Per capita income and public health expenditure: what makes good child health outcomes in Tanzania? a comparison of Frequentist and Bayesian approach (1995-2013)
Keywords:Bayesian, Frequentist, Health Outcomes, Public Spending.
Using data for World Bank Development Indicators (2015) database from 1995 to 2013, this paper explores the impact of public health expenditure on national health outcomes in Tanzania while GDP per capita and improved sanitation facilities as explanatory variables were controlled for. Two national health outcomes indicators namely, infant and under-five mortality were used as dependent variables. With separate modeling approach, Frequentist and Bayesian based on time series and Markov Chain Monte Carlo (MCMC) respectively, empirical evidence shows that income, represented by real GDP per capita lower infant and under-five mortality in Tanzania. Under both methodological approach regardless of the sample size, we failed to support evidence that, public health expenditure and improved sanitation facilities had an impact on child health outcomes. Our results imply that, public health spending in Tanzania is poorly targeted to bring good child health outcomes. The paper draws attention to policy makers in Tanzania to focus either within public health spending composition or beyond to other close determinants of infant and under-five mortality.
 Akinci, F., Hamid, S., Suvankulor, F., & Akhmedjonov, A. (2014). Examining the Impact of Health Care Expenditures on Health Outcomes in the Middle East and North Africa Region. Journal of Health Care Finance ,41(1), 2-23.
 Akinkugbe, O., & Mohanoe, M. (2009). Public Health Expenditure as a Determinant of Health Status in Lesotho. Social Work in Public Health, 24(1-2), 131-147. http://dx.doi.org/10.1080/19371910802569716
 Anand, S., & Ravallion, M. (1993). Human Development in Poor Countries: On the Role of Private Incomes and Public Services. Journal of Economic Perspectives, 7(1), 133-150.https://doi.org/10.1257/jep.7.1.133.
 Anyanwu, J., & Erhijakpor, A. E. (2007). Health Expenditures and Health Outcomes in Africa. Delta State University Economic Research. Working Paper No.91 .http://www.afdb.org/fileadmin/uploads/afdb/Documents/Knowledge
 Asiedu, E., Gaekwad, N. B., Nanivazo, M., Nkusu, M., & Yi, J. (2015). On the Impact of Income per Capital on Health Outcomes: Is Africa Different? Journal of Economic Literature, JEL F23, D72.
 Barenberg, A. J., Basu, D., & Soylu, C. (2015). The Effect of Public Health Expenditure on Infant Mortality: Evidence from a Panel of Indiana States 1983-1984 to 2011-2012. Working Paper,University of Massachusetts.
 Barlow, R., & Vissandjee, B. (1999). Determinants of National Life Expectancy.Canadian Journal of Development Studies, 20 (1), 9-29.
 Bidani, B., & Ravallion, M. (1997). Decomposing Social Indicators using Distributional Data. Journal of Econometrics, 77, 125-139. https://doi.org/10.1016/S0304-4076(95)01809-3.
 Bloom, D. E., Canning, D., & Sevilla, J. (2004). The Effects of Health on Economic Growth: A Production Function Approach. World Development, 32 (1), 1-13 https://doi.org/10.1016/j.worlddev.2003.07.002.
 Boachie, M. K., & Ramu, K. (2016). Effect of Public Health Expenditure on Health Status in Ghana.International Journal of Health, 4 (1), 6-11.https://doi.org/10.14419/ijh.v4i1.5794.
 Bokhari, F. A., Gai, Y., & Gottret, P. (2007). Government Health Expenditures and Health Outcome. Journal of Health Economics, 16 (3), 257-273.https://doi.org/10.1002/hec.1157.
 Burnside, C., & Dollar, D. (1998). Aid,the Incentive Regime and Poverty Reduction. Policy Research Working Paper No. 1937, World Bank, Washington DC.
 Byaro, M., & Musonda, P. (2016). Impact of Public Health Expenditure on Infant and Under -Five Mortality In Tanzania (1995-2013): An application of Bayesian Approach. Journal of Economics and Sustainable Developments, 7 (12), 178-187.
 Cevik, S., & Tasar, M. O. (2013). Public Spending on Health Care and Health Outcomes:Cross Country Comparison. Journal of Business,Economics and Finances, 2 (4), 82-100.
