Healthcare Expenditure and Development Indices of Health in Nigeria: A Time Series Econometric Approach
DOI:
https://doi.org/10.71637/tnhj.v25i1.954Keywords:
Good health and well-being, Reduced Inequalities, life expectancyAbstract
Background: This study analyses the relationship between healthcare expenditure and development indices of health in Nigeria, such as life expectancy, infant mortality, and maternal mortality. Although healthcare expenditure has improved following the Millennium Development Goals, Nigeria continues to lag in converting this investment into significant improvements in healthcare outcomes. This motivates the study of the performance of various expenditure structures.
Method: The study utilises annual time series data from reputable organisations such as the Central Bank of Nigeria and the World Health Organisation. The Least Squares (LS) and Autoregressive Distributed Lag (ARDL) cointegration approaches estimate short-run and long-run relationships between health expenditure and health indicators.
Findings: The findings reveal that public health expenditure is positively related to life expectancy and negatively related to infant and maternal mortality, though the latter relationships are not always statistically significant. Private health expenditure is positively associated with life expectancy and negatively with mortality. Foreign health assistance and health expenditure per capita show weak associations with life expectancy and mortality rates. Out-of-pocket spending is negatively correlated with life expectancy and positively with infant and maternal mortality. Population growth is strongly linked to increased life expectancy and reduced mortality rates.
Conclusion: The study discovers that private health spending is a more significant determinant of increasing Nigeria's health outcomes over public spending, and out-of-pocket spending is a reverse determinant. Such conclusions suggest the necessity of greater public-private collaboration and reduction in out-of-pocket dependence to achieve improved development measures of health in Nigeria.
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References
1. Aboubacar B, Xu D. The impact of health expenditure on economic growth in sub-Saharan Africa. Theor Econ Lett. 2017;7(3):615–22. doi:10.4236/tel.2017.73046
2. Ali MA, Ullah MI, Asghar M. Effect of health expenditure on GDP, a panel study based on Pakistan, China, India and Bangladesh. Int J Health Econ Policy. 2017;2(2):57–62. doi: 10.11648/j.hep.20170202.13
3. Anyanwu JC, Erhijakpor AEO. Health expenditures and health outcomes in Africa. Afr Dev Bank Econ Res Work Pap. 2007;(91):1–40.
4. Baal PV, Obulqasim P, Brouwer W, Nusselder W, Mackenbach J. The influence of health care spending on life expectancy. Netspar Panel Pap. 2013;(35).
5. Banda P, Masiye F, Kaonga O, Bump J, Berman P. Determining household out-of-pocket payments, incidence of catastrophic expenditures and impoverishment among patients with malaria in Zambia’s path towards universal health coverage. PLoS One. 2024;19(12):e0312906.
6. Barasa EW, Maina T, Ravishankar N. Assessing the impoverishing effects, and factors associated with the incidence of catastrophic health care payments in Kenya. Int J Equity Health. 2017;16:1–14.
7. Bassey JU, Riman HB, Edu BE, Ibi EE. Poverty, health expenditure, and health status: a long-term perspective with evidence from Nigeria. 2010a. Available from: http://www.ssrn.com
8. Bassey JU, Riman HB, Edu BE. Health care expenditure in Nigeria: does the level of government spending really matter? 2010b. Available from: http://www.ssrn.com
9. Bedir S. Healthcare expenditure and economic growth in developing countries. Adv Econ Bus. 2016;4(2):76–86. doi:10.13189/aeb.2016.040202
10. Bello RA. Reducing malaria in Nigeria: a public health expenditure conundrum. Niger J Econ Soc Stud. 2005;47(2):175–88.
11. Brenner MH. Influence of health care expenditures, GDP, employment and globalization on cardiovascular disease mortality: potential implications for the current recession. Int J Bus Soc Sci. 2012;3(20): Special Issue.
12. Breyer F, Felder S. Life expectancy and health care expenditures: a new calculation for Germany using the costs of dying. Health Policy. 2006;75(2):178–86.
13. Chandrasiri J, Anuranga C, Wickramasinghe R, Rannan-Eliya RP. The impact of out-of-pocket expenditures on poverty and inequalities in use of maternal and child health services in Bangladesh: evidence from the household income and expenditure surveys 2000–2010. Asian Dev Bank RETA–6515 Country Brief. 2012.
