BMJ open · 2026
Impact of government health expenditure on health outcomes in China: a quantitative analysis of mediation and threshold effects.
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Gui Mei, Kuang Xianming, Ji Caifa
Аннотация
OBJECTIVES: To investigate the impact of government health expenditure on health outcomes in China, including its direct effects, underlying pathways and how these effects vary under different conditions of expenditure scale, health resource availability and economic development.
DESIGN: A quantitative study using provincial panel data from 2008 to 2023. Analysis was conducted using a fixed-effects model, with instrumental variables employed to address potential endogeneity. A mediation model was used to examine indirect pathways and a threshold regression model was applied to explore heterogeneous effects across different levels of key variables.
SETTING: The study was conducted using data from Chinese provinces over the period 2008-2023, within the context of China's national health policy and the 'Healthy China' strategy.
PARTICIPANTS: 31 provinces, autonomous regions and municipalities in China were included, with data extracted from official statistical yearbooks and health reports over the 16-year period.
PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes: maternal mortality and perinatal mortality.
SECONDARY OUTCOME: life expectancy.
RESULTS: Government health expenditure significantly reduced maternal mortality and perinatal mortality but its effect on life expectancy was not statistically significant. The number of health institutions showed a negative mediating effect. Threshold analysis revealed that the impact of government health expenditure varied across levels of expenditure scale, health resources and economic development. In low-income contexts, government health expenditure could even produce adverse effects; however, with improved economic development and greater health resource availability, its positive impact on health outcomes became increasingly evident.
CONCLUSIONS: The health effects of government health expenditure are highly context-dependent. Optimal policy effectiveness requires coordinated interaction among multiple factors, including expenditure scale, health resource endowment and regional economic development.
DESIGN: A quantitative study using provincial panel data from 2008 to 2023. Analysis was conducted using a fixed-effects model, with instrumental variables employed to address potential endogeneity. A mediation model was used to examine indirect pathways and a threshold regression model was applied to explore heterogeneous effects across different levels of key variables.
SETTING: The study was conducted using data from Chinese provinces over the period 2008-2023, within the context of China's national health policy and the 'Healthy China' strategy.
PARTICIPANTS: 31 provinces, autonomous regions and municipalities in China were included, with data extracted from official statistical yearbooks and health reports over the 16-year period.
PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes: maternal mortality and perinatal mortality.
SECONDARY OUTCOME: life expectancy.
RESULTS: Government health expenditure significantly reduced maternal mortality and perinatal mortality but its effect on life expectancy was not statistically significant. The number of health institutions showed a negative mediating effect. Threshold analysis revealed that the impact of government health expenditure varied across levels of expenditure scale, health resources and economic development. In low-income contexts, government health expenditure could even produce adverse effects; however, with improved economic development and greater health resource availability, its positive impact on health outcomes became increasingly evident.
CONCLUSIONS: The health effects of government health expenditure are highly context-dependent. Optimal policy effectiveness requires coordinated interaction among multiple factors, including expenditure scale, health resource endowment and regional economic development.