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Research paper thumbnail of The impact of military expenditures on out of pocket healthcare payments: international evidence based on a dynamic panel data analysis

Euromed Journal of Business, May 17, 2022

PurposeThe empirical analysis dealt in this paper emphasizes on the impact of military expenditur... more PurposeThe empirical analysis dealt in this paper emphasizes on the impact of military expenditures on out of pocket (OOP) healthcare payments. A sizeable body of defence economics literature has investigated the trade-off between military and public health expenditure, by testing the crowding-out or growth-stimulating hypothesis; does military expenditure scaling up crowd-out or promote governmental resources for social and welfare programs, including also state health financing?Design/methodology/approachIn this study, panel data from 2000 to 2018 for 129 countries is used to examine the impact of military expenditure on OOP healthcare payments. The dataset of countries is categorized into four income-groups based on World Bank's income-group classification. Dynamic panel data methodology is applied to meet study objectives.FindingsThe findings of this study indicate that military expenditure positively affects OOP payments in all the selected groups of countries, strongly supporting in this way the crowding-out hypothesis whereby increased military expenditure reduces the public financing on health. Study econometric results are robust since different and alternative changes in specifications and samples are applied in our analysis.Practical implicationsUnder the economic downturn backdrop for several economies in the previous decade and on the foreground of a potential limited governmental fiscal space related to the Covid-19 pandemic adverse economic effects, this study provides evidence that policy-makers have to adjust their government policy initiatives and prioritize Universal Health Coverage objectives. Consequently, the findings of this study reflect the necessity of governments as far as possible to moderate military expenditures and increase public financing on health in order to strengthen health care systems efficiency against households OOP spending for necessary healthcare utilization.Originality/valueDespite the fact that a sizeable body of defence economics literature has extensively examined the impact of military spending on total and public health expenditures, nevertheless to the best of our knowledge there is no empirical evidence of any direct effect of national defence spending on the main private financing component of health systems globally; the OOP healthcare payments.

Research paper thumbnail of The impact of military expenditures on out of pocket healthcare payments: international evidence based on a dynamic panel data analysis

EuroMed Journal of Business

PurposeThe empirical analysis dealt in this paper emphasizes on the impact of military expenditur... more PurposeThe empirical analysis dealt in this paper emphasizes on the impact of military expenditures on out of pocket (OOP) healthcare payments. A sizeable body of defence economics literature has investigated the trade-off between military and public health expenditure, by testing the crowding-out or growth-stimulating hypothesis; does military expenditure scaling up crowd-out or promote governmental resources for social and welfare programs, including also state health financing?Design/methodology/approachIn this study, panel data from 2000 to 2018 for 129 countries is used to examine the impact of military expenditure on OOP healthcare payments. The dataset of countries is categorized into four income-groups based on World Bank's income-group classification. Dynamic panel data methodology is applied to meet study objectives.FindingsThe findings of this study indicate that military expenditure positively affects OOP payments in all the selected groups of countries, strongly sup...

Research paper thumbnail of The impact of macro-fiscal factors and private health insurance financing on public health expenditure: evidence from the OECD countries for the period 2000–2017

EuroMed Journal of Business, 2020

PurposeBecause of the 2008 global financial crisis aftermaths, economic downturn and prolonged re... more PurposeBecause of the 2008 global financial crisis aftermaths, economic downturn and prolonged recession, several OECD countries have adopted an austerity compound by significantly reducing public health expenditure (PHE) for dealing with their fiscal pressure and sovereign-debt challenges. Against this backdrop, this study aims to examine the responsiveness of PHE to macro-fiscal determinants, demography, as well to private health insurance (PHI) financing.Design/methodology/approachThe authors gather annual panel data from four international organizations databases for the total of OECD countries from a period lasting from 2000 to 2017. The authors apply static and dynamic econometric methodology to deal with panel data and assess the impact of several parameters on PHE.FindingsThe authors’ findings indicate that gross domestic product, fiscal capacity, tax revenues and population aging have a positive effect on PHE. Further, the authors find that both unemployment rate and volunt...

