Aggregate Health Care Expenditure Research Articles

Healthcare Expenditure and Human Development Index as Determinants of Environmental Quality: A Panel Study on Selected Asian Countries

This study explores how healthcare expenditure and human development index impact environmental quality in 26 Asian countries during the period 2000–2018. Both aggregate and disaggregate (public and private) variables of healthcare expenditure are used. The dynamic ordinary least squares and augmented mean group estimation techniques are employed to assess the impact of selected variables on environmental quality captured using carbon dioxide (CO2) emissions as a proxy. The causality among the variables is tested using the Dumitrescu–Hurlin panel causality test. The outcome of the study showed that scaling aggregate healthcare expenditure, disaggregate healthcare expenditure (public and private) and human development index deteriorates environmental quality. The causality tests confirm a bidirectional association between aggregate healthcare expenditure and CO2 emissions, disaggregate healthcare expenditure and CO2 emission and a one-way connection from human development index to CO2 emission. The study finds that the significant positive impact of healthcare expenditure and human development index on CO2 emission is a concern, as rising emissions have adverse effects on the environment, public health and global economy. The study highlights the need for policies to promote sustainable development in a way that balances the needs of healthcare, human development and the environment.

Abstract P4-07-46: The Out-of-Pocket Cost of Breast Cancer Care in Nigeria: A Prospective Analysis

Abstract Introduction A major barrier to timely breast cancer diagnosis and care in Nigeria is attributable to the out-of-pocket cost of accessing healthcare services, despite the presence of a National Health Insurance Scheme (NHIS). Excessive out-of-pocket payments are often associated with a catastrophic health care expenditure (CHE). Despite the rising incidence of breast cancer in Nigeria, there is a paucity of economic data on the cost of care and the impact healthcare expenditure may have on a household. This study provides a comprehensive, prospective analysis of out-of-pocket spending for breast cancer care at a single tertiary care institution in South West Nigeria. Methods Consecutive patients undergoing curative intent surgery for a new diagnosis of breast cancer at Obafemi Awolowo University Teaching Hospital (OAUTH) between August 2019-April 2022 were approached for enrolment. A novel, context specific questionnaire was developed for this study and administered by trained personnel. The questionnaire was delivered to patients and caregivers during hospital admission and again during six-month follow-up. Participants were asked to estimate monthly household income and expenditures. Out-of-pocket direct and indirect expenses for breast cancer diagnosis and care were elicited. Where feasible, hospital accounting records and individual receipts were used to minimize recall bias. Sequelae of the out-of-pocket costs were also elicited, such as the use of debt financing and important forgone expenditures, such as childhood education. Capacity-to-pay was calculated for each household from the provided data as the sum of annual non-food expenditures. A CHE was defined as an aggregate healthcare expenditure that exceeded 40% of a household’s capacity-to-pay. All monetary figures were collected in the local currency (Naira) and converted to USD using the Nigerian Central Bank conversion rate of 415.83N to 1USD. Research ethics board approval was obtained for this study from OAUTH. Results Data were collected from 57 eligible patients with a mean age of 49.8 years (SD 12). The median household size was five (range 1-10) and the majority (75.4%) had completed at least secondary education. Seventy four percent (73.6%) of patients had ≥ Stage III disease at presentation and 89.5% received systemic chemotherapy. Only seven percent (4/received adjuvant radiotherapy. The mean annual capacity-to-pay for the cohort was $2,840.8 ($2,913.6). The mean cost of care, including direct and indirect expenditure was $3,379.7 (SD $3032.2). Excluding indirect costs, such as the cost of travel and self-reported lost income, the mean cost of direct expenditures associated with diagnosis and treatment was $1,705.3 (SD $1,236.6). Out of the 57 patients enrolled in the study 52 (91.2%) experienced a CHE as a result of their breast cancer treatment. As a result, 56% of households had to borrow money and seven percent withdrew children from school. Sixty-three percent of patients had no form of health insurance. Conclusions Over 90% of breast cancer patients at a tertiary care facility in Nigeria experience a CHE as a result of out-of-pocket costs associated with accessing care. This limits access to costly evidence-based adjuncts (i.e. radiotherapy) and has a negative impact on the wellbeing of the broader household. There is a need for national and global initiatives to ensure financial protection from the cost of breast cancer care. Citation Format: Funmilola Wuraola, Chloe Blackman, Israel Adeyemi Owoade, Adeoluwa Oluwaseyi Adeleye, Peter Kingham, Olusegun Alatise, Gregory Knapp. The Out-of-Pocket Cost of Breast Cancer Care in Nigeria: A Prospective Analysis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-46.

