Capita Health Expenditure Research Articles

Estimation of direct and indirect cost of diabetes in Morocco

Due to its chronic nature with severe complications, diabetes needs costly prolonged treatment and care. The high economic burden of diabetes is particularly threatening low and middle income countries. World-wide, studies have shown that the cost of diabetes per person is much higher than the per capita health expenditure. This study is the first to estimate the direct and indirect cost of diabetes in Morocco. The direct cost of diabetes was computed by assuming three scenarios of prices (low, medium and high) due to different prices of insulin, oral drugs and other items used in diabetes treatment and care. Indirect costs of diabetes were estimated by the lifetime forgone earnings caused by premature death and disability due to diabetes. The direct cost of diabetes in Morocco was estimated to be between US $0.47 and US $1.5 billion whereas the indirect cost was estimated to be around US $2 billion accounting for 57% of the total cost of diabetes under the high cost scenario, 69% under the medium scenario and 81% under the low cost scenario. The average per capita indirect cost was estimated to be US $1113, relatively higher than the direct cost of diabetes which was seen to vary from US$ 259 to US $830. The results yielded by this study were compared to those obtained by similar studies in different regions and countries of the world. As a conclusion, the findings of this study indicate a high economic burden of diabetes and stress the importance that Moroccan health decision makers should give to sensitisation, early diagnosis and treatment of diabetes especially with the crucial growing trend of diabetes prevalence.

Convergence in per capita health expenditures and health outcomes in the OECD countries

Our analysis of 19 Organization for Economic Co-operation and Development (OECD) countries over the period 1972 to 2006 provides evidence of convergence in per capita health care expenditures for 17 countries, while the US and (to a lesser degree) Norway follow a different path. A simple decomposition of per capita health expenditures reveals that the divergence of the US comes from the divergence of the ‘ratio of health care expenditures to Gross Domestic Product (GDP)’ component, while Norway's divergence is mainly caused by the ‘labour productivity’ component. Interestingly, our results suggest that convergence in per capita health expenditures among the 17 OECD countries does not lead to convergence in health outcomes. Finally, we extend our analysis to examine convergence in various determinants of health expenditures.

Time to death and the forecasting of macro-level health care expenditures: Some further considerations

Although the effect of time to death (TTD) on health care expenditures (HCE) has been investigated using individual level data, the most profound implications of TTD have been for the forecasting of macro-level HCE. Here we estimate the TTD model using macro-level data from the Netherlands consisting of mortality rates and age- and gender-specific per capita health expenditures for the years 1981–2007. Forecasts for the years 2008–2020 of this macro-level TTD model were compared to forecasts that excluded TTD. Results revealed that the effect of TTD on HCE in our macro model was similar to those found in micro-econometric studies. As the inclusion of TTD pushed growth rate estimates from unidentified causes upwards, however, the two models’ forecasts of HCE for the 2008–2020 were similar. We argue that including TTD, if modeled correctly, does not lower forecasts of HCE.

No Child or Mother Left Behind; Implications for the US from Cuba's Maternity Homes.

Cuba, a "resource-poor" country, provides high-quality, free maternal care despite relatively low per capita health expenditures in comparison to similar expenditures in "resource rich" nations such as Canada and the US. This paper assesses maternal and child healthcare in Cuba, details the system of community-based regional maternity homes, and outlines specific recommendations for the US. Based on observations during a visit to Cuba, and supplemental research on international health expenditures and health indicators such as infant and maternal mortality, this paper details maternal and child health in Cuba. Cuba utilizes community-based regional maternity homes to provide comprehensive care for women with high-risk pregnancies. This effective strategy of investing in maternal health by safeguarding pregnancies has lowered infant and maternal mortality rates significantly. Cuba has achieved neonatal, infant and under-five mortality rates that are better than or on par with resource rich nations such as the US. Additionally, within the Latin American and Caribbean region, Cuba has a low rate of maternal mortality. Positioning maternal and child health priorities to the policy foreground were a critical step in saving the lives of Cuban women and children. The US may benefit from Cuba's example with respect to maternal and child health. Cuba's model provides important health; rights and policy lessons for all nations-are they resource rich or poor.