Research paper thumbnail of Macroeconomic and financing determinants of out of pocket payments in health care: Evidence from selected OECD countries

Journal of Policy Modeling, 2018

In this paper, we examine the impact of macroeconomic, as well public and private health insuranc... more In this paper, we examine the impact of macroeconomic, as well public and private health insurance financing (PHI) factors on out of pocket (OOP) healthcare expenditures, by using fixed/random effects and dynamic panel data methodology to a dataset of 26 EU and OECD countries for a period lasting from 1995 to 2013. The existing empirical literature has focused on testing the hypothesis that several macroeconomic and health financing determinants have an effect on OOP healthcare expenditures. Nevertheless, the related articles have not well tested the hypothesis concerning the potential impact of PHI financing on OOP spending. We find that public and PHI financing have a significant countervailing effect on OOP spending. Moreover, we show that unemployment rate has a significant positive impact on OOP expenditures. Sensitivity tests with variation of specifications and samples show that our findings are robust. We argue that policy-makers should give serious consideration to PHI institution; our results indicate that there is an inverse effect on OOP spending. We suggest that our examined countries have to provide financial risk protection to their citizens against OOP payments, rather than only attending health budgetary retrenchments in order to adjust public finances.

Research paper thumbnail of Combined social and private health insurance versus catastrophic out of pocket payments for private hospital care in Greece

International Journal of Health Economics and Management, 2017

The high level of out of pocket (OOP) payments constitutes a major concern for Greece and several... more The high level of out of pocket (OOP) payments constitutes a major concern for Greece and several other European and OECD countries as a result of the significant down turning of their public health finances due to the 2008 financial crisis. The basic objective of this study is to provide empirical evidence on the effect of combining social health insurance (SHI) and private health insurance (PHI) on OOP payments. Further, this study examines the catastrophic impact of OOP payments on insured's welfare using the incidence and intensity methodological approach of measuring catastrophic health care expenditures. Conducting a cross-sectional survey in Greece in 2013, we find that the combination of SHI-PHI has a strong negative influence on insured OOP payments for inpatient health care in private hospitals. Furthermore, our results indicate that SHI coverage is not sufficient by itself to manage with this issue. Moreover, we find that poor people present a greater tendency to incur catastrophic OOP expenditures for hospital health care in private providers. Drawing evidence from Greece, a country with huge fiscal problems that has suffered the consequences of the economic crisis more than any other, could be a starting point for policymakers to consider the perspective of SHI-PHI cooperation against OOP payments more seriously. Keywords OOP payments • SHI • PHI • Financial catastrophe • Informal payments • Greece JEL Classification I1 • I13 • G01 • C23 B Christos Floros

Research paper thumbnail of Out of pocket payments and social health insurance for private hospital care: Evidence from Greece

Health Policy, 2016

The Greek state has reduced their funding on health as part of broader efforts to limit the large... more The Greek state has reduced their funding on health as part of broader efforts to limit the large fiscal deficits and rising debt ratios to GDP. Benefits cuts and limitations of Social Health Insurance (SHI) reimbursements result in substantial Out of Pocket (OOP) payments in the Greek population. In this paper, we examine social health insurance's risk pooling mechanisms and the catastrophic impact that OOP payments may have on insured's income and well-being. Using data collected from a cross sectional survey in Greece, we find that the OOP payments for inpatient care in private hospitals have a positive relationship with SHI funding. Moreover, we show that the SHI funding is inadequate to total inpatient financing. We argue that the Greek health policy makers have to give serious consideration to the perspective of a SHI system which should be supplemented by the Private Health Insurance (PHI) sector.

Research paper thumbnail of The Effect of Out of Pocket Payments on the Income of Hospitalized Patients. Evidence from Greece

Purpose – To examine social health insurance’s risk pooling mechanisms and the catastrophic impac... more Purpose – To examine social health insurance’s risk pooling mechanisms and the catastrophic impact that health care OOPs can have on insureds’ income and wellbeing. Background: The Greek state has reduced their funding on health as part of broader efforts to limit the large fiscal deficits and rising debt ratios to GDP (OECD, 2013). Benefits cuts and limitations of Social Health Insurance (SHI) reimbursements result in Greek population substantial Out of Pocket Payments (OOP). Objective: To examine how well the new Greek SHI reform protects individuals against catastrophic OOPs for unexpected inpatient health shocks in private hospitals. Data: The data was obtained after a cross sectional survey in 2013 and comprised a sample of 413 insured who were hospitalized at once in affiliated private hospitals with SHI in the main three urban centers of the country. Methods: We used ordinary least squares methods, in order to estimate the relationship between OOPs and SHI funding for these h...