Heterogeneity in end of life health care expenditure trajectory profiles

Treatment at the end of life forms a major component of aggregate health care expenditure. Expenditure, however, begins to increase several years before death and varies substantially across individuals. This paper investigates heterogeneity in expenditure profiles across a 36 month period preceding death using group-based trajectory models. A mixture of generalised linear models with four components fits the data best, and identifies decedents in to high cost late rise, medium-high cost late rise, medium-low cost, and low cost late rise expenditure profiles. Approximately 35% of the sample is allocated to the high cost late rise trajectory with average monthly expenditure of £493 36 months prior to death rising linearly for about 28 months before exponential growth to £4000 in the month preceding death. Health conditions at the beginning of the period increase the risk of being in a higher cost trajectory with cancer having the largest impact. The existence of concurrent morbidities substantially raises the probability of membership to the high-cost late rise profile group. A better understanding of the determinants of expenditure profiles in the run up to death contributes to informing policies aimed at mitigating costs while not compromising quality of care.

Health Care Expenditures Among Individuals With Chronic Psychotic Disorders in Ontario: An Analysis Over Time.

Chronic psychotic disorders are severe and disabling mental disorders associated with poor psychiatric and medical outcomes, and among the most costly mental disorders to treat. Understanding trends in aggregate health care expenditures over time, and respective drivers, can provide relevant insights for decision makers, namely around appropriate allocation of scarce resources within the health care sector. Using administrative health care times series data from Ontario, this analysis examined trends in aggregate public health care expenditures and activity from 2012 to 2019 among all individuals with a diagnosis of a chronic psychotic disorder. Total aggregate health care expenditures for individuals with a chronic psychotic disorder in Ontario increased at a moderate rate over this time period, in line with the growth of the number of people diagnosed, and thus not likely driven by unit costs or resource use. Psychiatric hospitalizations made up the largest share of health care expenditures (~30%). Nonetheless, among all health services, expenditures of acute medical hospitalizations, outpatient prescription drugs and home care saw the largest growth over time. Mean/per capita health care expenditures were greater for females, and increased with age as well as with the presence of comorbidities/chronic conditions. In particular, mean/per capita health care expenditures increased steadily with the number of comorbidities and were highest for individuals with 5 or more comorbidities and those with congestive heart failure, highlighting the ever-increasing importance of addressing physical health conditions among this patient population. These findings will have important implications for decision makers, namely around the appropriate allocation of health care resources for patients with chronic psychotic disorders. Future research should continue to monitor health care expenditures for individuals with chronic psychotic disorders as well as extend this analysis beyond 2019 to understand how the COVID-19 pandemic, and resulting lockdowns, has impacted aggregate health care expenditures and outcomes for patients living with chronic psychotic disorders.

Did the universal zero-markup drug policy lower healthcare expenditures? Evidence from Changde, China

