| dc.description.abstract | Various international organizations have documented the existence of corruption and
similar practices in many different areas of the health care sector. Empirical studies
show that in many poor countries over 80 percent of the population has experienced
corrupt practices in the health sector. In rich countries corruption takes other forms
such as overbilling and bribes when contracts to build hospitals are signed. The
question addressed in this paper is if corruption also has a negative impact on
population health. In the theoretical section we argue that the causal link between low
levels of Quality of Government (QoG) and population health can be either direct or
indirect. The former takes place when, for example, low QoG causes high levels of
illegitimate absenteeism among health workers or demands for direct payment of
bribes for adequate treatment. The latter (indirect) causal link is when low QoG leads
to poverty, low social capital, and low levels of life satisfaction - all leading to
difficulties in handling various life challenges which in turn causes health problems.
Our central question is policy related. If you want to improve population health, is it
better to simply increase spending on health care (and if so, should this be public or
private money), or is it better to improve the overall quality of the countries’
government institutions? Using cross section data from more than 120 countries, our
findings in the bivariate analyses are that more of a QoG variable is positively
associated with higher levels of Life Expectancy, lower levels of Mortality Rates for
Children and Mothers, higher levels of Healthy Life Expectancies and higher levels of
Subjective Health feelings. In contrast to the strong relationships between the QoG
variables and the Health indicators, the relationships between the health spending
measures and population Health are rather weak most of the time and occasionally
non-existent. Moreover, for Private Health Spending as well as for Private Share of
Total Health Spending, the relation to good Health is close to zero or slightly
negative. The policy recommendation coming out of our study to improve Health
levels around the world, in rich countries as well as in poor countries, is to improve
the Quality of Government and to finance health care with public, not private, money. | sv |