Research paper thumbnail of Warfare vs. Welfare Finance: Assessing the Effect of Military Expenditure on Out of Pocket Healthcare Financing for NATO Countries

Theoretical economics letters, 2024

In the aftermath of the full-scale Russian invasion in Ukraine in 2022, the European political cl... more In the aftermath of the full-scale Russian invasion in Ukraine in 2022, the European political climate displays to fundamentally be transformed. The majority of European allies of NATO, committed to proceed on momentous increases in military spending to contain potential external threats, by abandoning their exclusive focus on economy, trade and welfare policies of a long-lasting period of peace on the continent. Despite the important findings emerging from the health financing and defence economics empirical literature, there is a limited scholarly consensus on the direct impact of military spending on the main pillar of private health financing for several countries. In this context, the aim of this paper is to empirically investigate the direct impact of military expenditure on out of pocket (OOP) healthcare financing, by using a panel data of the vast majority of NATO countries from 2000 to 2021 and applying the Generalized Method of Moments (GMM) estimator. After a series of several econometric tests and robustness checks that had been applied, the findings of this study show that military rearmaments positively affect OOP healthcare financing in the NATO Alliance. On the foreground of a new European political economy scenery with an unprecedented military spending impetus becoming the norm in several countries, this study enriches the literature, as well it provides useful insights to policy-makers that strong commitments for sharp increases in military spending inevitably confine social and welfare policies.

Research paper thumbnail of Assessing the responsiveness of out-of-pocket healthcare expenditure to macro-fiscal factors and different health financing systems: evidence from the European and OECD area

Euromed Journal of Business, 2021

PurposeIn this paper, the authors assess the responsiveness of OOP healthcare expenditure to macr... more PurposeIn this paper, the authors assess the responsiveness of OOP healthcare expenditure to macro-fiscal factors, as well as to tax-based, SHI, mixed systems and voluntary PHI financing. Although the relationship between OOP expenditure, macroeconomy, aggregate public and PHI financing is well documented in the existing empirical literature, little is known for the impact of several macro-fiscal drivers and the existing health financing arrangements associated with voluntary PHI on OOP expenditure.Design/methodology/approachThe authors gather panel data by applying three official organizations’ databases. They elaborate static and dynamic panel data methodology to a dataset of 49 European and OECD countries from 2000 to 2015.FindingsThe authors’ findings do not indicate a considerable impact of GDP growth and general government debt as a share of GDP on OOP payments. Unemployment rate presents as a positive driver of OOP payments in all three compulsory national health systems post...

Research paper thumbnail of The impact of macro-fiscal factors and private health insurance financing on public health expenditure: evidence from the OECD countries for the period 2000–2017

EuroMed Journal of Business, 2020

Purpose Because of the 2008 global financial crisis aftermaths, economic downturn and prolonged r... more Purpose
Because of the 2008 global financial crisis aftermaths, economic downturn and prolonged recession, several OECD countries have adopted an austerity compound by significantly reducing public health expenditure (PHE) for dealing with their fiscal pressure and sovereign-debt challenges. Against this backdrop, this study aims to examine the responsiveness of PHE to macro-fiscal determinants, demography, as well to private health insurance (PHI) financing.
Design/methodology/approach
The authors gather annual panel data from four international organizations databases for the total of OECD countries from a period lasting from 2000 to 2017. The authors apply static and dynamic econometric methodology to deal with panel data and assess the impact of several parameters on PHE.
Findings
The authors’ findings indicate that gross domestic product, fiscal capacity, tax revenues and population aging have a positive effect on PHE. Further, the authors find that both unemployment rate and voluntary private health insurance financing present a negative statistically significant impact on our estimated outcome variable. Different specifications and sample periods applied in the regression models reveal how inseparably associated are PHE and OECD's economies compliance on macro-fiscal policies for offsetting public finances derailment.
Practical implications
Providing more evidence on the responsiveness of PHE to several macro-fiscal drivers, it can be a helpful tool for governments to reconsider their persistence on fiscal adjustments measures and rank public health financing to the top of their political agenda. Health systems policies for meeting Universal Health Coverage (UHC) objectives, they should also take into consideration the voluntary PHI institution, especially for economies with insufficient fiscal capacity to raise public health financing.
Originality/value
To the best of knowledge, the impact of unemployment and voluntary PHI funding on public health financing, apart from other macro-fiscal and demographical parameters effect, remains unnoticed in the existing published studies on the topic.