BackgroundThe zero-markup drug policy (also known as the universal zero-markup drug policy (UZMDP)) was implemented in stages beginning with primary healthcare facilities in 2009 and eventually encompassing city public hospitals in 2016. This policy has been a central pillar of Chinese health reforms. While the literature has examined the impacts of this policy on healthcare utilization and expenditures, a more comprehensive and detailed assessment is warranted. The purpose of this paper is to explore the impacts of the UZMDP on inpatient and outpatient visits as well as on both aggregate healthcare expenditures and its various components (including drug, diagnosis, laboratory, and medical consumables expenditures).MethodsA pre-post design was applied to a dataset extracted from the Changde Municipal Human Resource and Social Security Bureau comprising discharge data on 27,246 inpatients and encounter data on 48,282 outpatients in Changde city, Hunan province, China. The pre-UZMDP period for the city public hospitals was defined as the period from October 2015 to September 2016, while the post-UZMDP period was defined as the period from October 2016 to September 2017. Difference-in-Difference negative binomial and Tobit regression models were employed to evaluate the impacts of the UZMDP on healthcare utilization and expenditures, respectively.ResultsFour key findings flow from our assessment of the impacts of the UZMDP: first, outpatient and inpatient visits increased by 8.89 % and 9.39 %, respectively; second, average annual inpatient and outpatient drug expenditures fell by 4,349.00 CNY and 1,262.00 CNY, respectively; third, average annual expenditures on other categories of healthcare expenditures increased by 2,500.83 CNY, 417.10 CNY, 122.98 CNY, and 143.50 CNY for aggregate inpatient, inpatient diagnosis, inpatient laboratory, and outpatient medical consumables expenditures, respectively; and fourth, men and older individuals tended to have more inpatient and outpatient visits than their counterparts.ConclusionsAlthough the UZMDP was effective in reducing both inpatient and outpatient drug expenditures, it led to a sharp rise in other expenditure categories. Policy decision makers are advised to undertake efforts to contain the growth in total healthcare expenditures, in general, as well as to evaluate the offsetting effects of the policy on non-drug components of care.

Income and healthcare financing system in the United States: an asymmetric analysis

PurposeThe purpose of this study is to first assess how the US healthcare financing system is influenced by income variation. Then, it examines whether or not the impact of income variation is asymmetric.Design/methodology/approachFor the analyses of this paper, the autoregressive distributed lag (ARDL) model is implemented to a data set covering the period from 1960 to 2018.FindingsThe results provide evidence that major funding sources of aggregate healthcare expenditure (HCE) respond differently to changes in income. The results also imply that the effect of income is not always symmetric.Originality/valueMany studies have attempted to identify the relationship between income and HCE. A common feature of past studies is that they have only focused on aggregate HCE, while one might be interested in knowing how major funders of aggregate HCE would be affected by changes in income. Another common feature of past studies is that they have assumed that the relationship between income and HCE is symmetric.

Policy induced increases in private healthcare financing provide short-term relief of total healthcare expenditure growth: Evidence from OECD countries

Healthcare reforms have long been advocated as a cure to the increasing healthcare expenditures in advanced economies. Nevertheless, it has not been established whether a market solution via private financing, rather than public financing, curb aggregate healthcare expenditures. To our knowledge, this paper is the first that quantifies the impact of reforms that significantly increases (decreases) the private (public) share of healthcare financing on total healthcare expenditures relative to income in 20 OECD countries. Our reform measure is based on structural break testing of the private share of total expenditures, and verification using evidence of policy reforms. To quantify the effect of these reforms we apply Propensity Score Matching and Inverse Probability Weighted regression analysis. Over a 5-year evaluation period the reforms lead to an accumulated cost saving 0.45 percentage points of GDP. The yearly effects of the reforms are largest in the first years in the post-reform period and decreases in size as a function of time since the reform. Our findings suggest that the investigated healthcare reforms have a relatively short-lived effect on aggregate health spending relative to GDP. The findings are robust to various sensitivity tests.

Asymmetric effect of income on the US healthcare expenditure: evidence from the nonlinear autoregressive distributed lag (ARDL) approach

Previous research that has investigated the relationship between income and Health Care Expenditure (HCE) assumes that the effect of income variation on HCE is symmetric. Additionally, while HCE consists of twelve different types of health services, most of the studies have only focused on the relationship between income and aggregate HCE. By applying the linear ARDL approach, introduced by Pesaran et al. Bounds testing approaches to the analysis of level relationships. J Appl Econom 16(3):289–326 (2001), this study expands the literature by estimating the income elasticity of HCE for all types of healthcare services. Our findings imply that while for some health services income elasticity is below unity, for some other services health spending tends to grow faster than GDP. We also applied the non-linear ARDL approach of Shin et al. Festschrift in honor of Peter Schmidt (2014), for the first time in the literature, to examine if the adjustment of income variation follows a non-linear path. This paper provides statistically significant and robust evidence that the effect of income variation on healthcare expenditure is not symmetric, despite what previous studies assume.

