Effect of early application of social distancing interventions on COVID-19 mortality over the first pandemic wave: An analysis of longitudinal data from 37 countries.

OBJECTIVES: To estimate the effect of early application of social distancing interventions on Covid-19 cumulative mortality during the first pandemic wave. METHODS: Ecological longitudinal study using multivariable negative binomial regression for panel data. Daily numbers of Covid-19 cases and deaths, and data on social distancing interventions, for the 37 member countries of the Organization for Economic Cooperation and Development (OECD) were analysed. RESULTS: Covid-19 cumulative mortality over the first pandemic wave varied widely across countries (range, 4.16 to 855 deaths per million population). On average, one-day delay in application of mass gatherings ban was associated with an adjusted increase in Covid-19 cumulative mortality by 6.97% (95% CI, 3.45 to 10.5), whilst a one-day delay in school closures was associated with an increase of 4.37% (95% CI, 1.58 to 7.17) over the study period. We estimated that if each country had enacted both interventions one week earlier, Covid-19 cumulative mortality could have been reduced by an average of 44.1% (95% CI, 20.2 to 67.9). CONCLUSIONS: Early application of mass gatherings ban and school closures in outbreak epicentres was associated with an important reduction in Covid-19 cumulative mortality during the first pandemic wave. These findings may support policy decision making.

Life Beyond 65: Changing Spatial Patterns of Survival at Older Ages in the United States, 2000-2016.

OBJECTIVES: To identify levels and trends in life expectancy at age 65 (e65) by geographic region and metropolitan status in the United States. METHODS: Using county-level data on population and deaths from the Census and National Center for Health Statistics, we consider spatial inequality in e65 across 4 metropolitan types and 10 geographic regions from 2000 to 2016. We examine whether changes in e65 are driven by mortality developments in metro types or geographic regions, and compare spatial patterns in the United States to mortality trends in other Organization of Economic Cooperation and Development (OECD) countries. We use decomposition and regression methods to estimate the contributions of 10 causes of death to changes and inequalities in e65. RESULTS: Life expectancy at age 65 increased in all spatial units from 2000 to 2016. Areas with higher e65 in 2000 also experienced larger gains. Longevity increases were greatest in large metropolitan areas and coastal regions. Nonmetropolitan areas and the interior lagged far behind not only other parts of the United States but all OECD comparison countries. Metropolitan status was a better predictor of mortality changes than geographic region. Circulatory diseases and diseases associated with smoking were the principal sources of life expectancy gains and spatial differentiation in those gains. Larger gains in smoking-related mortality accounted for greater improvements among men than women. DISCUSSION: Even at advanced ages, large geographic disparities in life expectancy remain. And as mortality has declined, these disparities have widened. Public health efforts should pay special attention to identifying and ameliorating the sources of lagging life expectancy in nonmetropolitan regions.

Correlation of population mortality of COVID-19 and testing coverage: a comparison among 36 OECD countries.

Although testing is widely regarded as critical to fighting the COVID-19 pandemic, what measure and level of testing best reflects successful infection control remains unresolved. Our aim was to compare the sensitivity of two testing metrics - population testing number and testing coverage - to population mortality outcomes and identify a benchmark for testing adequacy. We aggregated publicly available data through 12 April on testing and outcomes related to COVID-19 across 36 OECD (Organization for Economic Development) countries and Taiwan. Spearman correlation coefficients were calculated between the aforementioned metrics and following outcome measures: deaths per 1 million people, case fatality rate and case proportion of critical illness. Fractional polynomials were used to generate scatter plots to model the relationship between the testing metrics and outcomes. We found that testing coverage, but not population testing number, was highly correlated with population mortality (rs = -0.79, P = 5.975 × 10-9vs. rs = -0.3, P = 0.05) and case fatality rate (rs = -0.67, P = 9.067 × 10-6vs. rs = -0.21, P = 0.20). A testing coverage threshold of 15-45 signified adequate testing: below 15, testing coverage was associated with exponentially increasing population mortality; above 45, increased testing did not yield significant incremental mortality benefit. Taken together, testing coverage was better than population testing number in explaining country performance and can serve as an early and sensitive indicator of testing adequacy and disease burden.

Dynamic linkages among CO2 emissions, human development, financial development, and globalization: empirical evidence based on PMG long-run panel estimation.

