Moderating Effect of GDP Growth Rate on Public Health Care Financing and Tax Revenues, among the East Africa Community Members Countries?
DOI:
https://doi.org/10.47604/ijfa.3502Keywords:
GDP Growth Rate, Public Healthcare Financing, Tax Revenues, East Africa Member CountriesAbstract
Purpose: This research aimed at establishing the linkage between public healthcare financing and tax revenues and the moderating effect of GDP growth rate within the context of East Africa Community Countries.
Methodology: The target population was three EAC member countries comprised of Kenya Uganda and Tanzania. Causal and cross-sectional research design were applied. For hypothesis tests, stepwise multiple regression was used to test for moderation effect of GDP growth rate on public healthcare financing and tax revenues. The secondary data was sourced from the research departments of the National Treasury; State Departments of Planning / National Bureau of Statistics; the Revenue Authorities; and the Central Banks of the three countries using a set of data matrix for the period 1982 to 2022. Specifically, tax revenues were proxied by the sum of revenues realized. Public health financing was proxied by the total sum of expenditure towards health. And the GDP rate was indicated by the prevailing GDP rate over the period of study.
Findings: Findings reveal a statistically significant link between PHF and Tax revenues for East Africa member Countries; Although the R-square increased by 2.5%, when GDP rate was introduced into the model, it resulted that no significant moderating effect in the linkage between PHF and tax revenues in EAC. The PHF and Tax revenues relationship that was previously significant also became weaker and negative, hence no moderation.
Unique Contribution to Theory, Practice and Policy: The study extends on predictive insights of ability to pay theory in conceptualization, informing and understanding the linkage of PHF and tax revenues. The study adds to knowledge in PHF, GDP growth rate, and tax revenues by showing that the linkage of PHF and Tax revenues among East Africa member Countries is not direct but rather is moderated by GDP growth rate. Health, budgetary and finance sectors and other agencies in the government can be guided by the findings to inform policies that can address GDP growth rate, guide the healthcare allocations particularly when setting goals to expand tax revenues.
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References
Adebisi, Y. A., Alaran, A., Badmos, A., Bamisaiye, A.O., et al. (2021). How West African countries prioritize health. Trop Med Health, 49(1),1–7.
Akazili, I., Garshong, B., Aikins, M., & Gyapong, J. (2012). Progressivity of healthcare financing and incidence of service benefits in Ghana. Health Pol and Planning, 27, 263.
Andersen, L. A., & Aday, R. A. (2021). A framework for accessing medical care. Health Services Response, 109, 208–220.
Artekin, A. Ö., & Konya, S. (2020). Health expenditure and economic growth: Is the health-led growth hypothesis supported for selected OECD countries? Poslovna Izvrsnost Zagreb, Vol. XIV (1),77-89
Atilgan, E., Kilic, D., & Ertugrul, H. M. (2017). The dynamic relationship between health expenditure and economic growth: is the health-led growth hypothesis valid for Turkey? European Journal of Health Economics, 18(5),567-574
Auriol, E., & Warlters, M. (2005). Taxation base in developing countries. Journal of Public Economics, 89, 625–646.
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(26),1173–1182.
Behera, D. K., & Dash, U. (2017). Impact of GDP and tax revenue on health care financing: An investigation from Indian states. Theoretical and Applied Economics, 24(2),249-266.
Elmi, Z.M., Sadeghi, S. (2012). Health care expenditures and economic growth in developing countries: panel co-integration and causality. Middle-East J Sci Res.12(1),88–91
Erdil, E., & Yetkiner, I. H. (2009). The Granger-causality between health care expenditure and output: a panel data approach. Applied Economics, 41(4),511-518.
Eryiğit, S.B., Eryiğit, K.Y., Selen, U. (2023). The long-run linkages between education, health and defence expenditures and economic growth: evidence from Turkey. Def Peace Econ. 23(6),559–74.
Harrison, R. L., Reilly, T. M., & Creswell, J. W. (2020). Methodological rigor in mixed methods: An application in management studies. Journal of Mixed Methods Research, 14(14), 473–495. https://doi.org/10.1177/1558689819900585
Hashmati, A. (2010). On the causality between GDP and Health Care Expenditure in Augmented Solow Growth Model. Stockholm: Department of Economic Statistics Stockholm school of Economics.
Hu, B., & Mendoza, R.U. (2018). Public spending, governance and child health outcomes: revisiting the links. Journal of Human Development and Capabilities: A Multi-Disciplinary Journal for People Centred Development, 14(2),285-311.
Kar, M., & Taban, S. (2013). The impacts of the disaggregated public expenditure on economic growth. Ankara University Faculty of Political Science, 53(3),145–69.