 Deluna, R. J., & Peralta, T. F. (2014). Public Health Expenditures,Income and Health Outcomes in the Philippines. MPRA , 1 -20.
 Demery, L., & Walton, M. (1998). Are Poverty Reduction and Other 21st Century Social Goals Attainable? World Bank,Washington DC.
 Dieleman, J. L. (2013). Three Essays on Government Health Expenditure.Unpublished PhD Dissertation, University of Washngton. https://digital.lib.washington.edu https://doi.org/10.1177/1094428112457829.
 Elola, J., Daponte, A., & Navarro, V. (1995). Health Indicators and the Organization of Health Care System in Western Europe. American Journal of Public Health, 85 (10), 1397-1401.https://doi.org/10.2105/AJPH.85.10.1397.
 Emamgholipour, S., & Asemane, Z. (2016). Effects of Governance Indicators on Under-Five Mortality in OECD Nationals:Generalized Methods of Moments. Electronic Physician, 8 (1), 1747-1751.https://doi.org/10.19082/1747.
 Filmer, D., & Pritchett, L. (1999). The Impact of Public Spending on Health: Does Money Matter? Social Science and Medicine, 49 (10), 1309-1323.doi.org/10.1016/S0277-9536 (99)00150-1
 Filmer, D., Hammer, J., & Pritchett, L. (2000). Weaks Links in The Chain: A Diagnosis of Health Policy in Poor Countries. The World Bank Research Observer, 15(2), 199-224.https://doi.org/10.1093/wbro/15.2.199.
 Filmer, Deon, & Pritchett, L. (1997). Child Mortality and Public Spending on Health:How Much Does Money Matter? World Bank Policy Research Working Paper No. 1864.
 Gani, A. (2009). Health Care Financing and Health Outcomes in Pacific Island Countries. Health Policy and Planning, 24(1), 72-81.https://doi.org/10.1093/heapol/czn044.
 Gujarati, D. (2004). Basic Econometrics (4 Edition ed.). Washngton: Irwin and McGraw Hill,New York.
 Gupta, S., Verhoeven, M., & Tiongson, E. (2002). The Effectiveness of Government Spending on Education and Health Care in Developing and Transition Economies. European Journal of Political Economy, 18(4), 717-737.https://doi.org/10.1016/S0176-2680(02)00116-7.
 Hojman, E. D. (1996). Economic and Other Determinants of Infant and Child Mortality in Small Developing Countries:The Case of Central America and the Caribbean. Applied Economics, 28(3), 281-290.https://doi.org/10.1080/000368496328641.
 Holmes, H. A., Magoma, M., John, T., Levira, F., Msemo, G., Armstrong, C. E., et al. (2015). Tanzanias Countdown to 2015:An Analysis of Two Decades of Progress and Gaps for Reproductive,Maternal,Newborn, and Child Health,to Inform Priorities for Post 2015. The Lancent Global Health, 3(7), e396-e409.https://doi.org/10.1016/S2214-109X(15)00059-5.
 Issa, H., & Quattara, B. (2005). The Effects of Private and Public Health Expenditure on Infant Mortality Rates: Does the Level of Development Matters? University of Wales Swansea.
 Kim, K., & Moody, P. M. (1992). More Resources Better Health? A Cross National Perspectives. Social Science and Medicine, 34(8), 837-842.https://doi.org/10.1016/0277-9536(92)90253-M.
 Kim, T. K., & Lane, S. R. (2013). Government Health Expenditure and Public Health Outcomes:A Comparative Study Among 17 Countries and Implications for US Health Care Reform. American International Journal of Comtemporary Research, 3 (9), 8-13.
 Kruschke, J. K., Aguinis, H., & Jo, H. (2012). The Time Has Come:Bayesian Methods for Data Analysis in the Organizational Sciences. Sage Journals, 15(4),722 -752.
 Lopez, C. (2007). Health and Economic Growth:Findings and Policy Implications. MIT Press.
 Masanja, H., Savigny, D. d., Smithson, P., John, T., Mbuya, C., Upunda, G., et al. (2008). Child Survival Gains in Tanzania:Analysis of Data From Demographic and Health Surveys. The Lancent, 371 (9620), 1276-1283.https://doi.org/10.1016/S0140-6736(08)60562-0.