This study investigates the impact of the human capital index, globalization, and financial development on carbon dioxide of grouping OECD countries using pool mean group estimation technique from 1990 to 2015. This study also applies the second-generation cross-sectional augmented Dickey-Fuller and cross-sectional Im, Pesaran, Shin panel (CIPS) unit root, and the latest (Westerlund 2008) cointegration tests for further investigations. The result shows that both the human development index and financial development stimulate environmental improvement by using PMG long-run panel estimation approach. Furthermore, the pairwise Dumitrescu-Hurlin panel causality results prove the two-way causal association between financial development and carbon emissions. The unidirectional causality running from globalization and human development index towards carbon emission is also supported. Based on the aforementioned results, we provide a set of recommendations for policy implication. Graphical abstract.

Health Care Financing Systems and Their Effectiveness: An Empirical Study of OECD Countries.

Background: The primary aim of the research in the present study was to determine the effectiveness of health care in classifying health care financing systems from a sample of OECD (Organisation for Economic Co-operation and Development) countries (2012-2017). This objective was achieved through several stages of analysis, which aimed to assess the relations between and relation diversity in selected variables, determining the effectiveness of health care and the health expenditure of health care financing systems. The greatest emphasis was placed on the differences between health care financing systems that were due to the impact of health expenditure on selected health outputs, such as life expectancy at birth, perceived health status, the health care index, deaths from acute myocardial infarction and diabetes mellitus. Methods: Methods such as descriptive analysis, effect analysis (η2), binomial logistic regression analysis, linear regression analysis, continuity analysis (ρ) and correspondence analysis, were used to meet the above objectives. Results: Based on several stages of statistical processing, it was found that there are deviations in several of the relations between different health care funding systems in terms of their predisposition to certain areas of health outcomes. Thus, where one system proves ineffective (or its effectiveness is questionable), another system (or systems) appears to be effective. From a correspondence analysis that compared the funding system and other outputs (converted to quartiles), it was found that a national health system, covering the country as a whole, and multiple insurance funds or companies would be more effective systems. Conclusions: Based on the findings, it was concluded that, in analyzing issues related to health care and its effectiveness, it is appropriate to take into account the funding system (at least to verify the significance of how research premises affect the systems); otherwise, the results may be distorted.

[Examination of Regional Differences in Performance of Health Systems by Prefecture Using Cluster Analysis].

OBJECTIVE: The Organisation for Economic Co-operation and Development (OECD) pointed out the deterioration of the performance of health systems (performance) in Japan. To correct this, we evaluated the performances in different prefectures. METHODS: By the OECD method, we set 27 indicators concerning "health status (HS)", " risk factors (RFs)", " access to care (AC)", " quality of care (QC)", and " health care resources (HRs)". Next, the relative value (RV, ±4 standard deviation) from the average value of each indicator in each prefecture was obtained. On the basis of this RV, the prefectures were divided into A, B, and C by cluster analysis. Then, the 27 indicators of the three groups were subjected to multiple comparison tests and the performances were evaluated. RESULTS: A included Hokkaido, Ishikawa, Kyoto, Shimane, Okayama, Hiroshima, Yamaguchi, Tokushima, Kagawa, Ehime, Kochi, Fukuoka, Saga, Nagasaki, Kumamoto, Oita, Miyazaki, Kagoshima, and Okinawa, B included Aomori, Iwate, Akita, Fukushima, Ibaraki, Tochigi, Saitama, Tokyo, Osaka, and Wakayama, C included Miyagi, Yamagata, Gunma, Chiba, Kanagawa, Niigata, Toyama, Fukui, Yamanashi, Nagano, Gifu, Shizuoka, Aichi, Mie, Shiga, Hyogo, Nara, and Tottori. The multiple comparison test results showed that HS and RFs were not significantly different between A and C. In A, AC and QC were poor, but HRs were excessive, and the local allocation tax was high. RFs, AC, QC, HRs, and the local allocation taxes were not significantly different between B and C, but HS was poor in B. CONCLUSIONS: The performance of health systems was deteriorating in the 19 prefectures included in A, and correction is necessary in these prefectures.

