307085
Financing universal health coverage: Effects of alternative tax structures on public health systems in 89 low- and middle-income countries
Method: Using cross-national fixed effects models,investigated how alternative tax systems affect health coverage and associated child and maternal health outcomes in 89 low- and middle-income countries from 1995-2011.
Findings: We identified tax revenue as a major statistical determinant of progress towards Universal Health Coverage. Each $100 per capita per year of additional tax revenues corresponded to $9.86 yearly increase in government health spending (95% CI $3.92 to $15.8). This association was particularly strong for taxes on capital gains, profits and income ($16.7, 95% CI: $9.16 to $24.3). In countries with low tax revenues (<$1000 per capita per year), an additional $100 tax revenue per year substantially increased the extent of health coverage by 11.4 percentage points (95% CI 5.51 to 17.2). However, in contrast, $100 per capita increase in regressive forms of taxation, such as taxes on goods and services, which may reduce the ability of the poor to afford essential goods, was associated with higher rates of under five mortality rate by 0.43 per 100,000 population (95% CI: 0.14 to 0.72).
Interpretation: Increasing domestic tax revenues is a key element of a strategy to achieving Universal Health Coverage. Pro-poor taxes on profits and capital gains appear to support expansion of health coverage without the adverse effects on health outcomes of higher taxes on goods and services.
Learning Areas:
Public health or related public policySocial and behavioral sciences
Learning Objectives:
Describe the association between tax revenue and government spending on health in low- and middle-income countries.
Explain the association between tax revenue and progress toward Universal Health Coverage.
Describe how different tax regimes influence infant mortality in low- and middle-income countries.
Keyword(s): Universal Health Care, Maternal and Child Health
Qualified on the content I am responsible for because: I have a PhD in sociology am currently working an EU-funded grant examining poverty reduction and health. The political economy of healthcare and social stratification are some of my primary scientific interests.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.