TY - UNPB
T1 - Assessing the impact of health care expenditures on mortality using cross-country data
AU - Nakamura, Ryota
AU - Lomas, James Richard Scott
AU - Claxton, Karl Philip
AU - Bokhari , Farasat
AU - Moreno Serra, Rodrigo Antonio
AU - Suhrcke, Marc Eckart
PY - 2016/4
Y1 - 2016/4
N2 - A significant body of literature has examined the impact of public health expenditure on mortality,
using a global cross-section or panel of country-level data. However, while a number of studies do
confirm such a relationship, the magnitude of the impact varies considerably between studies, and
several studies show statistically insignificant effects. In this paper we re-examine the literature that
identifies this effect using cross-country data. Our analysis builds on the two instrumental variables
(IV) approaches embodied by key publications in the field – Bokhari et al. (2007) and Moreno-Serra
and Smith (2015). Using exactly the same data and econometric specifications as the published
studies, we start by successfully replicating their findings. However, further analyses using updated
data and ‘streamlined’ econometric specifications, plus statistical data imputation and extensive
robustness checks, reveal highly sensitive results. In particular, the relevance of the IVs is seriously
compromised in the updated data, leading to imprecise estimations of the relationship. While our
results should not be taken to imply that there is no true mortality-reducing impact of public health
care expenditures on mortality, the findings do call for further methodological work, for instance in
terms of identifying more suitable IVs or by applying other estimation strategies, in an effort to
derive more robust estimates of the marginal productivity of public health care funding.
AB - A significant body of literature has examined the impact of public health expenditure on mortality,
using a global cross-section or panel of country-level data. However, while a number of studies do
confirm such a relationship, the magnitude of the impact varies considerably between studies, and
several studies show statistically insignificant effects. In this paper we re-examine the literature that
identifies this effect using cross-country data. Our analysis builds on the two instrumental variables
(IV) approaches embodied by key publications in the field – Bokhari et al. (2007) and Moreno-Serra
and Smith (2015). Using exactly the same data and econometric specifications as the published
studies, we start by successfully replicating their findings. However, further analyses using updated
data and ‘streamlined’ econometric specifications, plus statistical data imputation and extensive
robustness checks, reveal highly sensitive results. In particular, the relevance of the IVs is seriously
compromised in the updated data, leading to imprecise estimations of the relationship. While our
results should not be taken to imply that there is no true mortality-reducing impact of public health
care expenditures on mortality, the findings do call for further methodological work, for instance in
terms of identifying more suitable IVs or by applying other estimation strategies, in an effort to
derive more robust estimates of the marginal productivity of public health care funding.
M3 - Discussion paper
T3 - CHE Research Paper
SP - 1
EP - 57
BT - Assessing the impact of health care expenditures on mortality using cross-country data
PB - Centre for Health Economics, University of York
CY - York, UK
ER -