On the nexus of air pollution and health expenditures: new empirical evidence / Relación entre la contaminación atmosférica y los gastos sanitarios: nueva evidencia empírica

Objective: To analyse the impact of per capita income and environmental air quality variables on health expenditure determinants. Method: In this study, we analyse the relationship between air pollution and health expenditure in 29 OECD countries over the period 1995-2014. In addition, we test whether our findings differ between countries with higher or lower incomes. Results: The econometric results show that per capita income has a positive effect on health expenditure, but is not as statistically significant as expected when lag-time is incorporated. In addition, an anchorage effect is observed, which implies that about 80%-90% of previous expenditure explain current expenditure. Our empirical results are quite consistent between groups and when compared with the full sample. Nevertheless, there appear to be some differences when broken down by financing scheme (total, public, and private). Conclusions: Overall, our findings could be used to clarify the appropriate health expenditure level or to obtain better environmental quality and social well-being. That is, empirical support is provided on how health management and policy makers should include more considerations for the use of cleaner fuels in developed countries

Objetivo: Estudiar el impacto que tienen la renta per cápita y las variables de calidad ambiental sobre los gastos sanitarios. Método: Analizamos la relación entre la contaminación atmosférica y el gasto sanitario en 29 países de la OCDE durante el periodo 1995-2014. Además, estudiamos si nuestros hallazgos difieren según los países (con ingresos más altos o más bajos). Resultados: Los resultados econométricos muestran que la renta per cápita tiene un efecto positivo en los gastos sanitarios, pero no tan estadísticamente significativo como se esperaba al incorporar demoras. Además, se aprecia un efecto de anclaje, el cual implica que alrededor del 80-90% de los gastos anteriores explican los actuales. Nuestros resultados empíricos son bastante concordantes entre los grupos considerados, al compararse estos con la muestra completa. Sin embargo, parecen existir algunas diferencias al desglosar por tipo de financiación (total, pública y privada). Conclusión: En general, nuestros hallazgos podrían utilizarse para esclarecer el nivel adecuado de gasto sanitario, o bien para obtener una mejor calidad ambiental y bienestar social. Es decir, se brinda apoyo empírico sobre cómo la Administración (sanitaria) y los responsables de las distintas políticas públicas deberían incluir más consideraciones para el uso de combustibles más limpios en los países desarrollados

Resistance proportions for eight priority antibiotic-bacterium combinations in OECD, EU/EEA and G20 countries 2000 to 2030: a modelling study.

BackgroundAntimicrobial resistance is widely considered an urgent global health issue due to associated mortality and disability, societal and healthcare costs.AimTo estimate the past, current and projected future proportion of infections resistant to treatment for eight priority antibiotic-bacterium combinations from 2000 to 2030 for 52 countries.MethodsWe collated data from a variety of sources including ResistanceMap and World Bank. Feature selection algorithms and multiple imputation were used to produce a complete historical dataset. Forecasts were derived from an ensemble of three models: exponential smoothing, linear regression and random forest. The latter two were informed by projections of antibiotic consumption, out-of-pocket medical spending, populations aged 64 years and older and under 15 years and real gross domestic product. We incorporated three types of uncertainty, producing 150 estimates for each country-antibiotic-bacterium-year.ResultsAverage resistance proportions across antibiotic-bacterium combinations could grow moderately from 17% to 18% within the Organisation for Economic Co-operation and Development (OECD; growth in 64% of uncertainty sets), from 18% to 19% in the European Union/European Economic Area (EU/EEA; growth in 87% of uncertainty sets) and from 29% to 31% in Group of Twenty (G20) countries (growth in 62% of uncertainty sets) between 2015 and 2030. There is broad heterogeneity in levels and rates of change across countries and antibiotic-bacterium combinations from 2000 to 2030.ConclusionIf current trends continue, resistance proportions are projected to marginally increase in the coming years. The estimates indicate there is significant heterogeneity in resistance proportions across countries and antibiotic-bacterium combinations.

Trends in hospitalisation rates for inflammatory bowel disease in western versus newly industrialised countries: a population-based study of countries in the Organisation for Economic Co-operation and Development.