Spending on Health Care in the Netherlands: Not Going So Dutch

The Netherlands is among the top spenders on health in the OECD. We document the life-cycle profile, concentration and persistence of this expenditure using claims data covering both curative and long-term care expenses for the full Dutch population. Spending on health care is strongly concentrated: the one per cent of individuals with the highest levels of expenditure account for one quarter of the aggregate in any one year. Averaged over three years, the top one per cent still accounts for more than a fifth of the total, indicating a very high degree of persistence in the largest expenses. Spending on long-term care, which amounts to one third of all expenditure on health care, is even more concentrated: the top one per cent accounts for more than half of total spending on this type of care. Average expenditure rises steeply with age and even more so with proximity to death. Spending on individuals in their last year of life absorbs one tenth of aggregate health care expenditure. In a given year, spending on health care is highly skewed toward individuals with lower incomes. Average expenditure on the poorest fifth is more than three times that on the richest fifth. Spending on long-term care is five times more concentrated on the poor.

Income and Technology as Drivers of Australian Healthcare Expenditures.

The roles of income and technology as the major determinants of aggregate healthcare expenditure (HEXP) continue to interest economists and health policy researchers. Concepts and measures of medical technologies remain complex; however, income (on the demand side) and technology (on the supply side) are important drivers of HEXP. This paper presents analysis of Australia's HEXP, using time-series econometrics modeling techniques applied to 1971-2011 annual aggregate data. Our work fills two important gaps in the literature. First, we model the determinants of Australia's HEXP using the latest and longest available data series. Second, this novel study investigates several alternative technology proxies (input and output measures), including economy-wide research and development expenditures, hospital research expenditures, mortality rate, and two technology indexes based on medical devices. We then apply the residual component method and the technology proxy approach to quantify the technology effects on HEXP. Our empirical results suggest that Australian aggregate healthcare is a normal good and a technical necessity with the income elasticity estimates ranging from 0.51 to 0.97, depending on the model. The estimated technology effects on HEXP falling in the 0.30-0.35 range and mimicking those in the literature using the US data, reinforce the global spread of healthcare technology. Copyright © 2016 John Wiley & Sons, Ltd.

Spending on Health Care in the Netherlands: Not Going So Dutch

AbstractThe Netherlands is among the top spenders on health in the OECD. We document the life‐cycle profile, concentration and persistence of this expenditure using claims data covering both curative and long‐term care expenses for the full Dutch population. Spending on health care is strongly concentrated: the 1 per cent of individuals with the highest levels of expenditure account for one‐quarter of the aggregate in any one year. Averaged over three years, the top 1 per cent still account for more than a fifth of the total, indicating a very high degree of persistence in the largest expenses. Spending on long‐term care, which amounts to one‐third of all expenditure on health care, is even more concentrated: the top 1 per cent account for more than half of total spending on this type of care. Average expenditure rises steeply with age and even more so with proximity to death. Spending on individuals in their last year of life absorbs one‐tenth of aggregate health care expenditure. In a given year, spending on health care is highly skewed toward individuals with lower incomes. Average expenditure on the poorest fifth is more than three times that on the richest fifth.

Spending on Health Care in the Netherlands: Not Going So Dutch

The Netherlands is among the top spenders on health in the OECD. We document the life-cycle profile, concentration and persistence of this expenditure using claims data covering both curative and long-term care expenses for the full Dutch population. Spending on health care is strongly concentrated: the one per cent of individuals with the highest levels of expenditure account for one quarter of the aggregate in any one year. Averaged over three years, the top one per cent still accounts for more than a fifth of the total, indicating a very high degree of persistence in the largest expenses. Spending on long-term care, which amounts to one third of all expenditure on health care, is even more concentrated: the top one per cent accounts for more than half of total spending on this type of care. Average expenditure rises steeply with age and even more so with proximity to death. Spending on individuals in their last year of life absorbs one tenth of aggregate health care expenditure. In a given year, spending on health care is highly skewed toward individuals with lower incomes. Average expenditure on the poorest fifth is more than three times that on the richest fifth. Spending on long-term care is five times more concentrated on the poor.