Registration of cancer in girls remains lower than expected in countries with low/middle incomes and low female education rates

Background:A decade ago it was reported that childhood cancer incidence was higher in boys than girls in many countries, particularly those with low gross domestic product (GDP) and high infant mortality rate. Research suggests that socio-economic and cultural factors are likely to be responsible. This study aimed to investigate the association between cancer registration rate sex ratios and economic, social and healthcare-related factors using recent data (1998–2002).Methods:For 62 countries, childhood (0–15 years) cancer registration rate sex ratios were calculated from Cancer Incidence in Five Continents Vol IX, and economic, social and healthcare indicator data were collated.Results:Increased age standardised cancer registration rate sex ratio (M : F) was significantly associated with decreasing life expectancy (P=0.05), physician density (P=0.05), per capita health expenditure (P=0.05), GDP (P=0.01), education sex ratios (primary school enrolment sex ratio (P<0.01); secondary school enrolment sex ratio (P<0.01); adult literacy sex ratio (P<0.01)) and increasing proportion living on less than Int$1 per day (P=0.03).Conclusion:The previously described cancer registration sex disparity remains, particularly, in countries with poor health system indicators and low female education rates. We suggest that girls with cancer continue to go undiagnosed and that incidence data, particularly in low- and middle-income countries, should continue to be interpreted with caution.

The income elasticity of health care spending in developing and developed countries

To date, international analyses on the strength of the relationship between country-level per capita income and per capita health expenditures have predominantly used developed countries' data. This study expands this work using a panel data set for 173 countries for the 1995-2006 period. We found that health care has an income elasticity that qualifies it as a necessity good, which is consistent with results of the most recent studies. Furthermore, we found that health care spending is least responsive to changes in income in low-income countries and most responsive to in middle-income countries with high-income countries falling in the middle. Finally, we found that 'Voice and Accountability' as an indicator of good governance seems to play a role in mobilizing more funds for health.

Health in India: Need for a paradigm shift

Three of the Millennium Development Goals call for specific health improvements. This paper seeks to estimate how far the BRIC nations are from meeting their health MDG commitments. The factors responsible for India's poor performance on the health MDGs are poverty, illiteracy, gender bias, urban bias, poor quality health services and lack of access to proper health services. India has one of the lowest per capita health expenditures in the world and government health expenditure is completely inadequate. Improvements in public health require a paradigm shift in the government's approach to health.

Trends in Scale and Structure of Korea's Health Expenditure over Last Three Decades (1980-2009): Financing, Functions and Providers

This paper introduces statistics related to the size and composition of Korea's total health expenditure. The figures produced were tailored to the OECD's system of health accounts. Korea's total health expenditure in 2009 was estimated at 73.7 trillion won (US$ 57.7 billion). The annual per capita health expenditure was equivalent to US$ PPP 1,879. Korea's total health expenditure as a share of gross domestic product was 6.9% in 2009, far below the OECD average of 9.5%. Korea's public financing share of total health expenditure increased rapidly from less than 50% before 2000 to 58.2% in 2009. However, despite this growth, Korea's share remained the fourth lowest among OECD countries that had an average public share of 71.5%. Inpatient, outpatient, and pharmaceutical care accounted for 32.1%, 33.0%, and 23.7% of current health expenditure in 2009, respectively. A total of 41.1% of current health expenditure went to hospitals, 28.1% to providers of ambulatory healthcare (15.9% on doctor's clinics), and 17.9% to pharmacies. More investment in the translation of national health account data into policy-relevant information is suggested for future progress.

P2-372 Rates of childhood cancer in females remain lower than expected in developing countries

A decade ago it was reported that childhood cancer incidence was higher in boys than in girls in many countries, particularly in those with low gross domestic product and relatively...

