Increased child mortality linked to decreased government healthcare spending

1. When multi-national government healthcare spending decreased by 1%, a significant increase in mortality for children under 5 years old was seen, lasting for up to 5 years.

2. The decrease in healthcare spending had a greater effect on lower income countries compared to higher income countries as greater rates of infant mortality were seen in all age categories.

Evidence Rating Level: 2 (Good)           

Study Rundown: The World Health Organization’s Millennium Development Goals includes an aim to reduce the mortality of children under 5 years of age by two-thirds in high mortality countries. Government spending on this project is influenced by fluctuations in the current economy, and there is little research detailing how changes in funding affect global population health. Researchers in the current study sought to analyze the effect of government spending reductions on child mortality worldwide. Results displayed significant increases in mortality for children less than 5 years of age, for up to 5 years, when government healthcare funds were decreased. Greater effects from decreased healthcare spending were seen in low income countries.  Results may be limited as individual country data were not evaluated, trends were only followed for 5 years, and efficacy of government funding was not analyzed. However, results were significant and should encourage improvement in the efficacy of healthcare delivery in times of reduced government healthcare spending.

Click to read the study published today in Pediatrics

Relevant Reading: The global financial crisis: an acute threat to health

Study Author, Ka Ying Bonnie Ng, talks to 2 Minute Medicine: Obstetrics and Gynaecology Department, Chelsea and Westminster Hospital, London, United Kingdom.

“Our study has shown that reductions in government healthcare spending may be associated with increases in child mortality. Cuts in government healthcare spending could adversely affect child health to a greater scale in lower income countries.

With recent pressures to diminish health expenditures at times of austerity, we caution that reduced spending should be achieved through increased efficiency of care delivery, rather than budgetary cuts. There is also a need for additional research into the mechanisms by which economic factors affect child health, to promote policies and interventions that will effectively reduce preventable child deaths.”

In-Depth [retrospective cohort]: Researchers obtained economic and child mortality data from the World Bank’s World Development Indicators and the Institute for Health Metrics and Evaluation for 176 countries from 1981 to 2010. The potential association between child mortality and changes in government health care spending was evaluated using multivariate regression analysis. Results were further scrutinized by controlling for additional variables such as economic (inflation, etc.), infrastructure controls, infectious disease, out-of-pocket health expenditures, and private healthcare spending. It was found that a 1% decrease in government healthcare spending was associated with a significant increase in all 4 measured child mortality rates (neonatal: birth to 28 days of life, postneonatal: 28 days of life to 1 year of age, 1-5 years old, and under 5 years old; p < .0001 for all). A time lag analysis showed significant increases in mortality in all 4 measured ages for up to 5 years after the initial decrease in funding. Low income countries showed greater increases in mortality than high income countries (neonatal-1.31 times greater, postneonatal- 2.81 times, 1 to 5 year-8.08 times, and under 5-2.85 times; p < .0001 for all).

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