The Economic Impact of Smoking and of Reducing Smoking Prevalence: Review of Evidence.

The Economic Impact of Smoking and of Reducing Smoking Prevalence: Review of Evidence.

Inadequate Physical Activity and Health Care Expenditures in the United States

This study estimates the percentage of health care expenditures in the non-institutionalized United States (U.S.) adult population associated with levels of physical activity inadequate to meet current guidelines. Leisure-time physical activity data from the National Health Interview Survey (2004–2010) were merged with health care expenditure data from the Medical Expenditure Panel Survey (2006–2011). Health care expenditures for inactive (i.e., no physical activity) and insufficiently active adults (i.e., some physical activity but not enough to meet guidelines) were compared with active adults (i.e., ≥150minutes/week moderate-intensity equivalent activity) using an econometric model. Overall, 11.1% (95% CI: 7.3, 14.9) of aggregate health care expenditures were associated with inadequate physical activity (i.e., inactive and insufficiently active levels). When adults with any reported difficulty walking due to a health problem were excluded, 8.7% (95% CI: 5.2, 12.3) of aggregate health care expenditures were associated with inadequate physical activity. Increasing adults’ physical activity to meet guidelines may reduce U.S. health care expenditures.

Ageing, chronic conditions and the evolution of future drugs expenditure: a five-year micro-simulation from 2004 to 2029

The healthy ageing assumptions may lead to substantial changes in paths of aggregate health care expenditure, notably catastrophic expenditure of people at the end of the life. But clear assessments of involved amounts are not available when we specifically consider ambulatory care (as drug expenditure) generally offered to chronically-ill people. We estimate the effects of epidemiological and life expectancy changes on French health expenditure until 2029 by applying a Markovian micro-simulation model from a nationally representative database. The originality of these simulations holds in using an aggregate indicator of morbidity–mortality, capturing vital risk and making it possible to adapt the quantification of life expectancies by taking into account the presence of severe chronic pathologies. We forecast future national drugs expenditure, under different epidemiological scenarios of chronic morbidity: trend scenario, healthy ageing scenario and medical progress scenario. For the population aged 25+, results predict an increase in reimbursable drug expenditure of between 1.1% and 1.8% (annual growth rate), attributable solely to the ageing population and changes in health status.

Aggregate Annual Health Care Expenditures Associated with Heart Transplantation in the United States: 1980-2011

Purpose No attempt has been made to estimate the aggregate annual health care expenditures associated with heart transplantation in the U.S. Methods and Materials The data required for this analysis were abstracted from previously published reports. Results The average billed charge for a heart transplant in 1983 was $96,538. This figure included hospital charges, physician fees, and organ procurement costs. Based on actuarial analyses, this figure has substantially increased.Furthermore, as shown, the actual average billed per procedure charge greatly exceeds the expected average charge, given inflation. There is no obvious explanation for the observed variation between actual and expected charges, other than inflated hospital markups intended to address substantial third party payer discounts, which are typically based on a percentage of billed charges. For example, one major insurer promotes its so-called “centers of excellence network” by claiming that “clients save an average of 51 percent per transplant episode.” National estimates of health care expenditures reflect billed charges, not actual reimbursement. This is misleading but, if the same logic is applied to heart transplantation, insurers were billed $1.9 billion for heart transplants in 2011, compared with $695.0 million in 1988, the year after Medicare began paying for heart transplantation and $10.4 million in 1980. Conclusions Third party reimbursement for heart transplantation is increasingly adverse. To cope, hospitals have increased their charges. Thus, in constant dollars, total health care expenditures associated with heart transplantation in the U.S continue to increase disproportionately relative to inflation. Heart Tranplantation Procedure Average Billed Charges ($) Year Actual Charge Expected Charge Difference 1983 96,538 96,538 0 1993 166,600 139,980 26,620 1996 202,800 152,530 50,270 1999 228,100 161,218 66,882 2002 296,700 174,734 121,966 2005 349,800 189,214 160,586 2006 370,600 195,007 175,593 2007 513,500 200,799 312,701 2008 631,500 208,522 422,978 2011 782,400 218,176 564,224

Demographic Changes and Aggregate Healthcare Expenditure in Europe

This paper extracts the policy implications from ENEPRI Research Report No. 32, prepared under Work Package VI B of the AHEAD Project (Ageing, Health Status and Determinants of Health Expenditure) for the European Commission. The main purpose of this paper is to investigate the relationship between ageing and aggregate healthcare expenditure in EU countries on a macroeconomic level when including economic and institutional variables.