Research paper thumbnail of The impact of military expenditures on out of pocket healthcare payments: international evidence based on a dynamic panel data analysis

Euromed Journal of Business, May 17, 2022

PurposeThe empirical analysis dealt in this paper emphasizes on the impact of military expenditur... more PurposeThe empirical analysis dealt in this paper emphasizes on the impact of military expenditures on out of pocket (OOP) healthcare payments. A sizeable body of defence economics literature has investigated the trade-off between military and public health expenditure, by testing the crowding-out or growth-stimulating hypothesis; does military expenditure scaling up crowd-out or promote governmental resources for social and welfare programs, including also state health financing?Design/methodology/approachIn this study, panel data from 2000 to 2018 for 129 countries is used to examine the impact of military expenditure on OOP healthcare payments. The dataset of countries is categorized into four income-groups based on World Bank's income-group classification. Dynamic panel data methodology is applied to meet study objectives.FindingsThe findings of this study indicate that military expenditure positively affects OOP payments in all the selected groups of countries, strongly supporting in this way the crowding-out hypothesis whereby increased military expenditure reduces the public financing on health. Study econometric results are robust since different and alternative changes in specifications and samples are applied in our analysis.Practical implicationsUnder the economic downturn backdrop for several economies in the previous decade and on the foreground of a potential limited governmental fiscal space related to the Covid-19 pandemic adverse economic effects, this study provides evidence that policy-makers have to adjust their government policy initiatives and prioritize Universal Health Coverage objectives. Consequently, the findings of this study reflect the necessity of governments as far as possible to moderate military expenditures and increase public financing on health in order to strengthen health care systems efficiency against households OOP spending for necessary healthcare utilization.Originality/valueDespite the fact that a sizeable body of defence economics literature has extensively examined the impact of military spending on total and public health expenditures, nevertheless to the best of our knowledge there is no empirical evidence of any direct effect of national defence spending on the main private financing component of health systems globally; the OOP healthcare payments.

Research paper thumbnail of The impact of military expenditures on out of pocket healthcare payments: international evidence based on a dynamic panel data analysis

EuroMed Journal of Business

PurposeThe empirical analysis dealt in this paper emphasizes on the impact of military expenditur... more PurposeThe empirical analysis dealt in this paper emphasizes on the impact of military expenditures on out of pocket (OOP) healthcare payments. A sizeable body of defence economics literature has investigated the trade-off between military and public health expenditure, by testing the crowding-out or growth-stimulating hypothesis; does military expenditure scaling up crowd-out or promote governmental resources for social and welfare programs, including also state health financing?Design/methodology/approachIn this study, panel data from 2000 to 2018 for 129 countries is used to examine the impact of military expenditure on OOP healthcare payments. The dataset of countries is categorized into four income-groups based on World Bank's income-group classification. Dynamic panel data methodology is applied to meet study objectives.FindingsThe findings of this study indicate that military expenditure positively affects OOP payments in all the selected groups of countries, strongly sup...

Research paper thumbnail of The impact of macro-fiscal factors and private health insurance financing on public health expenditure: evidence from the OECD countries for the period 2000–2017

EuroMed Journal of Business, 2020

PurposeBecause of the 2008 global financial crisis aftermaths, economic downturn and prolonged re... more PurposeBecause of the 2008 global financial crisis aftermaths, economic downturn and prolonged recession, several OECD countries have adopted an austerity compound by significantly reducing public health expenditure (PHE) for dealing with their fiscal pressure and sovereign-debt challenges. Against this backdrop, this study aims to examine the responsiveness of PHE to macro-fiscal determinants, demography, as well to private health insurance (PHI) financing.Design/methodology/approachThe authors gather annual panel data from four international organizations databases for the total of OECD countries from a period lasting from 2000 to 2017. The authors apply static and dynamic econometric methodology to deal with panel data and assess the impact of several parameters on PHE.FindingsThe authors’ findings indicate that gross domestic product, fiscal capacity, tax revenues and population aging have a positive effect on PHE. Further, the authors find that both unemployment rate and volunt...

