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Determinants of efficiency in reducing child mortality in developing countries. The role of inequality and government effectiveness

Health Care Management Science volume 20, pages 500–516 (2017)Cite this article

Abstract

The main aim of this article was to analyze the relationship of income inequality and government effectiveness with differences in efficiency in the use of health inputs to improve the under-five survival rate (U5SR) in developing countries. Robust Data Envelopment Analysis (DEA) and regression analysis were conducted using data for 47 developing countries for the periods 2000–2004, 2005–2009, and 2010–2012. The estimations show that countries with a more equal income distribution and better government effectiveness (i.e. a more competent bureaucracy and good quality public service delivery) may need fewer health inputs to achieve a specific level of the U5SR than other countries with higher inequality and worse government effectiveness.

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Notes

  1. It is worth noting the kind of institutions these authors refer to. They consider key public sector institutions, including public service provision, the bureaucracy, and the legal and tax system, sharing the view of Knowles and Owen [12], among others.

  2. The U5MR and Infant Mortality Rate (IMR) are the most used outcome indicators of health achievements in developing countries. However, the U5MR is preferable to the IMR as a measure of survival mainly because the indirect techniques employed to estimate it are less sensitive to assumptions about underlying mortality patterns than are the techniques used to estimate the IMR [23]. In contrast to adult or old-age mortality, child mortality is the one indicator that is based on a comparably large amount of empirical data in low-income and middle-income countries, which makes it unique from a monitoring perspective [1]. In addition, the U5MR has three substantial advantages over life expectancy at birth [7]: under-five deaths are more often due to preventable causes, and thus should be easier to reduce through appropriate policies; the death of a child represents more years of life foregone than does the death of an older person; a new cohort of babies is born every year, so the U5MR is more sensitive than life expectancy to new socioeconomic circumstances and to changes in social service delivery.

  3. Health outcomes refer to the health consequences brought about by the treatment of a health condition or as the result of an interaction with the healthcare system. Thus, health outcomes encompass a wide range of health-related consequences of healthcare interventions and programs (i.e. health outputs) [25].

  4. Three reasons justify the use of this indicator as a measure of health output:

    • Immunization is considered to be a good proxy for the use of basic maternal and infant health services [7], which are strong predictors of the U5MR. In addition, vaccinations are strongly associated with further vaccinations: people who get one are likely to get another [55].

    • Measles is one of the most important causes of child death in poor countries despite the availability of a safe and effective vaccine. In addition, the between-country distribution of alternative indicators, such as DPT (diphtheria, tetanus, and pertussis) vaccination coverage, is similar to that in countries employing measles vaccination coverage.

    • Given the potential of measles vaccination to reduce child mortality and that measles vaccination coverage can be considered to be a marker of access to child health services, routine measles vaccination coverage was also selected as an indicator for monitoring progress towards MDG 4.

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Acknowledgments

We are grateful for the thoughtful comments from the three anonymous reviewers. We take responsibility for any remaining errors.

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Affiliations

  1. Departamento de Economía Aplicada (Estructura Económica), Universidad de Málaga, Campus El Ejido, 29071, Málaga, Spain

    Bienvenido Ortega, Jesús Sanjuán & Antonio Casquero

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  1. Bienvenido Ortega
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  2. Jesús Sanjuán
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Correspondence to Bienvenido Ortega.

Appendix

Appendix

Table 4 Variable returns to scale input-orientated DEA scores. Period 2000–2004
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Table 5 Variable returns to scale input-orientated DEA scores. Period 2005–2009
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Table 6 Variable returns to scale input-orientated DEA scores. Period 2010–2012
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Ortega, B., Sanjuán, J. & Casquero, A. Determinants of efficiency in reducing child mortality in developing countries. The role of inequality and government effectiveness. Health Care Manag Sci 20, 500–516 (2017). https://doi.org/10.1007/s10729-016-9367-1

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Key words

  • Under-five mortality rate (U5MR)
  • Efficiency
  • Robust Data Envelopment Analysis (DEA)
  • Income inequality
  • Government effectiveness
  • Developing countries