UNPACKING HEALTH AID EFFECTIVENESS

This thesis provides an unpacked analysis of health aid effectiveness using Mozambique as a case-study. It comprises of three main papers of independent but related research. The first paper adds to the literature by employing a new model to study the impact of health aid on health outcomes. By taking into account the heterogeneity that exists in the amount of health aid received between Mozambican provinces, a multilevel model is specified. After recognizing significant variation of health outcomes between provinces, I found no statistical evidence that health aid was a cause of those variations. The second paper provides a systematic analysis of donors’ health aid disbursement decisions in-country. Using a game theoretic framework and grounded in qualitative evidence from Mozambique, this paper shows that donors have allocation tactics other than state-to-state aid to pursue their goals which are translated into opting for alternative channels of delivery. Simultaneously, this research acknowledges the non-passive role of the recipient country, i.e., donors’ decisions of how to allocate aid are mediated by the recipient’s response to their actions. This chapter suggests that recipient-donors’ strategic interactions are crucial to understand donors’ allocation behaviour and have direct consequences for aid effectiveness. The last paper explores empirically and theoretically aid coordination efforts of aid agencies. After providing an insight into the implementation of coordination in the health sector in Mozambique, this chapter explores why different agencies differ in their motivations to coordinate, based on the distinction between public and private good properties of coordination. Finally, using a collective action theory framework and aided by Schelling’s (1973) diagrams, this chapter illustrates why it is so hard to coordinate. My results show that individual incentives to coordinate are neither strong nor stable. Furthermore, the success of coordination depends, inter alia, on the number of agencies that perceive coordination as a public versus private good and the role and involvement of the lead donor and the recipient country

Taxation and public spending efficiency : an international comparison

This paper evaluates the relevance of the taxation for public spending efficiency in a sample of OECD economies in the period 2003-2017. First, we compute the data envelopment analysis (DEA) scores and the Malmquist productivity index to measure the change in total factor productivity, the change in efficiency and the change in technology. Second, we explain these newly computed public efficiency scores with tax structures using a reduced-form panel data regression specification. Looking at the period between 2007 and 2017, our main findings are as follows: inputs could be theoretically lower by approximately 32-34%; the Malmquist indices show an overall decrease in technology and in TFP. Crucial for policymaking, we find that expenditure efficiency is negatively associated with taxation, more specifically direct and indirect taxes negatively affect government efficiency performance, and the same is true for social security contributions.info:eu-repo/semantics/publishedVersio

Structural tax reforms and public spending efficiency

We empirically assess the effects of structural tax reforms on government spending efficiency in a sample of 18 OECD economies over the period 2006–2017. After calculating input spending efficiency scores, we evaluate in a panel setup the relevance for public sector efficiency of narrative tax changes. We find that: i) input efficiency scores average around 0.6–07; ii) increases in tax rates, primarily for PIT, negatively affect public sector efficiency; iii) controlling for endogeneity, increases in tax rates are still associated with lower public sector efficiency, mainly for PIT and increases in tax bases improve public sector efficiency; vi) in expansionary periods, increasing the CIT base and reducing PIT rates, positively affect public sector efficiency; ix) in contrast, during recessions efficiency improves when PIT and VAT bases increase and the CIT rate increases.info:eu-repo/semantics/publishedVersio

Government spending efficiency, measurement and applications : a cross-country efficiency dataset

This chapter conducts a review of the literature dealing with overall public sector performance and efficiency, it defines a methodology to assess public sector efficiency and it creates a novel and large cross-sectional panel dataset of government indicators and public sector efficiency scores. The focus is on a balanced sample covering all 36 OECD countries over the time period between 2006 and 2017. First, we define a set of economic and sociodemographic metrics necessary to construct performance composite indicators. Second, we calculate and report a full set of (input and output oriented) efficiency scores based on the performance indicators previously computed.info:eu-repo/semantics/publishedVersio

A tale of government spending efficiency and trust in the state

This paper empirically links the efficiency and performance assessment of the general government, proxied by efficiency scores, to the trust in government. Government spending efficiency scores are first computed via data envelopment analysis (DEA). Then, relying on panel data and instrumental variable approaches, we estimate the effect of public sector efficiency on citizens trust on national governments. The sample covers 36 OECD countries between 2007 and 2019. We find that the more efficient countries in terms of government spending are Australia, Chile, Ireland, New Zealand, South Korea, Switzerland. Secondly, our main finding is that better public sector spending efficiency is positively associated with citizens’ higher trust in governments. In general, political economy variables and the existence of fiscal rules do not seem to significantly affect our measure of trust. Results were held using alternative proxies for public sector efficiency, specifications with different control variables and instrumental variables approaches.info:eu-repo/semantics/publishedVersio

Structural tax reforms and public spending efficiency

We evaluate the effects of structural tax reforms on government spending efficiency in a sample of OECD economies over the period 2007-2016. After calculating input spending efficiency scores, we assess the relevance for efficiency of narrative tax changes in a panel setup. We find that: i) input efficiency scores average around 0.6-07; ii) increases in the tax rates are reflected in falling public sector efficiency; iii) such negative effect is significant for PIT and VAT; iv) controlling for endogeneity, increases in tax rates are still associated with lower public sector efficiency, mainly in PIT; v) increasing tax bases for PIT and VAT improve public sector efficiency; vi) in economic expansion periods, increasing CIT base and reducing PIT rates, positively affect public sector efficiency; ix) in recessions, efficiency improves when PIT and VAT bases increase and CIT rate increases.info:eu-repo/semantics/publishedVersio

Government spending and tax revenue decentralization and public sector efficiency : do natural disasters matter?