Research paper thumbnail of Macroeconomic and financing determinants of out of pocket payments in health care: Evidence from selected OECD countries

Journal of Policy Modeling, 2018

In this paper, we examine the impact of macroeconomic, as well public and private health insuranc... more In this paper, we examine the impact of macroeconomic, as well public and private health insurance financing (PHI) factors on out of pocket (OOP) healthcare expenditures, by using fixed/random effects and dynamic panel data methodology to a dataset of 26 EU and OECD countries for a period lasting from 1995 to 2013. The existing empirical literature has focused on testing the hypothesis that several macroeconomic and health financing determinants have an effect on OOP healthcare expenditures. Nevertheless, the related articles have not well tested the hypothesis concerning the potential impact of PHI financing on OOP spending. We find that public and PHI financing have a significant countervailing effect on OOP spending. Moreover, we show that unemployment rate has a significant positive impact on OOP expenditures. Sensitivity tests with variation of specifications and samples show that our findings are robust. We argue that policy-makers should give serious consideration to PHI institution; our results indicate that there is an inverse effect on OOP spending. We suggest that our examined countries have to provide financial risk protection to their citizens against OOP payments, rather than only attending health budgetary retrenchments in order to adjust public finances.

Research paper thumbnail of Combined social and private health insurance versus catastrophic out of pocket payments for private hospital care in Greece

International Journal of Health Economics and Management, 2017

The high level of out of pocket (OOP) payments constitutes a major concern for Greece and several... more The high level of out of pocket (OOP) payments constitutes a major concern for Greece and several other European and OECD countries as a result of the significant down turning of their public health finances due to the 2008 financial crisis. The basic objective of this study is to provide empirical evidence on the effect of combining social health insurance (SHI) and private health insurance (PHI) on OOP payments. Further, this study examines the catastrophic impact of OOP payments on insured's welfare using the incidence and intensity methodological approach of measuring catastrophic health care expenditures. Conducting a cross-sectional survey in Greece in 2013, we find that the combination of SHI-PHI has a strong negative influence on insured OOP payments for inpatient health care in private hospitals. Furthermore, our results indicate that SHI coverage is not sufficient by itself to manage with this issue. Moreover, we find that poor people present a greater tendency to incur catastrophic OOP expenditures for hospital health care in private providers. Drawing evidence from Greece, a country with huge fiscal problems that has suffered the consequences of the economic crisis more than any other, could be a starting point for policymakers to consider the perspective of SHI-PHI cooperation against OOP payments more seriously. Keywords OOP payments • SHI • PHI • Financial catastrophe • Informal payments • Greece JEL Classification I1 • I13 • G01 • C23 B Christos Floros

Research paper thumbnail of Out of pocket payments and social health insurance for private hospital care: Evidence from Greece

Health Policy, 2016

The Greek state has reduced their funding on health as part of broader efforts to limit the large... more The Greek state has reduced their funding on health as part of broader efforts to limit the large fiscal deficits and rising debt ratios to GDP. Benefits cuts and limitations of Social Health Insurance (SHI) reimbursements result in substantial Out of Pocket (OOP) payments in the Greek population. In this paper, we examine social health insurance's risk pooling mechanisms and the catastrophic impact that OOP payments may have on insured's income and well-being. Using data collected from a cross sectional survey in Greece, we find that the OOP payments for inpatient care in private hospitals have a positive relationship with SHI funding. Moreover, we show that the SHI funding is inadequate to total inpatient financing. We argue that the Greek health policy makers have to give serious consideration to the perspective of a SHI system which should be supplemented by the Private Health Insurance (PHI) sector.

Research paper thumbnail of The Effect of Out of Pocket Payments on the Income of Hospitalized Patients. Evidence from Greece

Purpose – To examine social health insurance’s risk pooling mechanisms and the catastrophic impac... more Purpose – To examine social health insurance’s risk pooling mechanisms and the catastrophic impact that health care OOPs can have on insureds’ income and wellbeing. Background: The Greek state has reduced their funding on health as part of broader efforts to limit the large fiscal deficits and rising debt ratios to GDP (OECD, 2013). Benefits cuts and limitations of Social Health Insurance (SHI) reimbursements result in Greek population substantial Out of Pocket Payments (OOP). Objective: To examine how well the new Greek SHI reform protects individuals against catastrophic OOPs for unexpected inpatient health shocks in private hospitals. Data: The data was obtained after a cross sectional survey in 2013 and comprised a sample of 413 insured who were hospitalized at once in affiliated private hospitals with SHI in the main three urban centers of the country. Methods: We used ordinary least squares methods, in order to estimate the relationship between OOPs and SHI funding for these h...

