Regional well-being inequalities arising from healthcare expenditure public policies in Spain

Health expenditure, governance and SDG3 nexus: a longitudinal analysis in BRICS economies

BACKGROUND

Achieving Sustainable Development Goal 3 (SDG3): good health and well-being, requires significant health investments and effective governance. While many studies explored the influence of health expenditure and governance, little is known about how different levels of governance affect the relationship between health expenditure and SDG3 in a globalised world. Thus, this study aims to fill that gap by examining the marginal effects of health expenditure on SDG3 under varying levels of governance in BRICS economies.

METHODS

This study uses quantitative data spanning a panel of 2000-2023 years. Governance is measured using worldwide governance indicators, while health spending is represented by current health costs, government health costs, and private health costs from the World Development Indicators. Data on SDG3 comes from the SDG Index. Cross-sectional dependency, stationarity and cointegration tests are employed to choose appropriate panel data models. The final results are obtained using Fully Modified OLS, while System GMM is used to address issues like endogeneity, autocorrelation, instrumentation, and causality. To ensure the results are reliable, the study also tests alternative measures of governance.

RESULTS

1% increase in current and government health spending improves SDG3 by 3.92% and 2.86%, respectively, while a 1% rise in private health spending reduces it by 0.677%. This negative impact in BRICS nations is likely due to market failures in private healthcare, where profit-driven models limit access and efficiency. The positive impact of current and government health expenditure on health outcomes is comparatively weaker at lower levels of governance but private health expenditure and SDG3 are weakening by governance at different levels which is indicative of inefficiencies in resource allocation and implementation. This study supports institutional theory, which states that strong governance improves the effectiveness of public health spending, leading to better health outcomes. The study highlights how the geopolitical prominence of governance frameworks interacts to optimise the benefits of health investments, demonstrating their role as leaders in advancing global health initiatives. Thus, policymakers need an integrated approach in health investments with institutional reforms in achieving health outcomes more effectively as good governance significantly amplifies the relationship.

CONCLUSIONS

This study highlights that governance plays a key role in improving the impact of health spending on SDG3. Strong governance boosts the benefits of public health expenditure and limits the negative effects of private health expenditure. Thus, the findings stress the importance of effective governance in enhancing health outcomes in BRICS economies.

Assessment of radiological capacity and disparities in TB diagnosis: a comparative study of Mozambique, South Africa and Spain

Background

Tuberculosis (TB) remains a significant global health challenge, particularly in children, where diagnosis is challenging. Radiological resources such as chest X-rays and CT scans play a crucial role in early screening and diagnosis, especially in the absence of microbiological confirmation of disease. However, radiological capacity and access vary widely across regions and countries.

Methods

This study retrospectively audited licensed X-ray and CT units in Mozambique, South Africa and Spain in 2022. Population data were used to calculate units per million people. The study used choropleth maps to visualise regional disparities and to explore potential interactions between radiological capacity, population density and TB notifications.

Results

Mozambique had the lowest radiological capacity, with 3.6 X-ray units and 0.4 CT units per million people, compared with South Africa's 34.2 X-ray units, 5.8 CT units and Spain's 811.5 X-ray units and 19.3 CT units. The private sector exhibited higher capacity than the public sector in all countries. Regional disparities were evident, particularly in Mozambique, highlighting urban-rural discrepancies and in-country inequalities.

Conclusion

This study underscores significant disparities in radiological capacity between low-income, middle-income and high-income countries, with economic factors playing a pivotal role. Addressing these disparities is crucial for improving TB and other disease diagnostic capabilities, particularly in resource-limited settings. Potential solutions include establishing dedicated national radio-diagnostic departments, developing national guidelines and integrating portable AI-powered X-ray or point-of-care ultrasonography technology. These findings provide valuable insights for policymakers and stakeholders to advocate for improved radiological resources and equitable healthcare access.

What drives China's healthcare expenditure? A theoretical and empirical study of determinants and trends

As economic development advances, there is an increasing focus on improving health conditions, making healthcare expenditure a critical issue worldwide. In China, healthcare spending has shown a marked upward trend, highlighting the importance of understanding its underlying determinants to guide effective policy-making. This study introduces the application of an SV-TVP-FAVAR model to examine the drivers of healthcare expenditure in China from 2007 to 2022. The analysis reveals that economic factors, demographic composition, and policy interventions significantly influence healthcare spending dynamics. Economic growth is strongly linked to increased healthcare expenditure, with economic factors having a particularly pronounced impact during periods of prosperity. Although an aging population drives greater demand for healthcare, the growth rate of healthcare spending has not kept pace with demographic aging, especially following China's economic slowdown. Policy variables present a dual-edged impact: while increased fiscal outlays contribute to budget deficits, limiting the fiscal space for healthcare investment, government emphasis on scientific and technological progress tends to enhance healthcare spending, indicating a synergistic relationship between these areas. Furthermore, the study identifies a prolonged impact of the COVID-19 pandemic on healthcare expenditure, which continues to interact with other driving factors over an extended period. The empirical findings from this research provide crucial evidence to support the development of informed healthcare policies.

Estimation of Additional Costs in Patients with Ventilator-Associated Pneumonia

Healthcare-associated infections (HAIs) present a global public health challenge, contributing to high morbidity and mortality and substantial economic burdens. Ventilator-associated pneumonia (VAP) ranks as the second most prevalent HAI in intensive care units (ICUs), emphasizing the need for economic analyses in this context. This retrospective cohort study, conducted at the General Hospital of Alicante from 2012 to 2019, aimed to assess additional costs related to VAP by comparing the extended length of stay for infected and non-infected ICU patients undergoing mechanical ventilation (MV) for more than 48 h. Employing propensity score association, 434 VAP patients were compared to an equal number without VAP. The findings indicate a significantly longer mechanical ventilation period for VAP patients (17.40 vs. 8.93 days, p < 0.001), resulting in an extra 13.56 days of stay and an additional cost of EUR 20,965.28 per VAP episode. The study estimated a total cost of EUR 12,348,965.28 for VAP during the study period, underscoring the economic impact of VAP. These findings underscore the urgent need for rigorous infection surveillance, prevention, and control measures to enhance healthcare quality and reduce overall expenditures.

COVID-19 and Public Health Spending; Effects on the Economic Sustainability of the Spanish Private Healthcare System

This research analyzes the influence of COVID-19 and public health spending policies on the economic sustainability of Spanish private hospitals. Moreover, it explores the relationship between public health spending policies and the spread of COVID-19 in Spain. Private health care is an understudied sector, yet it is fundamental to the health of citizens. Moreover, the economic causes linked to the spread of the pandemic have not yet been clearly established. Therefore, this work covers a gap in the literature. Private hospital profitability was analyzed by applying ordinary least squares and panel data regressions on financial and macroeconomic data for the period 2017-2020. The spread of COVID-19 was examined by means of cluster and component analysis. The results show that the COVID-19 pandemic negatively affected the economic sustainability of Spanish private hospitals, which was also influenced by public health spending. In turn, the spread of the pandemic was mainly related to population density, but was also influenced by public health spending and the gross domestic product of the region. Therefore, policymakers must consider that it is essential to make adequate investments in the healthcare system to cope with pandemics such as COVID-19. In addition, managers can see how corporate social responsibility is a valuable strategy for maintaining hospital profitability.