Does Public Spending Reflect the Need for Health: A Cross-sectional Analysis at District Level in India.

BACKGROUND: There is mixed evidence on the extent of association between the allocation of public revenue for healthcare and its indicators of need. OBJECTIVE: In this study, we examined the relationship between allocations through state health financing (SHF) and the Central Government with infant mortality. MATERIALS AND METHODS: District-wise infant mortality rate (IMR) was computed using National Family Health Survey-4 data. State-wise data for health budgets through SHF and National Health Mission (NHM, a Centrally Sponsored Scheme), were obtained for the year 2015-16. We used a multivariable analysis through generalized linear model method using identity-link function. RESULTS: We found per capita SHF (₹3169) to be more than 12 times that of public health spending per capita through NHM (₹261). IMR was lower in districts with higher SHF allocation, although statistically insignificant. The allocation through NHM was higher in districts with higher IMR, which is statistically significant. Every unit percentage increase in per capita net state domestic product and female literacy led to 0.31% and 0.54% decline, while a 1% increase in under-five diarrhoea prevalence led to 0.17% increase in IMR. CONCLUSION: The NHM has contributed to enhancing vertical equity in health-care financing. The States' need to be more responsive to the differences in districts while allocating health-care resources. There needs to be a focus on spending on social determinants, which should be the cornerstone for any universal health coverage strategy.

Investigating the relationship of government revenue and expenditure on economic growth using a generalized method of moments: Does state-level panel ensure sustainable growth?

The current research project investigates the correlation between economic growth, government spending, and public revenue in seventeen Indian states spanning the years 1990 to 2020. An analysis of the relationship between key fiscal policy variables and economic growth was conducted utilising a panel data approach, the Generalised Method of Moments (GMM), and fully modified Ordinary Least Squares (FMOLS & DOLS) estimation. In our investigation, we assessed the impacts of non-tax revenue, development plan expenditure, tax revenue, and development non-plan expenditure on (i) the net state domestic product (NSDP) and (ii) the NSDP per capita. The findings indicate that the selected fiscal variables are significantly related. The results indicate that expeditious expansion of the fiscal sector is obligatory to stimulate economic growth in India and advance the actual development of the economies of these states.

Análise econômica dos gastos diretos com internações hospitalares por vítimas de trauma do Sistema Único de Saúde em um município de Minas Gerais, 2011-2021 / Economic analysis of direct expenses with hospital admissions for victims of trauma in the United Health System in a municipality of Minas Gerais, 2011-2021

Objetivo: Determinar o perfil epidemiológico de pacientes atendidos pelo Sistema Único de Saúde (SUS), em determinado município do interior de Minas Gerais, bem como os gastos financeiros e o repasse financeiro para os centros de atendimento de traumas. Material e métodos: Trata-se de um estudo ecológico, descritivo, realizado a partir da coleta de dados pelo SIH-SUS, no período de janeiro de 2011 a dezembro de 2021, em um município do interior de Minas Gerais. Resultados: Foi identificado um total de 14.138 pacientes, com maior acometimento de pessoas do sexo masculino, com idade entre 15 e 44 anos. Como causas mais frequentes, destacaram-se os traumatismos de quadril e coxa, seguidos de traumatismos de membros superiores (ombro, antebraço, braço, punho e mão) e cabeça. Como tempo médio de permanência hospitalar, houve 4.693 diárias entre 2011 e 2021 secundárias a complicações em enfermarias e unidade de terapia intensiva, elevando cerca de 2,37% os valores repassados pelo SUS no período estudado. Em resumo, a análise da incidência de traumas nas emergências de um município do interior de Minas Gerais revela uma preocupante tendência em que homens na faixa etária de 15 a 44 anos emergem como as principais vítimas. Esse padrão pode ser influenciado por fatores como ocupação, comportamentos de risco e mobilidade. Conclusão: A compreensão dessa demografia específica é crucial para direcionar estratégias de prevenção e resposta adequadas. A implementação de medidas educativas, segurança no trânsito e promoção da saúde mental pode contribuir para mitigar os impactos dos traumas nesse grupo demográfico, melhorando sua qualidade de vida e a saúde geral da comunidade.

