How dynamics of public debt and health expenditures affects response to health crises: Europe during COVID 19 pandemic
DOI:
https://doi.org/10.17811/ebl.14.1.2025.51-62Keywords:
debt - to - GDP, Budget deficit, Economic Vulnerability, COVID 19Abstract
The main objective of this investigation is to analyze how high levels of public debt and deficit affect the preparedness of countries to face emergencies. In particular, this study examines the relationship between level of public debt and deficit as a share of GDP and health expenditures to face preparedness of European countries in the presence of COVID-19 pandemic crisis. Empirical evidence reveals that European countries with lower COVID-19 fatality rates had average lower government gross debt and deficit as a share of GDP both in 2009 and 2019 (period before the arrival of the pandemic) compared to countries with higher fatality rates. The findings show that policies for public finance of countries having high level of public debt and deficit reduce health expenditures weakening healthcare system and increasing vulnerability of socioeconomic system in the presence of crises, such as COVID-119 pandemic.
References
Aba G, Ateş M (2016) The relationship between health expenditure and socioeconomic/demographic indicators: an international comparison. Journal of International Health Sciences and Management, 2(2): 113-118.
Agoraki MK, Kardara S, Kollintzas T, Kouretas GP (2023) Debt-to-GDP changes and the great recession: European Periphery versus European Core. International Journal of Finance and Economics, 28(3): 3299–3331
Aizenman J, Ito H (2023) Post COVID-19 exit strategies and emerging markets economic challenges. Review of International Economics, 31(1): 1–34
Alesina A, Favero C, Giavazzi F (2019) Austerity: When It Works and When It Doesn’t. Princeton University Press. https://doi.org/10.2307/j.ctvc77f4b
Azizi H, Esmaeili ED, Fakhari A (2020) Challenges and accurate estimates of mortality and case-fatality rates due to COVID-19. New microbes and new infections, 38, 100775. https://doi.org/10.1016/j.nmni.2020.100775
Bacchiocchi E, Borghi E, Missale A (2011) Public Investment under Fiscal Constraints. Fiscal Studies, 32: 11-42.
Beaulieu M, Roy J, Rebolledo C, Landry S (2022) The management of personal protective equipment during the COVID-19 pandemic: The case of the province of Quebec. Healthcare Management Forum, 35(2):48-52. doi:10.1177/08404704211053996
Beleche T, Kuecken M, Sassi A, Toran K, Galloway E, Henry TC (2022) Characteristics of Medical Device Shortages in The US, 2006-20. Health Affairs, 41(12): 1790-1794. doi: 10.1377/hlthaff.2022.00643
Benati I.,Coccia M. 2022. Global analysis of timely COVID-19 vaccinations: improving governance to reinforce response policies for pandemic crises. International Journal of Health Governance, vol. 27, No. 3, pp. 240-253. https://doi.org/10.1108/IJHG-07-2021-0072
Bouchet MH, Clark E, Groslambert B (2023) Country Risk Assessment: A Guide to Global Investment Strategy 1st Edition, Wiley.
Burriel Llombart P, Checherita-Westphal C, Jacquinot P, et al. (2020) Economic consequences of high public debt: evidence from three large scale DSGE models. Documentos de Trabajo/Banco de España: 2029. http://dx.doi.org/10.2139/ssrn.3676264
Burrowes SA, Casey SM, Pierre-Joseph N, Talbot SG, Hall T, Christian-Brathwaite N, Del-Carmen M, Garofalo C, Lundberg B, Mehta PK, Mottl-Santiago J (2023) COVID-19 pandemic impacts on mental health, burnout, and longevity in the workplace among healthcare workers: A mixed methods study. Journal of Interprofessional Education & Practice, 2023 Jun 8:100661.
Coccia M. (2017). Asymmetric paths of public debts and of general government deficits across countries within and outside the European monetary unification and economic policy of debt dissolution, The Journal of Economic Asymmetries, vol. 15, June, pp. 17-31, https://doi.org/10.1016/j.jeca.2016.10.003
Coccia M. (2023). Sources, diffusion and prediction in COVID-19 pandemic: lessons learned to face next health emergency[J]. AIMS Public Health, 2023, 10(1): 145-168. doi: 10.3934/publichealth.2023012
Coccia M., Benati, I. (2024). Effective health systems facing pandemic crisis: lessons from COVID-19 in Europe for next emergencies, International Journal of Health Governance, https://doi.org/10.1108/IJHG-02-2024-0013
Crivelli E, Leive A, Stratmann MT (2010) Subnational health spending and soft budget constraints in OECD countries. International Monetary Fund; 2010 Jun 1.
De Soyres C., Kawai R., Wang, M. (2022). Public Debt and Real GDP: Revisiting the Impact. International Monetary Fund.
Essers D, Cassimon D (2022) Towards HIPC 2.0? Lessons from past debt relief initiatives for addressing current debt problems. Journal of Globalization and Development.13(2):187-231.
Eurostat (2024) General government gross debt. Available from: https://ec.europa.eu/eurostat/databrowser/view/sdg_17_40/default/table?lang=en
Eurostat (2024a) Government deficit/surplus, debt and associated data. https://ec.europa.eu/eurostat/databrowser/view/gov_10dd_edpt1/default/table?lang=en&category=gov.gov_gfs10.gov_10dd
Fan RY, Lederman D, Nguyen H, et al. (2023) Calamities, debt, and growth in developing countries. IMF Economic Review, 1-21.
