Asymmetric impact of governance determinants and health expenditure on health outcomes in E7 countries: an empirical simulation using MMQR techniques

Despite substantial investments in health, many emerging economies continue to face challenges in achieving desired health outcomes, highlighting the need to understand how health expenditure interacts with governance quality. The present study investigates the asymmetric impacts of health expenditure and governance on health outcomes in the key E7 economies, Brazil, China, India, Indonesia, Mexico, Russia, and Turkey, over the period 2000–2023. Using Method of Moments Quantile Regression and Structural Equation Modeling (SEM), the analysis examines the effects of current and government health expenditure alongside governance indicators on progress toward Sustainable Development Goal 3, which focuses on health and well-being. The findings reveal that public and private health spending positively influence health outcomes, particularly when issues of marginal efficiency at high-performance levels are considered. Governance indicators, especially regulatory quality and government effectiveness, strengthen the impact of health expenditure, whereas the role of voice and accountability is more ambiguous and often indirect. These results underscore that institutional quality is crucial for translating health investments into sustainable improvements. Overall, the study provides evidence-based insights for policymakers, emphasizing the importance of aligning governance reforms and health financing with national capacities and priorities.