Objective: To determine the epidemiological profile of patients assisted by the unified health system, in a certain municipality in the interior of Minas Gerais, as well as the financial expenses and the financial transfer to trauma care centers. Material and methods: This is an ecological, descriptive study, carried out from data collection by SIH-SUS, from January 2011 to December 2021 in a municipality in the interior of Minas Gerais. Results: a total of 14,138 patients were identified, with greater involvement of male people aged between 15 and 44 years. As the most frequent causes, trauma to the hip and thigh stood out, followed by trauma to the upper limbs (shoulder, forearm, arm, wrist and hand) and head. As for the average length of hospital stay, there were 4,693 daily stays between 2011 and 2021 secondary to complications in wards and the intensive care unit. Increasing about 2.37% in the values transferred by the unified health system between the studied decade. In summary, the analysis of the incidence of trauma in emergencies in a municipality in the interior of Minas Gerais reveals a worrying trend in which men aged 15 to 44 years emerge as the main victims. This pattern can be influenced by factors such as occupation, risky behavior and mobility. Conclusion: Understanding this specific demographic is crucial to targeting appropriate prevention and response strategies. The implementation of educational measures, road safety and mental health promotion can help to mitigate the impacts of trauma in this demographic group, improving their quality of life and the general health of the community.

Public expenditure on health care and the incidence of non-communicable diseases (NCDs) in China from 2008 to 2018.

OBJECTIVES: This study investigates whether differences in individual-level and provincial-level health funding could explain or mitigate health inequalities among older people in terms of non-communicable diseases within a population served by fragmented health insurance schemes. STUDY DESIGN: A national repeated cross-sectional analysis was done of the 2008, 2011, 2014, and 2018 Chinese Longitudinal Healthy Longevity Surveys. These provided a total of 44,623 persons aged 60 and over. MAIN OUTCOME MEASURES: Respondents were asked whether they had been diagnosed with any types of non-communicable diseases by doctors. A dichotomous outcome variable was constructed to indicate whether older people had any diagnosed non-communicable diseases. RESULTS: Compared with uninsured older persons, those who were enrolled in social health insurance schemes designed for civil servants as cadres, urban employees and urban residents were more likely to report a higher incidence of non-communicable diseases. There were no significant differences in the prevalence of non-communicable diseases between uninsured older people and those in the New Rural Cooperative Medical Scheme. Although the incidence of non-communicable diseases among older persons increased over the study period, greater health expenditure was significantly associated with a lower risk of non-communicable diseases. The interaction results between individual social health insurance schemes and public health expenditure indicate that disparities in the incidence of non-communicable diseases among different health insurance schemes diminish as public health expenditure increases. Older individuals with Public Free Medical Services benefited the most in provinces with higher public health expenditure compared with other health insurance schemes. CONCLUSIONS: Given the evidence of the beneficial effects of universal health coverage on non-communicable diseases among older persons, these results should encourage policy makers to increase public health funding and to raise the overall benefit packages for social health insurance schemes.

Маблағгузории тандурустӣ, хароҷотҳои давлатӣ, Тоҷикистон, фарогирии умумии хизматрасониҳои тандурустӣ

Ҳисоботи мазкур мухтасари арзёбии Матритсаи Пешрафти Маблағгузории Тандурустӣ (HFPM) дар Тоҷикистонродар бар мегирад, ки ҷиҳатҳои қавӣ ва заъфи системаи мавҷудаи маблағгузории тандурустӣ ва инчунин онмушкилоти маблағгузории тандурустиро муайян мекунад, ки бояд барои ноил гардидан ба фарогирии умумиихизматрасониҳои тандурустӣ (ФУХТ) ҳал карда шаванд. Натиҷаҳо дар якчанд ҷадвалҳои гуногуни ҷамъбастӣдар асоси ҳафт соҳаи арзёбӣ ва 19 хусусияти дилхоҳи маблағгузории тандурустӣ пешниҳод карда мешаванд. Ботамаркуз ҳам ба вазъи кунунӣ ва ҳам самтҳои афзалиятноки ислоҳоти оянда, ин гузориш рӯзномаи афзалиятнокробарои корҳои таҳлилӣ ва дастгирии техникии марбут ба он пешниҳод мекунад. Маълумоти охирин дар бораинишондиҳандаҳои Тоҷикистон дар робита ба ФУХТ ва нишондиҳандаҳои асосии хароҷоти тандурустӣ низ пешниҳодкарда мешаванд. Ҷавобҳои муфассал ба саволҳои инфиродӣ дар пойгоҳи иттилоотии СУТ дар бораи арзёбиикишварҳо ё тибқи дархост дастрасанд.

