Punctuated Equilibrium Theory: An Empirical Investigation of its Relevance for Global Health Expenditure

Abstract

We use Punctuated Equilibrium Theory (PET) to examine the distribution of annual change in national government spending on global health through bilateral agencies by 17 OECD nations for 1990–2009. Consistent with our expectations and the PET literature, we find that the distribution of annual log percent change in commitments and disbursements for global health is leptokurtic rather than close to the normal distribution anticipated under incrementalism. Our findings illustrate the value of PET's focus on distributions rather than on time trends in levels alone when examining government allocation behavior, while adding to the literature on global health finance. This study also highlights the impact of choice of log percent change or percent change in examining budgetary change distributions. Better understanding of allocation patterns in this arena can inform those interested in global health policy and its vital outcomes.