IDEAS home Printed from https://ideas.repec.org/a/spr/futbus/v11y2025i1d10.1186_s43093-025-00472-3.html
   My bibliography  Save this article

Evaluating the nexus between health expenditure and health outcomes with consideration for income characteristics in SSA countries

Author

Listed:
  • Ebere Ume Kalu

    (University of Nigeria)

  • Chuck Augustine Arize

    (Texas A&M University—Commerce)

  • Felicia Osondu Okwueze

    (University of Nigeria)

  • Ndubuisi Udemezue

    (Alex Ekwueme Federal University)

Abstract

This paper revisits the interaction between health expenditure and health outcomes and government effectiveness with consideration for the income classification of the investigated countries. It is an inquiry into the degree to which income status of countries can influence the health expenditure and health outcome nexus in the SSA countries. The data for the study were drawn from sub-Saharan African Countries (SSA) covering the period 1960–2020. The study follows a country-specific comparative approach using the autoregressive distributed lag model (ARDL) as the major estimation technique. It was discovered that poor health outcomes are not just due to inadequate budgetary allocations to the sector, but it is also symptomatic of the inefficiency associated to management of public resources in SSA countries. The study further found cointegrating relationship and strong adjustment of health outcomes to the shocks and dynamics of not just health expenditure but also government effectiveness. In the income classification dimensions, it was found out that the health expenditure and outcome nexus in high- and middle-income countries of SSA tend to be higher as income status gave vent to higher budgetary allocation. It is therefore that strong institutions, improved budgetary allocation and support for the low-income countries be made to increase the beneficial impact of public health spendings.