Оценка системы финансирования здравоохранения, Таджикистан 2023: матрица оценки прогресса в области финансирования здравоохранения

В этом отчете представлено краткое изложение оценки Матрицы прогресса в области финансирования здравоохранения (МПФЗ)в Таджикистане, определяющее сильные и слабые стороны существующей системы финансирования здравоохранения, а такжете области финансирования здравоохранения, которые необходимо решить, чтобы обеспечить прогресс на пути к всеобщемуздравоохранению. покрытие (ВОУЗ). Результаты представлены в нескольких различных сводных таблицах, основанных на семиобластях оценки и 19 желательных атрибутах финансирования здравоохранения. Сосредоточив внимание как на текущей ситуации,так и на приоритетных направлениях будущих реформ, этот отчет представляет собой приоритетную программу аналитическойработы и соответствующей технической поддержки. Также представлена последняя информация о достижениях Таджикистана вобласти ВОУЗ и ключевых показателей расходов на здравоохранение. Подробные ответы на отдельные вопросы доступны в базеданных страновых оценок ВОЗ МПФЗ или по запросу.

[PUBLIC EXPENDITURE ON MENTAL HEALTH IN ISRAEL: CALCULATION, ANALYSIS AND INTERNATIONAL COMPARISON].

INTRODUCTION: This is the first health economics study to calculate and analyze public expenditure on mental health in Israel from 2019 through 2021. Financing of the NIS 4 billion expenses is divided equally between the health funds and direct financing from the state budget.

Old age takes its toll: Long-run projections of health-related public expenditure in Luxembourg.

This paper simulates long-term trends in Luxembourg's public expenditure on healthcare and on long-term care. We combine population projections with micro-simulations of individuals' health status that account for their demographic, socio-economic characteristics and their childhood circumstances. Model equations estimated on data from the SHARE survey and from several branches of Social Security provide a rich framework to study policy-relevant applications. We simulate public expenditure on healthcare and long-term care under different scenarios to evaluate the separate contributions of population ageing, costs of producing health-related services, and the distribution of health status across age cohorts. Results suggest that rising per capita expenditure on healthcare will mostly result from production costs, while rising expenditure on long-term care will mostly reflect population ageing.

Effects of public expenditures on environmental pollution: evidence from G-7 countries.

In this study, the effect of public expenditures and, their sub-components on environmental pollution is discussed in G-7 countries. Two different periods were used in the study. These are the period 1997-2020 for general public expenditure, and the period 2008-2020 for public expenditure sub-components. For cointegration, Westerlund cointegration test was used, and according to the analysis result there is a cointegration relationship between general government expenditure and environmental pollution. Panel Fourier Toda-Yamamoto causality test was used to determine the causality relationship between public expenditures and environmental pollution and the result indicates that there is bidirectional causality between public expenditures and CO2 on a panel basis. For models estimation, System the Generalized Method of Moments (GMM) method was used. The findings of the study indicate that general public expenditures decrease environmental pollution. Considering at the results of the sub-components of public expenditures, housing and community amenities, social protection, health expenditure, economic affairs, recreation, culture & religion expenditures have a negative effect on environmental pollution. Other control variables generally  have a statistically significant effect on environmental pollution. Energy consumption and population density increase environmental pollution but environmental policy stringency index, renewable energy and GDP per capita reduce environmental pollution.

What is the impact of national public expenditure and its allocation on neonatal and child mortality? A machine learning analysis.

