Universal Health Coverage and Labor Productivity in ASEAN: A Lagged Panel Analysis of Health Systems as Economic Infrastructure, 2000–2023
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https://doi.org/10.65166/p3v11r43关键词:
universal health coverage, labor productivity, GDP per person employed, ASEAN; panel data, two-way fixed effects, lagged analysis, health systems摘要
This study analyzes whether universal health coverage (UHC), treated as an indicator of health-system strength, is associated with labor productivity in ASEAN economies. Framed within the view that health systems may function as economic infrastructure, the study examines the relationship between UHC service coverage and GDP per person employed using panel data from the ten ASEAN member states covering 2000 to 2023. The analysis uses descriptive statistics, correlation analysis, pooled ordinary least squares, and two-way fixed-effects (TWFE) panel regression with country and year effects. Lagged models at one-year, two-year, and three-year intervals are estimated to test temporal persistence, while alternative mediation models using life expectancy and tuberculosis incidence are examined. A controlled lagged TWFE specification further incorporates labor force participation, inflation, trade openness, and urban population share. Descriptive results from the balanced core panel of 240 country-year observations show a mean UHC index of 64.31, mean life expectancy of 71.17 years, and mean GDP per person employed of 54,015.41 constant PPP international dollars. Correlation analysis indicates strong positive associations between UHC and life expectancy (r = 0.9315) and between UHC and logged productivity (r = 0.8817). In the contemporaneous TWFE model, UHC is positively associated with logged GDP per person employed (β = 0.0263, p = 0.0020), implying that a one-point increase in the UHC index is associated with approximately 2.63% higher productivity. The lagged direct models yield highly stable estimates: β = 0.0267 (p = 0.0010) for the one-year lag, β = 0.0273 (p = 0.0006) for the two-year lag, and β = 0.0275 (p = 0.0006) for the three-year lag. In the controlled lagged TWFE models, the coefficients decline but remain statistically significant, at 0.0127 (p = 0.0463), 0.0137 (p = 0.0206), and 0.0142 (p = 0.0076), respectively. UHC also significantly predicts life expectancy and lower tuberculosis incidence, but neither variable emerges as a statistically conclusive mediator of the productivity relationship once UHC is included in the full models. Overall, the findings show that stronger UHC service coverage is robustly associated with higher output per worker in ASEAN, even after lagging the explanatory variable and controlling for key macro-structural conditions. The results support the interpretation that health systems contribute to economic performance not only through welfare improvement but also through the productive conditions that sustain labor efficiency.
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