Kazemian, M., Abolhalaj, M., & Nazari, H. (2017). Assessment of equity in public health care financing in 2013. Journal of Clinical Nursing and Midwifery, 6(1),64-72.
Khan, R., Salim, H., & Laila, A. (2019). Does improved health can raise GDP? A longitudinal study of Pakistan economy airlines. Journal of Econ and Business Studies, (2)8,1-4.
Lau, M.C.K., & Fung, K.W.T (2015). Convergence in health care expenditure of 14 EU countries: New evidence from non-linear panel unit root test. MPRA Paper No.52871.
Lelnikova, J., & Wilinski, A. (2022). Impact-Investing in the healthcare in terms of the new socially responsible state investment policy. Business Ethics and Leadership, 6(6),57-64
Liping, Y., & Zhang, X. (2018). Nonlinear granger causality between health care expenditure and economic growth in the OECD and major developing countries. International Journal of Environmental Research and Public Health, 15(1953),2-16.
Lu, C., Schneider, M. T., Gubbins, P., Leach-Kemon, K., Jamison, D., & Murray, C. J. (2016). Public financing of health in developing countries: A cross-national systematic analysis. Lancet, 395,1375–1387.
Lusardi, A., Schneider, D., & Tufano, P. (2015). Economic crisis and medicalcare use: comparative evidence from five high-income countries. Soc Sci. Quarterly, 96, 202-213.
Maina, T., & Kirigia, D. (2015). Annual evaluation of the abolition of user fees at primary healthcare facilities in Kenya. Washington, DC: Futures Group, Health Policy Project.
Mills, A., Ataguba, J. E., & Akazili, J. (2012). Equity in financing and health care in Ghana, South Africa and Tanzania: implications for paths to UHC. Lancet, 380,126–133.
Moore, M. (2018). Revenues, state formation, and the quality of governance in developing countries. International Political Science Review, 25, 297–319. https://doi.org/10.1177/0192512104043018.
Munge, K., & Harvey-Briggs, A. (2014). The progressivity of healthcare financing in Kenya. Health Policy and Planning, 29,912–920. https://doi.org/10.1093/heapol/czt073.
Ngepah, N., & Ndzignat, A.E. M. (2024). Trends in household out-of-pocket health expenditures and their underlying determinants: explaining variations within African regional economic communities from countries panel data. Globalization and Health, 20(27),2-17
OECD (2017). Financing of health care, in Health at a Glance 2017: OECD Indicators, OECD Publishing, Paris. DOI: https://doi.org/10.1787/health_glance-2017-46-en
Osoro, K. (2015). Macro-economic and public health expenditures in Kenya. International Journal of Education and Research, 3(9),15-32.
Palmer, N., & Lagarde, M. (2018). The impact of health financing on access to health services in low and middle income countries. The Cochrane Database of Systematic Rev, 2(4),6-8
Peacock, A.T., & Wiseman, J. (1967). Growth of public expenditure in the United Kingdom, Rev edn., George Allen & Unwin Ltd., London
Pradhan, R. P., & Bagchi, T.P. (2012). Economic growth and health in India: panel cointegration assessment. Int. J. Healthcare Technology and Management, 13(4),223-241.
Renmans, D., Holvoet, N., & Criel, B. (2017). Combining theory-driven evaluation and causal loop diagramming for opening the ‘black box’of intervention in health sector in Western Uganda. International journal of environmental research and public health, 14(9),1007.
Smith, A. (1980). An inquiry into the nature and causes of the wealth of nations. Oxford: Clarendon Press.
Takuma, W., & Iyke, B. N. (2017). The links between economic growth and tax revenue in Ghana: An Empirical Investigation. MPRA Paper No. 76010,1-26.
Tepovic, M. (2022). GDP growth and health care expenditures worldwide. Wentham Open. 9,9-18
Thiagarajan, K. (2022). Covid-19 exposes the high cost of India’s reliance on private healthcare. BMJ, 370
Tily, G. (2007). Keynes's general theory, the rate of interest and ‘Keynesian’ economics. London: Palgrave Macmillan
WHO (2022). The world health report 2021: World Health Organization, Geneva: Switzerland.
Yu, C. P., Whynes, D. K., & Sach, T. H. (2017). Equity in health care financing: the case of Malaysia. International Journal of Equity Health, 11, 32.
Yusuf, I. G., & Yıldura, C. (2018). An econometric examination over the relation between health expenditure and economic growth. Journal of Economic and Knowledge Management, 4(2),57–70.
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Copyright (c) 2025 Martin Riungu, Prof. Winnie Nyamute (PhD), Dr. Duncan Elly Ochieng’ (FFA, CPA, CIFA), Dr. Laura Barasa (PhD)

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