 McGuire, J. W. (2006). Basic Health Care Provision and Under Five Mortality: A cross National study on developing countries. World Development, 34 (3), 405-425.https://doi.org/10.1016/j.worlddev.2005.08.004.
 Meshkani, Z., Karyani, A. K., Kazemi, Z., Shaahmadi, F., & Arefi, Z. (2015). The Main Determinants of Under-Five Mortality Rate in OECD Countries: A Cross Sectional Study. International Journal of Pediatr, 3 (14), 421- 427. http:// ijp.mums.ac.ir.
 Musgrove, P. (1996). Public and Private roles in Health.In Technical Report 339. Washington DC: World Bank.
 Narayan, S., Narayan, P. K., & Mishra, S. (2010). Investigating the Relationship between Health and Economic Growth. Empirical Evidence from a Panel of 5 Asian Countries. Journal of Asian Economics, 21 (4), 404-411https://doi.org/10.1016/j.asieco.2010.03.006.
 Nishiyama, A. (2011). Economic Growth and Infant Mortality in Developing Countries. European Journal of Development Research, 23(4), 630-647.https://doi.org/10.1057/ejdr.2011.17.
 Nixon, J., & Ulmann, P. (2006). The Relationship Between Health Care Expenditure and Health Outcomes. European Journal of Health Economics, 7(1), 7-18.https://doi.org/10.1007/s10198-005-0336-8.
 Novignon, J., Olakojo, S., & Justice, N. (2012). The Effects of Public and Private Health Care Expenditure on Health Status in Sub-Saharan Africa: A New Evidence from Panel Data Analysis. Health Economic Review, 2 (22).https://doi.org/10.1186/2191-1991-2-22.
 Ntzoufras, L. (2009). Bayesian Modelling Using WinBUGS. John Wiley and Sons, Inc.https://doi.org/10.1002/9780470434567.
 O' Hare. B., Makuta, I., Chiwaula, L., & Zeev, N. B. (2013). Income and Child Mortality in Developing Countries: A Systematic Review and Meta Analysis. Journal of the Royal Society of Medicine, 106 (10), 408-414. https://doi.org/10.1177/0141076813489680.
 Pritchett, L., & Summers, L. H. (1996). Wealthier is Healthier. Journal of Human Resources, 31 (4), 841-868.https://doi.org/10.2307/146149.
 Quintana, P. G., & Nason, J. M. (2012). Bayesian Estimation of DSGE Models. Working Paper No 12-4,Federal Reserve Bank of Philadelphia, p. 12.
 Schell CO., Reilly M., Rosling H., Peterson S., & Ekstrom AM. (2007). Socioeconomic Determinants of Infant Mortality: A Worldwide Study of 152 Low, Middle and High Income Countries.Scandnavia Journal of Public Health, 35(3), 288-97.https://doi.org/10.1080/14034940600979171.
 Singh, S. R. (2014). Public Health Spending and Population Health. A Systematic Review. American Journal of Preventive Medicine, 47 (5), 634-640.https://doi.org/10.1016/j.amepre.2014.05.017.
 Ssozi, J., & Amlani, S. (2015). The Effectiveness of Health Expenditure on the Proximate and Ultimate Goals of Healthcare in Sub Saharan Africa. World Development, 76, 165-179.https://doi.org/10.1016/j.worlddev.2015.07.010.
 Susuman, S. A., & Hamisi, F. H. (2012). Under-Five Mortality in Tanzania:Demographic Scenario. Iranian Journal of Public Health, 41 (12), 8-18.
 Wagstaff, A., & Claeson, M. (2004). The Millenium Development Goals for Health:Rising to the Challenges: 169-174.
 WHO. (2000). The World Health Report:Health Systems,Improving Perfomance. World Health Organization.
 World Bank. (2015). World Development Indicators Database. Washington, DC: World Bank.Available online athttp://data.worldbank.org/data-catalog/world-development-indicator.
 Yaqub, O., & Yussuff. (2012). Public Health Expenditure and Health Outcome in Nigeria: The Impact of Governance. European Scientific Journal, 8 (13), 189-201.