We assess notably how do extreme events affect the public sector efficiency of decentralized governance. Hence, we empirically link the public sector efficiency scores, to tax revenue and spending decentralization. First, we compute government spending efficiency scores via data envelopment analysis. Second, relying on panel data and impulse response approaches, we estimate the effect of decentralization on public sector efficiency and how extreme natural disasters mediate this relationship. The sample covers 36 OECD countries between 2006 and 2019. Our results show that tax revenue decentralization decreases public sector efficiency, while spending decentralization and a regional authority index are positively related to public sector efficiency, both for local projections and panel analysis. For instance, efficiency rises by 10 percent following a spending decentralization shock (reaching over 20 percent after 4 years). Nevertheless, in cases of natural disasters, spending decentralization reduces public sector efficiency. Specifically, in the presence of most extreme natural disasters, the improvement in public sector efficiency after a spending decentralization shock is smaller than in their absence. Moreover, extreme natural disasters also deteriorate the negative effect of tax revenue decentralization on public sector efficiency. These results suggest that sub-national discretionary spending and tax revenue responses might be less fruitful when such extreme events occur.info:eu-repo/semantics/publishedVersio

Do financial markets reward government spending efficiency?

We link governments’ spending efficiency scores, to sovereign debt assessments made by financial markets´, more specifically by three rating agencies (Standard & Poors, Moody´s and Fitch). Public efficiency scores are computed via data envelopment analysis. Then, we rely notably on ordered response models to estimate the response of sovereign ratings to changes in efficiency scores. Covering 34 OECD countries over the period 2007-2018, we find that increased public spending efficiency is rewarded by financial markets via higher sovereign debt ratings. In addition, higher inflation and government indebtedness lead to sovereign rating downgrades, while higher foreign reserves contribute to rating upgrades.info:eu-repo/semantics/publishedVersio

Does government spending affect income poverty? A meta-regression analysis

This paper presents the results of a meta-regression analysis of the relationship between government spending and income poverty, with a focus on low- and middle-income countries. Through a comprehensive search and screening process, we identify a total of 19 cross-country econometric studies containing 169 estimates of this relationship. We find that the size and direction of the estimated relationship are affected by a range of factors, most notably the composition of the sample used for estimation, the control variables included in the regression model, and the type of government spending. Overall, we find no clear evidence that higher government spending has played a significant role in reducing income poverty in low- and middle-income countries. This is consistent with the view that fiscal policy plays a much more limited redistributive role in developing countries, in comparison with OECD countries. In addition, we find that the relationship between government spending and poverty is on average less negative for countries in Sub-Saharan Africa, and more negative for countries in Eastern Europe and Central Asia, compared to other regions. We also find that the relationship is less negative for government consumption spending, in comparison with other sectors. Finally, we find some evidence indicating the possibility of publication bias

Dominância arterial coronariana e sua importância clínica: uma revisão da literatura / Coronary arterial dominance and its clinical importance: a literature review

Introdução: O coração humano é irrigado pelas artérias coronárias direita e esquerda, ramos diretos da aorta. Para indicar o padrão de dominância é utilizado como parâmetro a artéria coronária que fornece o ramo interventricular posterior. Objetivo: Conhecer a prevalência de dominância coronariana direita, esquerda e codominância relatadas na literatura e entender as suas consequências clínicas para o paciente. Métodos: Revisão integrativa da literatura com busca nas bases de dados científicos PubMed, SciELO e BVS por publicações dos últimos 15 anos usando os seguintes descritores encontrados no Descritores em Ciências da Saúde (DeCS): circulação coronária, coração e dominância. Os critérios de inclusão foram artigos completos com prevalência da dominância coronariana e as repercussões clínicas nos pacientes. Dos 307 artigos encontrados, seis foram selecionados e incluídos nesta revisão. Resultados: O número de publicações que discutiam a circulação do coração cresceu, mas ainda são escassos. Quatro dos estudos incluídos avaliam que a dominância esquerda está associada a maior mortalidade e complicações arrítmicas.  Todos estudos apontam que a artéria coronária direita é a responsável pelo padrão de dominância na maioria das populações estudadas. Conclusões: Reitera-se que a dominância direita é mais prevalente e que a dominância esquerda está proporcionalmente mais relacionada à desfechos fatais e maior risco de complicações cardíacas