BACKGROUND: Understanding the impact of national public expenditure and its allocation on child mortality may help governments move towards target 3.2 proposed in the 2030 Agenda. The objective of this study was to estimate the impacts of governmental expenditures, total, on health, and on other sectors, on neonatal mortality and mortality of children aged between 28 days and five years. METHODS: This study has an ecological design with a population of 147 countries, with data between 2012 and 2019. Two steps were used: first, the Generalized Propensity Score of public spending was calculated; afterward, the Generalized Propensity Score was used to estimate the expenditures' association with mortality rates. The primary outcomes were neonatal mortality rates (NeoRt) and mortality rates in children between 28 days and 5 years (NeoU5Rt). RESULTS: The 1% variation in Int$ Purchasing Power Parity (Int$ PPP) per capita in total public expenditures, expenditure in health, and in other sectors were associated with a variation of -0.635 (95% CI -1.176, -0.095), -2.17 (95% CI -3.051, -1.289) -0.632 (95% CI -1.169, -0.095) in NeoRt, respectively The same variation in public expenditures in sectors other than health, was associates with a variation of -1.772 (95% CI -6.219, -1.459) on NeoU5Rt. The results regarding the impact of total and health public spending on NeoU5Rt were not consistent. CONCLUSION: Public investments impact mortality in children under 5 years of age. Likely, the allocation of expenditures between the health sector and the other social sectors will have different impacts on mortality between the NeoRt and the NeoU5Rt.

Effect of Public Expenditure on Economic Growth in the Case of Ethiopia.

This study's primary goal was to explain how Ethiopia's economic growth affected government spending. The time series data utilized in the study were gathered between 1980 and 2018. The time series data were subjected to the Johansen cointegration test and the vector error correction model (VECM) in order to evaluate the short- and long-term correlations between public spending and economic growth in Ethiopia. According to the study, both long- and short-term economic growths are positively and significantly impacted by government spending on education. Long-term economic growth is negatively impacted by government expenditure on agriculture, while short-term effects are negatively impacted and considerable. In the long run, investment spending has a positive but negligible impact on economic growth; however, in the short run, it has a negative but large effect. Defense spending by the government has a positive and negligible effect on economic growth over the short and long terms. Both in the short and long terms, spending on health has a favorable and considerable impact on economic growth. According to the study, government spending on the education sector would help to foster the conditions that could result in higher labor force participation rates and, consequently, higher rates of economic growth. Aiming to establish a healthy and productive society that promotes economic progress, policy should focus on complementary measures to scale-up initiatives in the health sector.

Analysis and intervention of heatwave related economic loss: Comprehensive insights from supply, demand, and public expenditure into the relationship between the influencing factors.

Increasing extreme temperatures are producing a serious impact on the economies of cities. However, the importance of social factors is typically neglected by the existing research. In this work, we first establish a supply-demand-public expenditure (SDP) framework for assessing and forecasting heat-related economic loss. Compared with the previous framework, SDP possesses a more comprehensive index system and functions that apply to all types of cities. We selected different economic development and geographical locations (Nanjing, Suzhou, and Yancheng) as case studies to verify the wide applicability of the SDP framework. A qualitative analysis and quantitative prediction of heatwaves and socioeconomic factors on losses were conducted for different cities. The results showed that different loss types displayed obvious regional heterogeneity among the cities. The labor value loss was the most significant type, and health loss was the most vulnerable type. In addition, public expenditure played a neglected critical regulatory role. Apart from these, the current level of public expenditure for heat prevention and control remains insufficient. Based on an assessment of the effects of interventions, policymakers need to make more efforts to increase the proportion of heat-related public spending and ensure stable socio-economic development by utilizing pathways with positive intervention potentials.

Expenditure of biological drugs for rheumatoid arthritis treatment in the Brazilian public health system

ABSTRACT OBJECTIVE This work aims to analyze the quantity and expenses related to biological drugs used for the treatment of rheumatoid arthritis (RA) in outpatient public care within the Brazilian Unified Health System (SUS). METHODS It is a cross-sectional descriptive study based on secondary data from a historical series, referring to the purchase, volume, and the number of patients treated with different biological drugs (infliximabe, etanercept, adalimumab, rituximab, abatacept, tocilizumab, golimumab, and certolizumab pegol) for RA treatment in outpatient care from 2012 to 2017. The data were extracted from the SUS Outpatient Information System database-SIA/SUS and included ten drugs used for RA treatment. The study assessed the quantity and expenditure of these drugs, the number of RA patients treated, and the expenditure by RA subtypes. The National Broad Consumer Price Index was used to adjust the expenditures for December 2017. RESULTS The Ministry of Health allocated approximately $500 million to provide about 2 million units of biological drugs for RA patients from 2012 to 2017. The supply of adalimumab 40 mg and etanercept 50 mg accounted for 68.3% of the total expenditure. The subtypes "other rheumatoid arthritis with rheumatoid factor" (ICD-10 M05.8), "rheumatoid arthritis without rheumatoid factor" (ICD-10 M06.0), and "Felty's syndrome" (M05. 0) represented 84.5% of the total expenditures. The proportion of patients treated with biological drugs increased by 33.0%. There was a significant 83.0% increase in the number of patients using biological drugs compared to the overall number of RA patients treated during the study period. CONCLUSIONS The results obtained allow us to draw a more recent profile of expenditure on RA treatment and indicate trends in the use of biological drugs for this condition, generating data that can support management decisions in public health policies.

