Pediatrics
April 2015, VOLUME 135 / ISSUE 4
http://pediatrics.aappublications.org/current.shtml

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Article
Government Health Care Spending and Child Mortality
Mahiben Maruthappu, MA, BM BCha, Ka Ying Bonnie Ng, BMedSci, MBChBa,b, Callum Williams, BAc,d, Rifat Atun, FRCP, MBA, FFPHa,e, and Thomas Zeltner, MD, LLMf,g
Author Affiliations
aImperial College London, London, United Kingdom;
bObstetrics and Gynaecology Department, Chelsea and Westminster Hospital, London, United Kingdom;
cThe Economist, London, United Kingdom;
dFaculty of History, University of Oxford, Oxford, United Kingdom;
eHarvard School of Public Health, Harvard University, Cambridge, Massachusetts;
fWorld Health Organization, Geneva, Switzerland; and
gUniversity of Bern, Bern, Switzerland.
Abstract
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.