Government health care spending and child mortality.
BACKGROUND
Government health care spending (GHS) is of increasing importance to child health. Our study determined the relationship between reductions in GHS and child mortality rates in high- and low-income countries.


METHODS
The authors used comparative country-level data for 176 countries covering the years 1981 to 2010, obtained from the World Bank and the Institute for Health Metrics and Evaluation. Multivariate regression analysis was used to determine the association between changes in GHS and child mortality, controlling for differences in infrastructure and demographics.


RESULTS
Data were available for 176 countries, equating to a population of ∼ 5.8 billion as of 2010. A 1% decrease in GHS was associated with a significant increase in 4 child mortality measures: neonatal (regression coefficient [R] 0.0899, P = .0001, 95% confidence interval [CI] 0.0440-0.1358), postneonatal (R = 0.1354, P = .0001, 95% CI 0.0678-0.2030), 1- to 5-year (R = 0.3501, P < .0001, 95% CI 0.2318-0.4685), and under 5-year (R = 0.5207, P < .0001, 95% CI 0.3168-0.7247) mortality rates. The effect was evident up to 5 years after the reduction in GHS (P < .0001). Compared with high-income countries, low-income countries experienced greater deteriorations of ∼ 1.31 times neonatal mortality, 2.81 times postneonatal mortality, 8.08 times 1- to 5-year child mortality, and 2.85 times under 5-year mortality.


CONCLUSIONS
Reductions in GHS are associated with significant increases in child mortality, with the largest increases occurring in low-income countries.
Imperial College London, London, United Kingdom; bonnie.ng@doctors.org.uk.
Mahiben
M
Maruthappu
Imperial College London, London, United Kingdom; Obstetrics and Gynaecology Department, Chelsea and Westminster Hospital, London, United Kingdom;
Ka Ying Bonnie
KY
Ng
The Economist, London, United Kingdom; Faculty of History, University of Oxford, Oxford, United Kingdom;
Callum
C
Williams
Imperial College London, London, United Kingdom; Harvard School of Public Health, Harvard University, Cambridge, Massachusetts;
Rifat
R
Atun
World Health Organization, Geneva, Switzerland; and University of Bern, Bern, Switzerland.
Thomas
T
Zeltner
D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D003363:Cost Control / Q000191:economics / Q000639:trends; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics*; D005380:Financing, Government / Q000191:economics*; D005544:Forecasting; D006301:Health Services Needs and Demand / Q000191:economics*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn
child health; child mortality; expenditure; government; health care; spending