BACKGROUND: Hospitalisation rates for inflammatory bowel disease (IBD) vary across the world. We aimed to investigate temporal patterns of hospitalisation for IBD in member countries of the Organisation for Economic Co-operation and Development (OECD). METHODS: From the OECD database, we assessed IBD-related hospitalisation rates (expressed as annual rates per 100 000 inhabitants) for 34 countries from 1990 to 2016. We calculated mean hospitalisation rates for the period 2010-15 and used joinpoint regression models to calculate average annual percentage changes with 95% CIs. FINDINGS: Mean hospitalisation rates for IBD from 2010 to 2015 were highest in North America (eg, 33·9 per 100 000 in the USA), Europe (eg, 72·9 per 100 000 in Austria), and Oceania (eg, 31·5 per 100 000 in Australia). Hospitalisation rates for IBD were stabilising or decreasing over time in many countries in these regions but increasing in others. Countries in Asia and Latin America and the Caribbean had the lowest IBD-related hospitalisation rates but the greatest increases in rates over time. For example, Turkey had an annual hospitalisation rate of 10·8 per 100 000 inhabitants and an average annual percentage change of 10·4% (95% CI 5·2-15·9). Similarly, Chile had an annual hospitalisation rate of 9·0 per 100 000 inhabitants and an average annual percentage change of 5·9% (4·9-7·0). INTERPRETATION: Hospitalisation rates for IBD are high in western countries but are typically stabilising or decreasing, whereas rates in many newly industrialised countries are rapidly increasing, which reflects the known increase in IBD prevalence in these countries. Potential explanations for these trends include changes in the epidemiology of IBD, health-care delivery, and infrastructure in these countries, as well as overall country-specific patterns in hospitalisations and differences between countries in data collection methods. FUNDING: None.

Revisiting the Income Inequality Hypothesis With 292 OECD Regional Units.

The income inequality hypothesis on the relationship between income inequality and population health has been debated for decades Disagreement exists on the hypothesis because empirical findings have reached inconsistent conclusions. At the cross-national level, the limited number of industrialized nations has created a chronic small-N problem for statistical analyses of the hypothesis. The OECD regional database containing statistics of hundreds of regional units can provide a breakthrough and is used for the first time for multiple regression in this article. It is found that income inequality is a statistically significant determinant of all the health indicators analysed. The findings support the income inequality hypothesis. In addition, the impact of income inequality seems to be stronger on infant mortality than on old-age mortality. GDP per capita also statistically significantly influences both life expectancy and old-age mortality but not infant mortality.

The Impact of Parental and Medical Leave Policies on Socioeconomic and Health Outcomes in OECD Countries: A Systematic Review of the Empirical Literature.

Policy Points: Historically, reforms that have increased the duration of job-protected paid parental leave have improved women's economic outcomes. By targeting the period around childbirth, access to paid parental leave also appears to reduce rates of infant mortality, with breastfeeding representing one potential mechanism. The provision of more generous paid leave entitlements in countries that offer unpaid or short durations of paid leave could help families strike a balance between the competing demands of earning income and attending to personal and family well-being. CONTEXT: Policies legislating paid leave from work for new parents, and to attend to individual and family illness, are common across Organisation for Economic Co-operation and Development (OECD) countries. However, there exists no comprehensive review of their potential impacts on economic, social, and health outcomes. METHODS: We conducted a systematic review of the peer-reviewed literature on paid leave and socioeconomic and health outcomes. We reviewed 5,538 abstracts and selected 85 published papers on the impact of parental leave policies, 22 papers on the impact of medical leave policies, and 2 papers that evaluated both types of policies. We synthesized the main findings through a narrative description; a meta-analysis was precluded by heterogeneity in policy attributes, policy changes, outcomes, and study designs. FINDINGS: We were able to draw several conclusions about the impact of parental leave policies. First, extensions in the duration of paid parental leave to between 6 and 12 months were accompanied by attendant increases in leave-taking and longer durations of leave. Second, there was little evidence that extending the duration of paid leave had negative employment or economic consequences. Third, unpaid leave does not appear to confer the same benefits as paid leave. Fourth, from a population health perspective, increases in paid parental leave were consistently associated with better infant and child health, particularly in terms of lower mortality rates. Fifth, paid paternal leave policies of adequate length and generosity have induced fathers to take additional time off from work following the birth of a child. How medical leave policies for personal or family illness influence health has not been widely studied. CONCLUSIONS: There is substantial quasi-experimental evidence to support expansions in the duration of job-protected paid parental leave as an instrument for supporting women's labor force participation, safeguarding women's incomes and earnings, and improving child survival. This has implications, in particular, for countries that offer shorter durations of job-protected paid leave or lack a national paid leave entitlement altogether.

Drowning mortality by intent: a population-based cross-sectional study of 32 OECD countries, 2012-2014.