Is health care a luxury or a necessity or both? Evidence from Turkey

This study investigates the effect of per capita income on per capita health expenditures in Turkey over the period 1975-2007 by using ARDL bounds test approach to the cointegration considering both demand and supply side variables. Since we reject the null hypothesis that there is no cointegration among the series, we estimate long run and short run elasticities. The results show that while income has no effect on health expenditures in the long run, it is a necessity good in the short run that is a 1% increase in per capita income creates an 0.75% increase in per capita health expenditures. On the other hand, by examining the coefficient of demand and supply side variables, we found that average length of stay and number of physicians has negative effect, percentage of older people has positive effect and infant mortality rate has no effect on health expenditures in both short and long runs.

Life Expectancy in Africa: Back to the Future?

In this issue, Mills and colleagues, using models based on patient-level data, conclude that life expectancy for young HIV-infected adults in Uganda who initiate combination antiretroviral therapy ...

Efeitos da regulação federal sobre o financiamento da saúde

The article aimed to analyze the impacts of earmarking revenues and conditional transfers on the supply of health financing in Brazil. After analyzing the role of these Federal regulation mechanisms on decentralized healthcare administration, the article verified the effects on total expenditure in health and disaggregated by level of government, evaluated whether transfers by the Unified National Health System (SUS) were consistent with the evolution in the decentralized supply, and measured the inequalities in per capital health spending by municipalities. The conclusions showed the complementary relationship between earmarking revenues and conditional transfers according to supply, which: (1) increased the share of State and Municipal governments in health financing; (2) provided incentives for the decentralization of primary care according to Federal guidelines; and (3) reduced the inequalities between municipalities in per capita health expenditures.

Estimating the Effects of Cigarette Taxes on Birth Outcomes

Employing provincial data from 1979 to 2004 allows us to exploit the significant (45 percent to 60 percent) reduction in excise taxes in Eastern Canada enacted in February 1994 to estimate the impacts of cigarette taxes on birth outcomes. Empirical estimates suggest that an increase in cigarette taxes is significantly associated with lower infant mortalities. However, we also find some evidence of a counter-intuitive positive correlation between taxes and fetal deaths. Overall, conditional on methodology, we find increased lagged per capita health expenditures and the number of physicians to be significantly associated with improvements in birth outcomes.

Standardizing the Inclusion of Indirect Medical Costs in Economic Evaluations

A shortcoming of many economic evaluations is that they do not include all medical costs in life-years gained (also termed indirect medical costs). One of the reasons for this is the practical difficulties in the estimation of these costs. While some methods have been proposed to estimate indirect medical costs in a standardized manner, these methods fail to take into account that not all costs in life-years gained can be estimated in such a way. Costs in life-years gained caused by diseases related to the intervention are difficult to estimate in a standardized manner and should always be explicitly modelled. However, costs of all other (unrelated) diseases in life-years gained can be estimated in such a way. We propose a conceptual model of how to estimate costs of unrelated diseases in life-years gained in a standardized manner. Furthermore, we describe how we estimated the parameters of this conceptual model using various data sources and studies conducted in the Netherlands. Results of the estimates are embedded in a software package called 'Practical Application to Include future Disease costs' (PAID 1.0). PAID 1.0 is available as a Microsoft® Excel tool (available as Supplemental Digital Content via a link in this article) and enables researchers to 'switch off' those disease categories that were already included in their own analysis and to estimate future healthcare costs of all other diseases for incorporation in their economic evaluations. We assumed that total healthcare expenditure can be explained by age, sex and time to death, while the relationship between costs and these three variables differs per disease. To estimate values for age- and sex-specific per capita health expenditure per disease and healthcare provider stratified by time to death we used Dutch cost-of-illness (COI) data for the year 2005 as a backbone. The COI data consisted of age- and sex-specific per capita health expenditure uniquely attributed to 107 disease categories and eight healthcare provider categories. Since the Dutch COI figures do not distinguish between costs of those who die at a certain age (decedents) and those who survive that age (survivors), we decomposed average per capita expenditure into parts that are attributable to decedents and survivors, respectively, using other data sources.