Cost-related variables in the public purchase of dental materials for endodontic application: 10-year analysis

Aim: This study analyzed public procurements for different endodontic materials used in the Brazilian public health system and evaluated the variables related to their cost. Methods: A time-series study was performed by screening materials for endodontic application in the public Brazilian Databank of Healthcare Prices from 2010 to 2019. Data were categorized according to material composition and clinical application. The collated variables were used in a multiple linear regression model to predict the impact of unit price in procurement processes. Results: A total of 5,973 procurement processes (1,524,693 items) were evaluated. Calcium hydroxides were found in 79% of the observations (4,669 processes). Prices drop each year by US$1.87 while MTAs and epoxy resins are increasingly purchased at higher prices (US$50.87; US$67.69, respectively). The microregion, the procurement modality, and the type of institution had no influence on unit prices in the adjusted model (p > 0.05). Conclusions: Calcium hydroxide-based materials were the cheapest and most frequently purchased endodontic materials in the public health care system. Novel formulations are being implemented into clinical practice over time and their cost may be a barrier to the broad application of materials such as MTAs, despite their effectiveness

Does increasing public expenditure on sports promote regional sustainable development: Evidence from China.

In the post-COVID era, how to improve the level of regional sustainable development has attracted much attention. And the vigorous development of the sports economy may be closely related to the regional sustainable development. This paper explores the impact and mechanism analysis of government sports public expenditure on regional sustainable development from the perspective of sports economic development. The study found that China's sustainable development presents obvious ladder-like characteristics and highlights the regional imbalance and inadequacy of regional green and coordinated development. And the government's increase in public expenditure on sports can significantly promote regional sustainable development and improve the level of regional green and coordinated development. With the continuous improvement of the regional economic development, the effect of sports public expenditure continues to increase. It can be seen from this that implementing the strategy of strengthening the country through sports under the government's guidance is an essential guarantee for the public health and quality of life and the sustainable development of the economy and society. Additionally, the development level of market finance is also an important driving factor for the government's public expenditure on sports to improve the level of sustainable development in the region. From the mechanism analysis, the government activates the local residents' consumption level by increasing the public expenditure on sports, thus promoting regional sustainable development.

Public Expenditure and Green Total Factor Productivity: Evidence from Chinese Prefecture-Level Cities.

Whilst effective public expenditure policies are essential for transforming the traditional factor-driven economy into a green and innovation-driven economy, the impacts of public expenditure's size and composition on green economic development have not been comprehensively investigated. This paper attempts to fill this research gap. Based on the data of Chinese prefecture-level cities from 2010 to 2018, we first measure green total factor productivity (GTFP), the proxy variable for green development, and briefly analyze its spatial-temporal trends. Then, using the dynamic panel models, dynamic panel mediation models, and dynamic panel threshold models, we evaluate how public expenditure affects GTFP. The main findings are fourfold: (1) there is a significant inverted U-shaped relationship between the expenditure size and GTFP. (2) The expansion of social expenditures and science and technology (S&T) and environmental protection expenditures play an important role in stimulating green growth, while economic expenditures and administrative expenditures have adverse effects. (3) Public expenditure mainly promotes green development through four channels: human capital accumulation, technological innovation, environmental quality improvement, and labor productivity increase. (4) The expenditure composition influences the turning point of the inverted U-shaped relationship. Based on these findings, we propose some targeted policy suggestions to promote green development.