Suggested Citation

  • Ebere Ume Kalu & Chuck Augustine Arize & Felicia Osondu Okwueze & Ndubuisi Udemezue, 2025. "Evaluating the nexus between health expenditure and health outcomes with consideration for income characteristics in SSA countries," Future Business Journal, Springer, vol. 11(1), pages 1-22, December.
    • Handle: RePEc:spr:futbus:v:11:y:2025:i:1:d:10.1186_s43093-025-00472-3
    DOI: 10.1186/s43093-025-00472-3
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1186/s43093-025-00472-3
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1186/s43093-025-00472-3?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Janet Currie & Mark Stabile, 2003. "Socioeconomic Status and Child Health: Why Is the Relationship Stronger for Older Children?," American Economic Review, American Economic Association, vol. 93(5), pages 1813-1823, December.
    2. Dreger, C. & Reimers, H.E., 2005. "Health Care Expenditures in OECD Countries: A Panel Unit Root and Cointegration Analysis," International Journal of Applied Econometrics and Quantitative Studies, Euro-American Association of Economic Development, vol. 2(2), pages 5-20.
    3. Farasat A. S. Bokhari & Yunwei Gai & Pablo Gottret, 2007. "Government health expenditures and health outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 16(3), pages 257-273, March.
    4. Bloom, David E. & Canning, David & Sevilla, Jaypee, 2004. "The Effect of Health on Economic Growth: A Production Function Approach," World Development, Elsevier, vol. 32(1), pages 1-13, January.
    5. Khanam, Rasheda & Nghiem, Hong Son & Connelly, Luke B., 2009. "Child health and the income gradient: Evidence from Australia," Journal of Health Economics, Elsevier, vol. 28(4), pages 805-817, July.
    6. Steffen Reinhold & Hendrik Jürges, 2012. "Parental income and child health in Germany," Health Economics, John Wiley & Sons, Ltd., vol. 21(5), pages 562-579, May.
    7. Marwa Farag & A. NandaKumar & Stanley Wallack & Dominic Hodgkin & Gary Gaumer & Can Erbil, 2012. "The income elasticity of health care spending in developing and developed countries," International Journal of Health Economics and Management, Springer, vol. 12(2), pages 145-162, June.
    8. Marijn Verhoeven & Mr. Sanjeev Gupta & Mr. Erwin H Tiongson, 1999. "Does Higher Government Spending Buy Better Results in Education and Health Care?," IMF Working Papers 1999/021, International Monetary Fund.
    9. Christopoulos, Konstantinos & Eleftheriou, Konstantinos, 2020. "The fiscal impact of health care expenditure: Evidence from the OECD countries," Economic Analysis and Policy, Elsevier, vol. 67(C), pages 195-202.
    10. Gary S. Becker, 1964. "Human Capital: A Theoretical and Empirical Analysis with Special Reference to Education, First Edition," NBER Books, National Bureau of Economic Research, Inc, number beck-5, October.
    11. Michael Jetter & Sabine Laudage & David Stadelmann, 2019. "The Intimate Link Between Income Levels and Life Expectancy: Global Evidence from 213 Years," Social Science Quarterly, Southwestern Social Science Association, vol. 100(4), pages 1387-1403, June.
    12. Y. Natalia Alfonso & Guiru Ding & David Bishai, 2016. "Income Elasticity of Vaccines Spending versus General Healthcare Spending," Health Economics, John Wiley & Sons, Ltd., vol. 25(7), pages 860-872, July.
    13. David Cutler & Grant Miller, 2005. "The role of public health improvements in health advances: The twentieth-century United States," Demography, Springer;Population Association of America (PAA), vol. 42(1), pages 1-22, February.
    14. Filmer, Deon & Pritchett, Lant, 1999. "The impact of public spending on health: does money matter?," Social Science & Medicine, Elsevier, vol. 49(10), pages 1309-1323, November.
    15. Gupta, Sanjeev & Verhoeven, Marijn & Tiongson, Erwin R., 2002. "The effectiveness of government spending on education and health care in developing and transition economies," European Journal of Political Economy, Elsevier, vol. 18(4), pages 717-737, November.
    16. Robert Haveman & Barbara Wolfe & Lawrence Buron & Steven C. Hill, 1995. "The Loss Of Earnings Capability From Disability/Health Limitations: Toward A New Social Indicator," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 41(3), pages 289-308, September.
    17. Chyke A Doubeni & Guruprasad D Jambaulikar & Hassan Fouayzi & Scott B Robinson & Margaret J Gunter & Terry S Field & Douglas W Roblin & Robert H Fletcher, 2012. "Neighborhood Socioeconomic Status and Use of Colonoscopy in an Insured Population – A Retrospective Cohort Study," PLOS ONE, Public Library of Science, vol. 7(5), pages 1-7, May.
    18. Bound, John, 1989. "The Health and Earnings of Rejected Disability Insurance Applicants," American Economic Review, American Economic Association, vol. 79(3), pages 482-503, June.
    19. Joseph P. Newhouse, 1977. "Medical-Care Expenditure: A Cross-National Survey," Journal of Human Resources, University of Wisconsin Press, vol. 12(1), pages 115-125.
    20. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-255, March-Apr.
    21. Pierre‐Yves Crémieux & Pierre Ouellette & Caroline Pilon, 1999. "Health care spending as determinants of health outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 8(7), pages 627-639, November.
    22. Hitiris, Theo & Posnett, John, 1992. "The determinants and effects of health expenditure in developed countries," Journal of Health Economics, Elsevier, vol. 11(2), pages 173-181, August.
    23. Mishra, Prachi & Newhouse, David, 2009. "Does health aid matter?," Journal of Health Economics, Elsevier, vol. 28(4), pages 855-872, July.
    24. Gallet, Craig A. & Doucouliagos, Hristos, 2017. "The impact of healthcare spending on health outcomes: A meta-regression analysis," Social Science & Medicine, Elsevier, vol. 179(C), pages 9-17.
    25. Lucia Hanmer & Robert Lensink & Howard White, 2003. "Infant and child mortality in developing countries: Analysing the data for Robust determinants," Journal of Development Studies, Taylor & Francis Journals, vol. 40(1), pages 101-118.
    26. Mikael Lindahl, 2005. "Estimating the Effect of Income on Health and Mortality Using Lottery Prizes as an Exogenous Source of Variation in Income," Journal of Human Resources, University of Wisconsin Press, vol. 40(1).
