经济增长、卫生支出与婴儿死亡率：基于中介效应的跨国分析

Economic Growth, Health Expenditure, and Infant Mortality: A Cross-National Mediation Analysis

摘要: 本文基于世界银行2000~2021年中等以上收入国家的跨国面板数据，以婴儿死亡率为因变量、人均GDP为自变量，选取当前医疗支出(占GDP百分比)、当前人均卫生支出、国内一般政府人均卫生支出、人均外部卫生支出、人均自付费用为中介变量，检验医疗卫生支出在人均GDP与婴儿死亡率之间的中介效应。结果表明，五个中介模型中，人均GDP对婴儿死亡率的直接效应均显著(P < 0.05)。各中介变量均发挥部分中介作用，其中当前人均卫生支出和国内一般政府人均卫生支出的中介效应最为突出，分别占总效应的75.16%和73.40%；人均自付费用次之(20.40%)；当前医疗支出占GDP比重(7.55%)和人均外部卫生支出(3.19%)的中介效应较弱。当前人均卫生支出与政府人均卫生支出是经济增长降低婴儿死亡率的核心中介变量，人均自付费用发挥次要作用，但需警惕其公平性风险。建议持续加大政府卫生投入，提升支出效率，强化个人负担管控。

Abstract: This article is based on cross-national panel data of middle- and high-income countries from the World Bank from 2000 to 2021. Infant mortality rate is the dependent variable and per capita GDP is the independent variable. The current medical expenditure (as a percentage of GDP), current per capita health expenditure, domestic general government per capita health expenditure, per capita external health expenditure, and per capita out of pocket expenses are selected as mediating variables to test the mediating effect of medical and health expenditure between per capita GDP and infant mortality rate. The results showed that among the five mediation models, the direct effect of per capita GDP on infant mortality rate was significant (P < 0.05). All mediator variables play a partial mediating role, among which the current per capita health expenditure and the domestic general government per capita health expenditure have the most prominent mediating effect, accounting for 75.16% and 73.40% of the total effect, respectively; per capita out-of-pocket expenses rank next (20.40%); The mediating effect of the current proportion of medical expenditure to GDP (7.55%) and per capita external health expenditure (3.19%) is weak. The current per capita health expenditure and government per capita health expenditure are the core mediating variables for economic growth to reduce infant mortality, with per capita out of pocket costs playing a secondary role, but caution should be exercised about their fairness risks. Suggest continuously increasing government investment in health, improving expenditure efficiency, and strengthening individual burden control.