14. Fabella MC, Fabella RV. Population growth and infant mortality. UP Sch Econ Discus Pap. 2008;(0810).
15. Frisch R. Statistic confluences analysis by means of complete regression systems. 1934.
16. Gbosi AN. International trade in theory and practice. Port Harcourt: Amethyst & Colleagues Publishers; 2011.
17. Gillani QD, Gillani SAS, Naeem MZ, Spulbar C, Coker-Farrell E, Ejaz A, et al. The nexus between sustainable economic development and government health expenditure in Asian countries based on ecological footprint consumption. Sustainability. 2021;13(12):6824. https://doi.org/10.3390/su13126824
18. Gujarati DN, Sangeetha. Basic econometrics. 4th ed. New Delhi: McGraw-Hill Companies; 2007.
19. Güven D, Şi̇mşek T, Güven A. Sağlik yönetimi kapsaminda sağlik harcamalarinin ekonomik büyüme üzerine etkisi: MENA ülkeleri üzerine bir panel regresyon analizi. SosyoEkon. 2018;26(37):33–55. doi:10.17233/sosyoekonomi.2018.03.02
20. Huang G, Guo F, Liu L, Taksa L, Cheng Z, Tani M, et al. Changing impact of COVID-19 on life expectancy 2019–2023 and its decomposition: findings from 27 countries. SSM Popul Health. 2024; 25:101568.
21. Jaba E, Balan CB, Robu LB. The relationship between life expectancy at birth and health expenditures estimated by a cross-country and time-series analysis. Emerg Mark Queries Finance Bus. 2014;15(1):108–14.
22. Jiménez-Gamero MD, Valdora M, Rodríguez D. Testing homoscedasticity of a large number of populations. Statistical Papers. 2025 Feb;66(2):1-32.
23. Kim DY, Jung HJ, Kim BH. How does medical expenditure affect economic development? Evidence from OECD countries. Int Rev Financ Consum. 2019;4(1):39–50. doi:10.36544/irfc.2019.1-1.3
24. Kim TK, Lane SR. Government health expenditure and public health outcomes: a comparative study among 17 countries and implications for US health care reform. Am Int J Contemp Res. 2013;3(9).
25. Li L, Wu M, Wu Z. The impact of public health expenditure on economic development – evidence from prefecture-level panel data of Shandong province. Res World Econ. 2017;8(2):59. doi:10.5430/rwe.v8n2p59
26. Murthy V, Okunade A. The core determinants of health expenditure in the African context: some econometric evidence for policy. Health Policy. 2009;91(1):57–62.
27. Ndaguba EA, Hlotywa A. Public health expenditure and economic development: the case of South Africa between 1996 and 2016. Cogent Econ Financ. 2021;9(1). doi:10.1080/23322039.2021.1905932
28. Nkemgha GZ, Tékam HO, Belek A. Healthcare expenditure and life expectancy in Cameroon. J Public Health (Berl). 2020;1–9. doi:10.1007/s10389-019-01181-2
29. Nketiah-Amponsah E. The impact of health expenditures on health outcomes in sub-Saharan Africa. J Dev Soc. 2019;35(1):134–52.
30. Novignon J, Olakojo SA, Nonvignon J. The effects of public and private health care expenditure on health status in sub-Saharan Africa: new evidence from panel data analysis. Health Econ Rev. 2012;2(22). Available from: http://www.healtheconomicsreview.com/content/2/1/22
31. Obrizan M, Wehby GL. Health expenditures and life expectancy around the world: a quantile regression approach. Discussion Paper Series. Kyiv: Kyiv School of Economics and Kyiv Economics Institute; 2012.
32. Odhiambo SA, Wambugu A, Kiriti-Ng’ang’a T. Effect of health expenditure on child health in sub-Saharan Africa: governance perspective. J Econ Sustain Dev. 2015;6(8).
33. Ogungbenle S, Olawumi OR, Obasuyi FOT. Life expectancy, public health spending and economic growth in Nigeria: a vector autoregressive (VAR) model. Eur Sci J. 2013;9(19).
34. Olaniyan O, Olayiwola S, Odubunmi S. The impact of health expenditure on the elderly in Nigeria. Pak J Soc Sci. 2011;8(4):212–8.