    27. Mihaela Onofrei & Anca-Florentina Vatamanu & Georgeta Vintilă & Elena Cigu, 2021. "Government Health Expenditure and Public Health Outcomes: A Comparative Study among EU Developing Countries," IJERPH, MDPI, vol. 18(20), pages 1-13, October.
    28. Ephraim Kleiman, 1974. "The Determinants of National Outlay on Health," International Economic Association Series, in: Mark Perlman (ed.), The Economics of Health and Medical Care, chapter 5, pages 66-88, Palgrave Macmillan.
    29. Gerdtham, Ulf-G. & Sogaard, Jes & Andersson, Fredrik & Jonsson, Bengt, 1992. "An econometric analysis of health care expenditure: A cross-section study of the OECD countries," Journal of Health Economics, Elsevier, vol. 11(1), pages 63-84, May.
    30. Mcintyre, Di & Meheus, Filip & Røttingen, John-Arne, 2017. "What level of domestic government health expenditure should we aspire to for universal health coverage?," Health Economics, Policy and Law, Cambridge University Press, vol. 12(2), pages 125-137, April.
    31. David Bloom & David Canning, 2003. "The Health and Poverty of Nations: From theory to practice," Journal of Human Development and Capabilities, Taylor & Francis Journals, vol. 4(1), pages 47-71.
    32. Bichaka Fayissa & Paulos Gutema, 2008. "A Health Production Function for Sub-Saharan Africa (SSA)," Working Papers 200808, Middle Tennessee State University, Department of Economics and Finance.
    33. Currie, Alison & Shields, Michael A. & Price, Stephen Wheatley, 2007. "The child health/family income gradient: Evidence from England," Journal of Health Economics, Elsevier, vol. 26(2), pages 213-232, March.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Micheal Kofi Boachie & Tatjana Põlajeva & Albert Opoku Frimpong, 2020. "Infant Mortality in Low- and Middle-income Countries: Does Government Health Spending Matter?," Journal of Development Policy and Practice, , vol. 5(1), pages 54-73, January.
    2. AfDB AfDB, 2007. "Working Paper 91 - Health Expenditures and Health Outcomes in Africa," Working Paper Series 2224, African Development Bank.
    3. AfDB AfDB, 2007. "Working Paper 91 - Health Expenditures and Health Outcomes in Africa," Working Paper Series 2304, African Development Bank.
    4. Micheal Kofi Boachie & K. Ramu & Tatjana Põlajeva, 2018. "Public Health Expenditures and Health Outcomes: New Evidence from Ghana," Economies, MDPI, vol. 6(4), pages 1-25, October.
    5. Yusuke Kamiya, 2010. "Determinants of Health in Developing Countries:Cross-Country Evidence," OSIPP Discussion Paper 10E009, Osaka School of International Public Policy, Osaka University.
    6. Muhammad Arshad Khan & Muhammad Iftikhar Ul Husnain, 2019. "Is health care a luxury or necessity good? Evidence from Asian countries," International Journal of Health Economics and Management, Springer, vol. 19(2), pages 213-233, June.
    7. Marwa Farag & A. NandaKumar & Stanley Wallack & Dominic Hodgkin & Gary Gaumer & Can Erbil, 2012. "The income elasticity of health care spending in developing and developed countries," International Journal of Health Economics and Management, Springer, vol. 12(2), pages 145-162, June.
    8. Marwa Farag & A. Nandakumar & Stanley Wallack & Dominic Hodgkin & Gary Gaumer & Can Erbil, 2013. "Health expenditures, health outcomes and the role of good governance," International Journal of Health Economics and Management, Springer, vol. 13(1), pages 33-52, March.
    9. Hilaire Gbodja Houeninvo, 2022. "Effects of health expenditures on infant and child mortality rates: A dynamic panel data analysis of 37 African countries," African Development Review, African Development Bank, vol. 34(2), pages 255-267, June.
    10. Owen O'Donnell & Eddy Van Doorslaer & Tom Van Ourti, 2013. "Health and Inequality," Tinbergen Institute Discussion Papers 13-170/V, Tinbergen Institute.
    11. Baltagi, Badi H. & Moscone, Francesco, 2010. "Health care expenditure and income in the OECD reconsidered: Evidence from panel data," Economic Modelling, Elsevier, vol. 27(4), pages 804-811, July.
    12. repec:dau:papers:123456789/7972 is not listed on IDEAS
    13. Otto Lenhart, 2019. "The effects of income on health: new evidence from the Earned Income Tax Credit," Review of Economics of the Household, Springer, vol. 17(2), pages 377-410, June.
    14. Felipa de Mello-Sampayo & Sofia de Sousa-Vale, 2014. "Financing Health Care Expenditure in the OECD Countries: Evidence from a Heterogeneous, Cross-Sectional Dependent Panel," Panoeconomicus, Savez ekonomista Vojvodine, Novi Sad, Serbia, vol. 61(2), pages 207-225.
    15. Fan, Victoria Y. & Savedoff, William D., 2014. "The health financing transition: A conceptual framework and empirical evidence," Social Science & Medicine, Elsevier, vol. 105(C), pages 112-121.
    16. Barkat, Karim & Sbia, Raschid & Maouchi, Youcef, 2019. "Empirical evidence on the long and short run determinants of health expenditure in the Arab world," The Quarterly Review of Economics and Finance, Elsevier, vol. 73(C), pages 78-87.
    17. Olorunfemi Yasiru Alimi & Kazeem Bello Ajide, 2021. "The role of institutions in environment–health outcomes Nexus: empirical evidence from sub-Saharan Africa," Economic Change and Restructuring, Springer, vol. 54(4), pages 1205-1252, November.
    18. Boachie, Micheal Kofi & Ramu, K., 2015. "Public Health Expenditure and Health Status in Ghana," MPRA Paper 66371, University Library of Munich, Germany.
    19. Otto Lenhart, 2019. "The effects of health shocks on labor market outcomes: evidence from UK panel data," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(1), pages 83-98, February.
    20. Y. Natalia Alfonso & Guiru Ding & David Bishai, 2016. "Income Elasticity of Vaccines Spending versus General Healthcare Spending," Health Economics, John Wiley & Sons, Ltd., vol. 25(7), pages 860-872, July.
    21. Mujaheed Shaikh & Afschin Gandjour, 2019. "Pharmaceutical expenditure and gross domestic product: Evidence of simultaneous effects using a two‐step instrumental variables strategy," Health Economics, John Wiley & Sons, Ltd., vol. 28(1), pages 101-122, January.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:futbus:v:11:y:2025:i:1:d:10.1186_s43093-025-00472-3. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.