Tuberculosis mortality in HIV-infected individuals: a cross-national systematic assessment

ObjectiveTuberculosis (TB) is a leading cause of death in human immunodeficiency virus (HIV)-positive individuals. We sought to compare mortality rates in TB/HIV co-infected individuals globally and by country/territory.DesignWe conducted a cross-national systematic assessment.MethodsTB mortality rates in HIV-positive and HIV-negative individuals were obtained from the World Health Organization (WHO) Stop TB department for 212 recognized countries/territories in the years 2006–2008. Multivariate linear regression determined the impact of health care resource and economic variables on our outcome variable, and TB mortality rates.ResultsIn 2008, an estimated 13 TB/HIV deaths occurred per 100,000 population globally with the African region having the highest death rate ([AFRH] ≥4% adult HIV-infection rate) at 86 per 100,000 individuals. The next highest rates were for the Eastern European Region (EEUR) and the Latin American Region (LAMR) at 4 and 3 respectively per 100,000 population. African countries’ HIV-positive TB mortality rates were 29.9 times higher than non-African countries (95% confidence interval [CI]: 16.8–53.4). Every US$100 of government per capita health expenditure was associated with a 33% (95% CI: 24%–42%) decrease in TB/HIV mortality rates. The multivariate model also accounted for calendar year and did not include highly active antiretroviral therapy (HAART) coverage.ConclusionsOur results indicate that while the AFRH has the highest TB/HIV death rates, countries in EEUR and LAMR also have elevated mortality rates. Increasing health expenditure directed towards universal HAART access may reduce mortality from both diseases.

Social class related inequalities in household health expenditure and economic burden: evidence from Kerala, south India

BackgroundIn the Indian context, a household's caste characteristics are most relevant for identifying its poverty and vulnerability status. Inadequate provision of public health care, the near-absence of health insurance and increasing dependence on the private health sector have impoverished the poor and the marginalised, especially the scheduled tribe population. This study examines caste-based inequalities in households' out-of-pocket health expenditure in the south Indian state of Kerala and provides evidence on the consequent financial burden inflicted upon households in different caste groups.MethodsUsing data from a 2003-2004 panel survey in Kottathara Panchayat that collected detailed information on health care consumption from 543 households, we analysed inequality in per capita out-of-pocket health expenditure across castes by considering households' health care needs and types of care utilised. We used multivariate regression to measure the caste-based inequality in health expenditure. To assess health expenditure burden, we analysed households incurring high health expenses and their sources of finance for meeting health expenses.ResultsThe per capita health expenditures reported by four caste groups accord with their status in the caste hierarchy. This was confirmed by multivariate analysis after controlling for health care needs and influential confounders. Households with high health care needs are more disadvantaged in terms of spending on health care. Households with high health care needs are generally at higher risk of spending heavily on health care. Hospitalisation expenditure was found to have the most impoverishing impacts, especially on backward caste households.ConclusionCaste-based inequality in household health expenditure reflects unequal access to quality health care by different caste groups. Households with high health care needs and chronic health care needs are most affected by this inequality. Households in the most marginalised castes and with high health care need require protection against impoverishing health expenditures. Special emphasis must be given to funding hospitalisation, as this expenditure puts households most at risk in terms of mobilising monetary resources. However, designing protection instruments requires deeper understanding of how the uncovered financial burden of out-patient and hospitalisation expenditure creates negative consequences and of the relative magnitude of this burden on households.

An Econometric Investigation of Infant Mortality Scenarios in Bangladesh

In this paper, three econometric models (linear regression model, Reciprocal model &amp; Double-log or log-linear regression model) comprised one outcome variable (infant mortality rate) and three explanatory variables (per capita gross domestic product, per capita health expenditure and mean age at marriage of female) have been considered over the period 1980 to 2007 for Bangladesh. At all stages of fitting model, it has been observed that at least one of the independent variables had significant effect on infant mortality rate. After removing multicollinearity and autocorrelation, two independent variables (per capita health expenditure and mean age at marriage of female) had significant effect on infant mortality rate in case of reciprocal model but per capita health expenditure had substantial effect on infant mortality rate in three econometric models. Results indicate for the policy makers at the national level for raising per capita health expenditure to decrease infant mortality rate.