The Influence of Supply and Demand Factors on Aggregate Health Care Expenditure with a Specific Focus on Age Composition

Expenditure on medical treatment has tended to increase as a proportion of national income throughout the European Union. Overall there has been a rising trend in the mean as low-spending countries such as the UK have faced political pressure to spend at least the average EU proportion of their national income on the provision of health services, medical treatment and long-term care. A particular concern is that with an ageing population and therefore the prospect of more old people around, the pressures on health care expenditure will increase further.The aim of this 6th work package (WP6) of the AHEAD project is to explain how demand and supply factors influence aggregate health care expenditure with a specific focus on age composition. Several studies in the past have shown that health care expenditure is not only influenced by demand factors, but also by those on the supply side, particularly technological progress, political decisions and economic framework conditions.In contrast with other studies (and aside from the focus on age), WP6 emphasizes variables describing health care and financing systems. The idea is that the inclusion of these variables affords a better explanation of health care expenditure. This report collects data on demand, supply and utilization of health care from official statistics and creates additional variables describing the health care and financing systems based on a literature review. In total, 63 variables are included in a basic data set for 28 countries, mostly covering the period 1980-2003. A brief statistical overview shows the development of some of the variables in the countries covered. The expected strong connection between health care expenditure and GDP can be seen in a cross-section analysis for 2003. The relation between health care expenditure and the share of the elderly in the population was also positive, but not as strong as in the case of GDP.

Study on drug related hospital admissions in a tertiary care hospital in South India

Background and objectives Accidental and intentional poisonings or drug overdoses constitute a significant source of aggregate morbidity, mortality, and health care expenditure. Studies evaluating drug related hospitalization have estimated that approximately 5–10% of all hospital admissions are drug related. The present study was carried out to investigate type, nature and incidence of drug related admissions in our hospital settings. Method A hospital based retrospective study was conducted in 575 cases of drug related admissions. The case records of patients admitted in various clinical departments of Amrita Institute of Medical Sciences (AIMS) Hospital during last 8 years (January 2002–December 2009) were collected and analyzed. Results During the retrospective study, the total number of drug related cases reported were 575. Out of these, 35.5% cases were induced by central nervous system (CNS) drugs, 19.8% were by cardiovascular system (CVS) drugs, 12.3% were by NSAIDs, 11.3% were by antibiotics and 9.9% were by anticoagulants, 11.3% by other drugs which includes hormones, cytotoxic drugs, hypolipidemics, etc. Four hundred and forty cases were admitted to emergency department. Common drug related problems resulting in hospital visits were due to intentional, accidental and overdose. The incidence of drug related hospital admissions was found to be 0.20%. Conclusion The most of the accidental and suicidal cases were reported are by CNS drugs. Psychiatric patients intentionally taking medicines as suicidal attempt and as a part of their illness. As drug related problems are so significant, increased awareness and enhanced collaborative efforts among patients, physicians, pharmacists and caregivers within community and hospital have the potential to minimize the impact of this problem.

An Econometric Analysis of the US Health Care Expenditure

This paper estimates the determinants of aggregate health care expenditure function for the U.S. by applying a cointegration test on a time series data. The evidence presented in the paper supports co integration. The paperlends support to the view that per capita income is the major determinant of aggregate health care expenditure inthe U. S. Age of the population, the number of practicing doctors and the share of public finance do notcontribute significantly to the explanation of the health care spending. The main policy recommendation that canbe drawn from the results is that the health expenditure policy should be coupled not necessarily with theincrease in the supply of physicians or policies that promote competition but, with long-run policies that promotehuman capital. We also find that the mixture of public-private funding does not contribute significantly to theexplanation of the health care expenditure in the U.S.