Huang BZ, Creekmur B, Yoo MS, Broder B, Subject C, Sharp AL (2022) Healthcare Utilization Among Patients Diagnosed with COVID-19 in a Large Integrated Health System. Journal of General Internal Medicine, 37(4): 830-837.
Iwata Y, IIboshi H (2023) The nexus between public debt and the government spending multiplier: fiscal adjustments matter. Oxford Bulletin of Economics and Statistics 85(4): 830-858. https://doi.org/10.1111/obes.12547
Jagric T, Grbenic SO, Jagric V (2023) What drives the healthcare sector's economic impact? Evidence from European countries. International Journal of Health Governance, 27(1): 41–53
JHU (2023) COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). Available from: https://www.arcgis.com/apps/dashboards/bda7594740fd40299423467b48e9ecf6 (accessed on 18 May 2023).
Jordan JA, Shannon C, Browne D, Carroll E, Maguire J, Kerrigan K, Hannan S, McCarthy T, Tully MA, Mulholland C, Dyer KF (2023) Healthcare staff mental health trajectories during the COVID-19 pandemic: findings from the COVID-19 Staff Wellbeing Survey. BJPsych Open, 9(4):e112.
Karanikolos M, Azzopardi-Muscat N, Ricciardi W, McKee M (2022) The impact of austerity policies on health systems in Southern Europe in Social Welfare Issues in Southern Europe (1st ed.). Routledge.
Kargı B, Coccia M, Uçkaç B. (2023) Findings from the first wave of covid-19 on the different impacts of lockdown on public health and economic growth. International Journal of Economic Sciences 12(2): 21-39, DOI: 10.52950/ES.2023.12.2.002
Kargı B, Coccia M, Bekir Cihan Uçkaç (2023a). The Relation Between Restriction Policies against Covid-19, Economic Growth and Mortality Rate in Society. Migration Letters, 20(5):, 218-231. DOI: https://doi.org/10.47059/ml.v20i5.3538
Levaggi R, Menoncin F (2013) Soft budget constraints in health care: evidence from Italy. The European Journal of Health Economics,14:725-37
Looi JC, Allison S, Bastiampillai T, Kisely SR, Robson SJ. Supply and demand–a health economic perspective on the Australian hospital and elective surgery crisis. Australian Health Review. Jun 21.
Macedo A, Gonçalves N, Febra C (2021). COVID-19 fatality rates in hospitalized patients: systematic review and meta-analysis. Annals of Epidemiology, 57: 14 - 21.
Marginean S, Orastean R (2022) Health Spending Patterns and COVID-19 Crisis in European Union: A Cross-Country Analysis. Systems,10(6):238.
McKee M, Karanikolos M, Belcher P, et al. (2012) Austerity: a failed experiment on the people of Europe. Clinical medicine 12(4): 346. https://doi.org/10.7861/clinmedicine.12-4-346
Nickel C, Rother P, Zimmermann L (2010) Major public debt reductions: Lessons from the past, lessons for the future. European Central Bank Working Paper series:1241, September.
Núñez-Delgado A, Bontempi E, Coccia M, et al. (2021). SARS-CoV-2 and other pathogenic microorganisms in the environment. Environmental Research 201: 111606. https://doi.org/10.1016/j.envres.2021.111606.
Persad G, Largent E (2022) COVID-19 vaccine refusal and fair allocation of scarce medical resources. JAMA Health Forum, 3(4): e220356-e220356)
Poon YS, Lin YP, Griffiths P, Yong KK, Seah B, Liaw SY (2022) A global overview of healthcare workers’ turnover intention amid COVID-19 pandemic: A systematic review with future directions. Human resources for health, 20(1):1-8.
Raghupathi V, Raghupathi W (2021) The association between healthcare resource allocation and health status: an empirical insight with visual analytics. Journal of Public Health. 2021:1-23.
Rajaram Pandey, AK, Saproo S, Bansal S (2022) A research study to understand the impact of pandemic on healthcare workers. Journal of Information and Optimization Sciences, 43(6): 1209-1220.Roche (2023). Growing healthcare capacity to improve access to healthcare. Available from: https://www.roche.com/about/strategy/access-to-healthcare/capacity/ (accessed on 20 February 2024).
Roehr B (2022) Rise in US spending on healthcare in 2009 was twice that in UK. BMJ: British Medical Journal (Online). 2012;344.
Sagan A, Erin W, Dheepa R, et al. (2021) Health system resilience during the pandemic: It’s mostly about governance. Eurohealth 27(1): 10-15.
Sagan A, Thomas S, McKee M, et al. (2020). COVID-19 and health systems resilience: lessons going forwards. Eurohealth 26(2): 20-24.
Souliotis K, Papadonikolaki J, Papageorgiou M, Economou M (2018) The impact of crisis on health and health care: Thoughts and data on the Greek case. Archives of Hellenic Medicine, 35: 9–16
The European Central Bank (2016) Government Debt Reduction Strategies in the Euro Area. Economic Bulletin 4: 1-20.
Theodoropoulou S (2022) Recovery, resilience and growth regimes under overlapping EU conditionalities: the case of Greece. Comparative European Politics, 20(2): 201–219
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