy implications) can be derived from different models, even within one paradigm of SFA models. This emphasizes the importance of exploring many alternative models, and scrutinizing their assumptions, before drawing policy implications, especially when such implications may substantially affect people’s lives, as is the case in the hospital sector.

As China’s industrial structure continues to upgrade and optimize, the consumption capacity of rural residents gradually improves and the role of consumption in economic growth is increasingly prominent. Against the background of weak external demand, the untapped potential of rural consumption has become a key force in expanding domestic demand. As one of the important means that the government has long relied on, fiscal support for agriculture has played a crucial role in activating the rural consumer market. This manuscript aims to explore the impact of local fiscal support for agricultural expenditure (FSAE) on rural consumption in China, as well as to examine the mediating role of the level of rural financial development.

In this manuscript, the authors use the provincial panel data of 31 provinces in China from 2000 to 2020. The data of all variables mainly come from China Statistical Yearbook and China Rural Statistical Yearbook. According to the variable selection above, 651 sample data of 31 provinces and cities across China from 2000 to 2020 are organized. In terms of methodology, multiple fixed-effects panel model is applied to regression.

Firstly, FSAE varies significantly, while rural consumption slowly but steadily rises, with a relatively stable consumption structure. Secondly, FSAE has a significant positive effect on rural consumption. Thirdly, mediation testing indicates that mechanisms such as income, uncertainty and financial development have significant positive mediating effects on rural consumption. Thirdly, there is evident regional heterogeneity in FSAE’s impact on rural consumption. The Western regions, under government fiscal support, show a more significant effect on the elevation of rural consumption levels, while the role of FSAE in optimizing the consumption structure of rural residents in eastern and central regions is more pronounced.

Firstly, a systematic examination of local FSAE and rural consumption has been conducted, enriching relevant theories. Secondly, utilizing econometric empirical methods to research the relationship between local FSAE and rural consumption provides an exploratory extension to empirical studies on rural consumption in China. This offers empirical evidence for local fiscal support in agricultural development and the promotion of rural consumption.