A política de esporte e lazer em Goiás: análise do financiamento e gasto de 2003 a 2018 / The sports and leisure policy in Goiás: analysis of financing and spending from 2003 to 2018 / La política de deporte y ocio en Goiás: análisis de financiación y gasto de 2003 a 2018

Esta investigação científica teve por objetivo analisar o financiamento e gasto com a política pública de esporte e lazer realizada pelo governo do estado de Goiás ao longo de 2003 a 2018. A pesquisa tem caráter quanti-qualitativo, é um estudo descritivo e se apoiou em pes-quisa documental, realizada na legislação de esporte e lazer do estado de Goiás, nos Planos Plurianuais e nos gastos governamentais. Conclui-se que a maior parte do financiamento do setor se deu sob a gestão do órgão responsável pela política de esporte e lazer, o gasto com este ocupou um lugar marginal no orçamento público do estado e a maior parte do gasto foi direcionado para Infraestrutura ­ sobretudo, de grandes instalações de esporte e lazer ­ e Pessoal (AU).

This scientific investigation aimed to analyze the funding and spending on public policy for sport and leisure carried out by the government of the state of Goiás from 2003 to 2018. The research has a quanti-qualitative character, is a descriptive study and was based on documental research, carried out in the sport and leisure legislation of the state of Goiás, in the Pluriannual Plans and in government expenditures. Most of the sector's financing was under the management of the body responsible for sports and leisure policy, spending on this occupied a marginal place in the state's public budget and most of the spending was directed to Infrastructure ­ above all, for large companies. sport and leisure facilities ­ and Staff (AU).

Esta investigación científica tuvo como objetivo analizar la financiación y el gasto en políticas públicas de deporte y ocio llevadas a cabo por el gobierno del estado de Goiás de 2003 a 2018. La investigación tiene un carácter cuanti-cualitativo, es un estudio descriptivo y se basó en una investigación documental, realizada en la legislación de deporte y ocio del estado de Goiás, en los Planes Plurianuales y en el gasto público. La mayor parte de la financiación del sector se realizó bajo la gestión del organismo responsable de la política deportiva y de ocio, el gasto en este ocupó un lugar marginal en el presupuesto público del estado y la mayor parte del gasto se dirigió a Infraestructuras ­ sobre todo, grandes instalaciones deportivas y de ocio ­ y Personal.(AU).

Public Health Expenditures and Clinical and Social Complexity of Tuberculosis Cases-Alameda County, California, July-December 2017.

CONTEXT: Alameda County, California, is a high tuberculosis (TB) burden county that reported a TB incidence rate of 8.1 per 100 000 during 2017. It is the only high TB burden California county that does not have a public health-funded TB clinic. OBJECTIVE: To describe TB public health expenditures and clinical and social complexities of TB case-patients. DESIGN, SETTING, AND PARTICIPANTS: Public health surveillance of confirmed and possible TB case-patients reported to Alameda County Public Health Department during July 1, 2017, to December 31, 2017. Social complexity status was categorized for all case-patients using surveillance data; clinical complexity status, either by surveillance definition or by the Charlson Comorbidity Index (CCI), was categorized only for confirmed TB case-patients. MAIN OUTCOME MEASURES: Total public health and per patient expenditures were stratified by insurance status. Cohen's kappa assessed concordance between clinical complexity definitions. All comparisons were conducted using Fisher's exact or Kruskal-Wallis tests. RESULTS: Of 81 case-patients reported, 68 (84%) had confirmed TB, 29 (36%) were socially complex, and 15 (19%) were uninsured. Total public health expenditures were $487 194, and 18% of expenditures were in nonlabor domains, 57% of which were for TB treatment, diagnostics, and insurance, with insured patients also incurring such expenditures. Median per patient expenditures were significantly higher for uninsured and government-insured patients than for privately insured patients ($7007 and $5045 vs $3704; P = .03). Among confirmed TB case-patients, 72% were clinically complex by surveillance definition and 53% by the CCI; concordance between definitions was poor (κ = 0.25; 95% confidence interval, 0.03-0.46). CONCLUSIONS: Total public health expenditures approached $500 000. Most case-patients were clinically complex, and about 20% were uninsured. While expenditures were higher for uninsured case-patients, insured case-patients still incurred TB treatment, diagnostic, and insurance-related expenditures. State and local health departments may be able to use our expenditure estimates by insurance status and description of clinically complex TB case-patients to inform efforts to allocate and secure adequate funding.

Asymmetric effect of FDI and public expenditure on population health: new evidence from Pakistan based on non-linear ARDL.