Research paper thumbnail of Warfare vs. Welfare Finance: Assessing the Effect of Military Expenditure on Out of Pocket Healthcare Financing for NATO Countries

Theoretical economics letters, 2024

In the aftermath of the full-scale Russian invasion in Ukraine in 2022, the European political cl... more In the aftermath of the full-scale Russian invasion in Ukraine in 2022, the European political climate displays to fundamentally be transformed. The majority of European allies of NATO, committed to proceed on momentous increases in military spending to contain potential external threats, by abandoning their exclusive focus on economy, trade and welfare policies of a long-lasting period of peace on the continent. Despite the important findings emerging from the health financing and defence economics empirical literature, there is a limited scholarly consensus on the direct impact of military spending on the main pillar of private health financing for several countries. In this context, the aim of this paper is to empirically investigate the direct impact of military expenditure on out of pocket (OOP) healthcare financing, by using a panel data of the vast majority of NATO countries from 2000 to 2021 and applying the Generalized Method of Moments (GMM) estimator. After a series of several econometric tests and robustness checks that had been applied, the findings of this study show that military rearmaments positively affect OOP healthcare financing in the NATO Alliance. On the foreground of a new European political economy scenery with an unprecedented military spending impetus becoming the norm in several countries, this study enriches the literature, as well it provides useful insights to policy-makers that strong commitments for sharp increases in military spending inevitably confine social and welfare policies.

Research paper thumbnail of Assessing the responsiveness of out-of-pocket healthcare expenditure to macro-fiscal factors and different health financing systems: evidence from the European and OECD area

Euromed Journal of Business, 2021

PurposeIn this paper, the authors assess the responsiveness of OOP healthcare expenditure to macr... more PurposeIn this paper, the authors assess the responsiveness of OOP healthcare expenditure to macro-fiscal factors, as well as to tax-based, SHI, mixed systems and voluntary PHI financing. Although the relationship between OOP expenditure, macroeconomy, aggregate public and PHI financing is well documented in the existing empirical literature, little is known for the impact of several macro-fiscal drivers and the existing health financing arrangements associated with voluntary PHI on OOP expenditure.Design/methodology/approachThe authors gather panel data by applying three official organizations’ databases. They elaborate static and dynamic panel data methodology to a dataset of 49 European and OECD countries from 2000 to 2015.FindingsThe authors’ findings do not indicate a considerable impact of GDP growth and general government debt as a share of GDP on OOP payments. Unemployment rate presents as a positive driver of OOP payments in all three compulsory national health systems post...

Research paper thumbnail of The impact of macro-fiscal factors and private health insurance financing on public health expenditure: evidence from the OECD countries for the period 2000–2017

EuroMed Journal of Business, 2020

Purpose Because of the 2008 global financial crisis aftermaths, economic downturn and prolonged r... more Purpose
Because of the 2008 global financial crisis aftermaths, economic downturn and prolonged recession, several OECD countries have adopted an austerity compound by significantly reducing public health expenditure (PHE) for dealing with their fiscal pressure and sovereign-debt challenges. Against this backdrop, this study aims to examine the responsiveness of PHE to macro-fiscal determinants, demography, as well to private health insurance (PHI) financing.
Design/methodology/approach
The authors gather annual panel data from four international organizations databases for the total of OECD countries from a period lasting from 2000 to 2017. The authors apply static and dynamic econometric methodology to deal with panel data and assess the impact of several parameters on PHE.
Findings
The authors’ findings indicate that gross domestic product, fiscal capacity, tax revenues and population aging have a positive effect on PHE. Further, the authors find that both unemployment rate and voluntary private health insurance financing present a negative statistically significant impact on our estimated outcome variable. Different specifications and sample periods applied in the regression models reveal how inseparably associated are PHE and OECD's economies compliance on macro-fiscal policies for offsetting public finances derailment.
Practical implications
Providing more evidence on the responsiveness of PHE to several macro-fiscal drivers, it can be a helpful tool for governments to reconsider their persistence on fiscal adjustments measures and rank public health financing to the top of their political agenda. Health systems policies for meeting Universal Health Coverage (UHC) objectives, they should also take into consideration the voluntary PHI institution, especially for economies with insufficient fiscal capacity to raise public health financing.
Originality/value
To the best of knowledge, the impact of unemployment and voluntary PHI funding on public health financing, apart from other macro-fiscal and demographical parameters effect, remains unnoticed in the existing published studies on the topic.