Cross
national determinants of health status "Wealthier
is Healthier" (with Lawrence Summers). Journal
of Human Resources. 31(4) 1996. This
paper demonstrates that there is a causal relationship from income
to health status (under 5 or infant mortality) by using changes in
health status on changes in income and using instrumental variables
for changes in income. This if course does not say income is
the only factor (as there are large improvements in mortality
"unexplained" by trends in come) nor does it rule out some
reverse causation from health status to subsequent growth (although
we do not provide evidence of any). "The Impact of Public Spending on Health: Does Money
Matter?" (with
Deon Filmer). Social Science and Medicine
49(10), 1999. This
paper produces cross-national regressions of the determinants of
under 5 mortality rates. It has three principal
findings: (a) a small set of socioeconomic determinants
(income, distribution of income, female education, predominant
religion, and ethnolinguistic diversity) explain nearly all the
variation in health status, (b) variations in public spending on
health explain almost none of the variation, (c) the gap between the
"apparent efficacy" of public spending in producing
improvements in health status and the estimates of "potential
efficacy" of individual interventions (e.g. the "medical
intervention cost-effectiveness") is often orders of
magnitude. This suggests a variety of reasons why
public spending has not been as effective as it might (see
below). Note that this does not say that public spending cannot
be effective or that it has never been effective, but
only that, on average across countries, given the existing patterns
of spending, the total of public spending appears not to have
been particularly effective in improving mortality. |