OBJECTIVE: To compare the drowning mortality rates and proportion of deaths of each intent among all drowning deaths in Organisation for Economic Co-operation and Development (OECD) countries in 2012-2014. DESIGN: A population-based cross-sectional study. SETTING: 32 OECD countries. PARTICIPANTS: Individuals in OECD countries who died from drowning. MAIN OUTCOME MEASURES: Drowning mortality rates (deaths per 100 000 population) and proportion (%) of deaths of each intent (ie, unintentional intent, intentional self-harm, assault, undetermined intent and all intents combined) among all drowning deaths. RESULTS: Countries with the highest drowning mortality rates (deaths per 100 000 population) were Estonia (3.53), Japan (3.49) and Greece (2.40) for unintentional intent; Ireland (0.96), Belgium (0.96) and Korea (0.89) for intentional self-harm; Austria (0.57), Korea (0.56) and Hungary (0.44) for undetermined intent and Japan (4.35), Estonia (3.70) and Korea (2.73) for all intents combined. Korea ranked 12th and 3rd for unintentional intent and all intents combined, respectively. By contrast, Belgium ranked 2nd and 15th for intentional self-harm and all intents combined, respectively. The proportion of deaths of each intent among all drowning deaths in each country varied greatly: from 26.2% in Belgium to 96.8% in Chile for unintentional intent; 0.7% in Mexico to 57.4% in Belgium for intentional self-harm; 0.0% in nine countries to 4.9% in Mexico for assault and 0.0% in Israel and Turkey to 38.3% in Austria for undetermined intent. CONCLUSIONS: A large variation in the practice of classifying undetermined intent in drowning deaths across countries was noted and this variation hinders valid international comparisons of intent-specific (unintentional and intentional self-harm) drowning mortality rates.

Projections of hip arthroplasty in OECD countries up to 2050.

OBJECTIVE: The study aims to estimate the future demand of hip arthroplasty for OECD countries and to compare the results with earlier studies. DESIGN: Based on data availability and validity 20 countries out of the OECD sample have been selected for projection analysis. Using historic data (1995-2012) and multiple linear regression technics a projection model was designed by an iterative process considering different explanatory variables such as health care expenditure, age groups, and projection time frames. RESULTS: The utilisation of hip implants in OECD countries continues to grow by a compound annual growth rate (CAGR) of 1.2%, leading to an increase from 1.8 million per year in 2015 to 2.8 (2.6-2.9) in the year 2050. The mean utilisation rate (incidence) of hip implants will increase from 184 (143-312) to 275 (174-457) per 100.000 total population in the same time. Australia, Ireland, Norway, Switzerland and other countries will face a significant increase of utilisation of hip implants between +95% and +120% from 2015 to 2050. CONCLUSIONS: Hip arthroplasty continues to rise significantly over the next 35 years. Therefore, some countries will face an exponential use of hip arthroplasty of additional 100% or more and thus challenges for their health care budgets. Revision burden will increase disproportionately. Thus, health technology assessment (HTA) for medical devices, longevity and quality control will become more relevant.

Stochastic convergence of renewable energy consumption in OECD countries: a fractional integration approach.

In this article, we have examined the hypothesis of convergence of renewable energy consumption in 27 OECD countries. However, instead of relying on classical techniques, which are based on the dichotomy between stationarity I(0) and nonstationarity I(1), we consider a more flexible approach based on fractional integration. We employ both parametric and semiparametric techniques. Using parametric methods, evidence of convergence is found in the cases of Mexico, Switzerland and Sweden along with the USA, Portugal, the Czech Republic, South Korea and Spain, and employing semiparametric approaches, we found evidence of convergence in all these eight countries along with Australia, France, Japan, Greece, Italy and Poland. For the remaining 13 countries, even though the orders of integration of the series are smaller than one in all cases except Germany, the confidence intervals are so wide that we cannot reject the hypothesis of unit roots thus not finding support for the hypothesis of convergence.

Revisiting energy intensity convergence: new evidence from OECD countries.

In this study, we examine the energy intensity convergence in OECD countries within the context of recent developments in unit root analysis by paying attention to modeling structural shifts. We collect the total primary energy consumption/GDP data of 27 OECD countries during the period 1980-2014. The findings indicate that controlling for shifts plays a crucial role, and different approximations in modeling breaks lead to changes in inferences. In conclusion, we present some policy proposals.

Social Policy Expenditures and Life Expectancy in High-Income Countries.