35. Park S. Medical service utilisation and out-of-pocket spending among near-poor National Health Insurance members in South Korea. BMC Health Serv Res. 2021;21(1):886.
36. Penghui X. Direct and indirect effects of health expenditure on economic growth in China. East Mediterr Health J. 2022;28(3):204–12. https://doi.org/10.26719/emhj.22.007
37. Pesaran MH, Shin Y, Smith RJ. Bounds testing approaches to the analysis of level relationships. J Appl Econ. 2001; 16:289–326.
38. Pesaran MH, Shin Y. An autoregressive distributed lag modelling approach to cointegration analysis. In: Strom S, editor. Econometrics and economic theory in the 20th century: The Ragnar Frisch Centennial Symposium. Cambridge: Cambridge University Press; 1999.
39. Piabuo SM, Tieguhong JC. Health expenditure and economic growth—a review of the literature and an analysis between the Economic Community for Central African States (CEMAC) and selected African countries. Health Econ Rev. 2017;7(1). https://doi.org/10.1186/s13561-017-0159-1
40. Rad EH, Vahedi S, Teimourizad A, Esmaeilzadeh F, Hadian M, Pour AT. Comparison of the effects of public and private health expenditures on the health status: a panel data analysis in Eastern Mediterranean countries. Int J Health Policy Manag. 2013;1(2):163–7.
41. Rahman MM, Khanam R, Rahman M. Health care expenditure and health outcome nexus: new evidence from the SAARC-ASEAN region. Glob Health. 2018;14(113):1–11.
42. Rezapour A, Mousavi A, Lotfi F, Soleimani Movahed M, Alipour S. The effects of health expenditure on health outcomes based on the classification of public health expenditure: a panel data approach. Shiraz E-Med J. 2019;20(12):1–7.
43. Roy A. A panel data study on the effect of climate change on life expectancy. PLoS Clim. 2024;3(1):e0000339.
44. Salari P, Di Giorgio L, Ilinca S, Chuma J. The catastrophic and impoverishing effects of out-of-pocket healthcare payments in Kenya, 2018. BMJ Glob Health. 2019;4(6).
45. Sangar S, Dutt V, Thakur R. Burden of out-of-pocket health expenditure and its impoverishment impact in India: evidence from National Sample Survey. J Asian Public Policy. 2022;15(1):60–77.
46. Steel N, Bauer-Staeb CMM, Ford JA, Abbafati C, Abdalla MA, Abdelkader A, et al. Changing life expectancy in European countries 1990–2021: a subanalysis of causes and risk factors from the Global Burden of Disease Study 2021. Lancet Public Health. 2025.
47. Tadiwos YB, Kassahun MM, Mebratie AD. Catastrophic and impoverishing out-of-pocket health expenditure in Ethiopia: evidence from the Ethiopia socioeconomic survey. Health Econ Rev. 2025;15(1):15.
48. Tufaner MB, Dizge F, Emir Z. Health expenditure-economic growth relationship in OECD countries. Int Conf Eurasian Econ. 2020.
49. Xu K, Saksena P, Holly A. The determinants of health expenditure: a country-level panel data analysis. World Health Organ Working Pap Results Dev Inst (R4D). 2011. Available from: www.resultsfordevelopment.org
50. Xu K, Saksena P, Jowett M, Indikadahena C, Kutzin J, David B, et al. Exploring the thresholds of health expenditure for protection against financial risk. World Health Report (2010) Background Paper. 2010;(19).
51. Yaqub JO, Ojapinwa TV, Yussuff RO. Public health expenditure and health outcome in Nigeria: the impact of governance. Eur Sci J. 2012;8(13).
52. Yimer Ali B, Moracha Ogeto R. Healthcare expenditure and economic growth in Sub-Saharan Africa. Asian J Econ Bus Account. 2020; 1-7. http://dx.doi.org/10.9734/ajeba/2019/v13i230170
53. Sede PI, Ohemeng W. Socio-economic determinants of life expectancy in Nigeria (1980 - 2011). Health Econ Rev [Internet]. 2015;5(1):2. Available from: http://dx.doi.org/10.1186/s13561-014-0037-z
54. Sengupta K. Health Expenditure and its Impact on health Status. Proceedings of International Academic Conferences [Internet]. 2015; Available from: https://ideas.repec.org/p/sek/iacpro/2804594.html
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