The core purpose of the study is to examine the asymmetric effect of foreign direct investment (FDI) and population health (measured by life expectancy index). The study takes time series data for 1980-2020. The non-linear autoregressive distributed lag (NARDL) bound testing to cointegration approach is applied to scrutinize an asymmetric association among foreign direct investment, government expenditures, trade openness, public debt, and population health. The study also used an asymmetric causality test to investigate the causal association between the measured variables. The findings affirm that cointegration exists between the variables in the occurrence of asymmetries. The asymmetric causality outcomes confirm that only positive changes in FDI have bidirectional causality to life expectancy while negative shocks have unidirectional that runs from FDI to life expectancy. The government expenditure and foreign direct investment also provided evidence of social sector health welfare in Pakistan. The output shows that increasing government expenditure can cause an increase in life expectancy while decreasing government expenditure can cause a decrease in life expectancy. The study found that investment in health care medical services is paramount to better results as far as government assistance (welfare) gains. The outcomes of the study have given numerous policy suggestions to boost life expectancy in the general public of Pakistan.

Uma avaliação empírica do tamanho ótimo dos municípios / An Empirical Assessment of the Optimal Size of Municipalities / Una evaluación empírica del tamaño ideal de los municipios

Esta pesquisa tem o objetivo de realizar uma investigação empírica sobre o tamanho ótimo dos municípios, isto é, a quantidade de habitantes que propicia o menor nível de despesas em relação ao PIB municipal, de modo que se obtenha escala econômica para otimização da aplicação dos recursos públicos. Este estudo analisa uma amostra de dados de 4.835 municípios com população inferior a 50.000 habitantes, que representam 89% do total de municípios brasileiros. A base de dados reúne informações de receitas e despesas municipais, extraídas do Finanças do Brasil - Dados Contábeis dos Municípios - Finbra 2010 e dados socioeconômicos do Censo Demográfico do IBGE 2010 e do PIB dos municípios do IBGE 2010. Os resultados empíricos indicam que o tamanho ótimo de população para um município brasileiro equivale aproximadamente a 31.667 habitantes por cidade, com base em métodos econométricos como mínimos quadrados ordinários com desvio padrão robusto. Esse porte populacional proporciona ganhos de escala na administração pública e confere maior autonomia local em relação ao governo central para ofertar bens públicos de qualidade.

This research aims to carry out an empirical investigation on the optimal size of the municipalities, that is, the number of inhabitants that offers the lowest level of expenditure in relation to the municipal GDP, obtaining an economic scale to provide the best level of public resources. This study analyzes a sample of data from 4.835 municipalities with a population of less than 50,000 inhabitants, which represent 89% of the total Brazilian municipalities. The database gathers information on municipal revenues and expenses extracted from Finance of Brazil - Accounting Data of Municipalities - FINBRA 2010, socioeconomic data from the 2010 IBGE Demographic Census and the municipalities GDP from the 2010 IBGE. The outcomes showed that the optimal population size for a Brazilian municipality is equivalent to 31.667 inhabitants per city, based on Ordinary Least Squares (OLS) with robust standards errors. This population size provides gains of scale in public administration and improves local autonomy in relation to the central government in order to offer quality public goods.

Esta investigación tiene como objetivo realizar una investigación empírica sobre el tamaño óptimo de los municipios, es decir, sobre el número de habitantes que proporciona el menor nivel de gasto en relación al producto bruto interno (PIB) municipal, de manera de obtener la escala económica para la optimización de la aplicación de recursos públicos. Para ello analiza una muestra de datos de 4835 municipios con una población de menos de cincuenta mil habitantes, lo que representa el 89 % de todos los municipios brasileños. La base de datos recopila información sobre ingresos y gastos municipales, extraídos de Finanzas de Brasil-Datos contables municipales-FINBRA 2010, datos socioeconómicos del censo demográfico del IBGE de 2010 y datos del PIB de los municipios en 2010. Los resultados empíricos informaron que el tamaño ideal de la población de un municipio brasileño es equivalente a aproximadamente 31.667 habitantes por ciudad, según métodos econométricos, como enteros cuadrados ordinarios con desviación estándar robusta. Este tamaño de población ofrece ganancias de escala en la administración pública y otorga mayor autonomía local en relación con el gobierno central para ofrecer bienes públicos de calidad.