INTRODUCTION: The U.S. spends more than any other country on health care, yet Americans have lower life expectancy than people in most industrialized countries. Recent studies suggest that lower expenditures on social policies in the U.S. may contribute to less-favorable trends in life expectancy. This study tests the hypothesis that greater social spending will be positively associated with life expectancy across the countries of the Organisation of Economic Co-operation and Development and that the magnitude of these associations will outweigh those between government healthcare spending and life expectancy. METHODS: In 2016, longitudinal data on six domains of social expenditures for the U.S. and 19 other wealthy nations between 1980 and 2010 were used to estimate the associations between prior year expenditures on education, family, unemployment, incapacity, old age, and active labor market programs, and period life expectancy using fixed effects models. RESULTS: Controlling for a wide set of confounders and government healthcare expenditures, a 1% increase in prior year education expenditures was associated with 0.160 (95% CI=0.033, 0.286) of a year gain in life expectancy, whereas a 1% increase in prior year incapacity benefit expenditures was associated with 0.168 (95% CI=0.003, 0.333) of a year gain in life expectancy. Counterfactual models suggest that if the U.S. were to increase expenditures on education and incapacity to the levels of the country with the maximum expenditures, life expectancy would increase to 80.12 years. CONCLUSIONS: The U.S. life expectancy lag could be considerably smaller if U.S. expenditures on education and incapacity programs were comparable with those in other high-income countries.

Suicide rates in European OECD nations converged during the period 1990-2010.

PURPOSE AND METHODS: The aim of this study was to investigate, with multiple regression analyses, the effect of selected characteristics on the rate of decrease of suicide rates in 21 OECD (Organisation for Economic Co-operation and Development) nations over the period 1990-2010, with initial levels of suicide rates taken into account. RESULTS: The rate of decrease seems mainly (83%) to be determined by the initial suicide rates in 1990. In nations with relatively high initial rates, the rates decreased faster. The suicide rates also converged. CONCLUSION: The study indicates that beta convergence alone explained most of the cross-national variations.

Achieving value for money in health: a comparative analysis of OECD countries and regional countries.

OBJECTIVE: To measure efficiency gains in health sector over the years 1995 to 2013 in OECD, EU, non-member European countries. METHODS: An output-oriented DEA model with variable return to scale, and residuals estimated by regression equations were used to estimate efficiencies of health systems. Slacks for health care outputs and inputs were calculated by using DEA multistage method of estimating country efficiency scores. RESULTS: Better health outcomes of countries were related with higher efficiency. Japan, France, or Sweden were found to be peer-efficient countries when compared to other developed countries like Germany and United States. Increasing life expectancy beyond a certain high level becomes very difficult to achieve. Despite declining marginal productivity of inputs on health outcomes, some developed countries and developing countries were found to have lowered their inefficiencies in the use of health inputs. Although there was no systematic relationship between political system of countries and health system efficiency, the objectives of countries on social and health policy and the way of achieving these objectives might be a factor increasing the efficiency of health systems. CONCLUSIONS: Economic and political stability might be as important as health expenditure in improving health system goals. A better understanding of the value created by health expenditures, especially in developed countries, will require analysis of specific health interventions that can increase value for money in health. Copyright © 2016 John Wiley & Sons, Ltd.

Robust analysis of the determinants of healthcare expenditure growth: evidence from panel data for low-, middle- and high-income countries.

This paper examines the determinants of healthcare expenditure for low-, middle- and high-income countries, and it quantifies their influences in order to assess policies for achieving universal health coverage. We elaborate two models, a fixed-effect model and the dynamic panel model, to estimate the factors associated with the total health expenditure growth as well as its major components for 167 countries over the period of 1993-2013. The panel data on total health expenditure per capita and its components were taken from the World Development Indicators. Overall, our results showed that total health expenditure per capita is rising in all countries over time as a result of rising incomes. However, our estimates showed that the income elasticity of health expenditure ranged from 0.75 to 0.96 in the fixed-effect static panel model, while in the dynamic panel model, it was smaller and ranged from 0.16 to 0.47. Our empirical findings indicate that development assistance for health reduced government domestic spending on health but increased total government health spending. Our results also indicate that the trend in health expenditure growth is significantly depending with the country's economic development. In addition, out-of-pocket expenditure is powerfully influenced by a country's capacity to increase general government revenues and social insurance contributions. Knowledge of factors associated to health expenditure might help policy makers to make wise judgments, plan health reforms and allocate resources efficiently. Copyright © 2016 John Wiley & Sons, Ltd.