The quality of medical care, behavioral risk factors, and longevity growth.

The rate of increase of longevity has varied considerably across U.S. states since 1991. This paper examines the effect of the quality of medical care, behavioral risk factors (obesity, smoking, and AIDS incidence), and other variables (education, income, and health insurance coverage) on life expectancy and medical expenditure using longitudinal state-level data. We examine the effects of three different measures of the quality of medical care. The first is the average quality of diagnostic imaging procedures, defined as the fraction of procedures that are advanced procedures. The second is the average quality of practicing physicians, defined as the fraction of physicians that were trained at top-ranked medical schools. The third is the mean vintage (FDA approval year) of outpatient and inpatient prescription drugs. Life expectancy increased more rapidly in states where (1) the fraction of Medicare diagnostic imaging procedures that were advanced procedures increased more rapidly; (2) the vintage of self- and provider-administered drugs increased more rapidly; and (3) the quality of medical schools previously attended by physicians increased more rapidly. States with larger increases in the quality of diagnostic procedures, drugs, and physicians did not have larger increases in per capita medical expenditure. We perform several tests of the robustness of the life expectancy model. Controlling for per capita health expenditure (the "quantity" of healthcare), and eliminating the influence of infant mortality, has virtually no effect on the healthcare quality coefficients. Controlling for the adoption of an important nonmedical innovation also has little influence on the estimated effects of medical innovation adoption on life expectancy.

Peripheral Blood Film Examination In Malawi: The Maximum Diagnostic Information for the Least Resources?.

AbstractAbstract 3799 Introduction:Malawi is the 23th least developed country according to the 2009 UN human development index and has a per capita health expenditure of $17 per year. In common with most of sub-Saharan Africa, severe haematological abnormalities are common in hospital patients, both contributing to ill health and reflecting the nature of underlying illnesses. Facilities for investigating abnormal results are limited and there are chronic problems with supply and maintenance of equipment and reagents. Examination of peripheral blood films provides extensive diagnostic information and can be performed with equipment routinely available even in district laboratories but there are few data on the feasibility and utility of routine blood film examination in this setting. Methods:Routine preparation of thin blood films stained with reverse Field's stain was introduced as a laboratory standard operating procedure for all FBC results meeting predetermined criteria [Hb<7.0 or >16.5 g/dl; MCV<60 or>100 fl; WBC <3.5 or >17.0 ×109/L; PLT <70 or >650 ×109/L] in the major teaching hospital. Films were reported by an experienced haematologist. Handwritten laboratory records of FBC and blood film reports over a 12 month period were reviewed retrospectively. Results:From 35449 FBC samples received 9543(26.9%) met criteria for film preparation. 3745 (39.2% of samples meeting criteria) were prepared. The proportion of films made improved during the study period; films were less likely to be prepared at weekends or late in the day. High day-to-day variability suggests that compliance levels may reflect staff on duty on individual days; workload on a given day did not appear negatively correlated with compliance. 69.5% of film reports gave added diagnostic information (other than simply confirming automated counts); many of the features found were not evident from the patient's clinical condition. Important findings included 33 new cases of leukaemia (14 acute leukemia, 6 CML and 13 CLL or other lymphoid disorders). 6.5% of films showed features suggesting haemolysis or increased red cell production. 2.2% showed specific features (not just macrocytosis) suggesting megaloblastic anaemia, 4.7% showed malaria parasites or other evidence of malaria such as pigment. 2.5% of films showed features raising the possibility of error in the automated counts. Reactive features were very common (57% of films). The 10 most common classes of film findings [see table 1] accounted for 75.8% of informative blood film reports.Table 1:Ten most frequent blood film findings in MalawiReportFrequency (% of informative films)“Reactive neutrophils”28.8Rouleaux20.6Neutrophil left shift16.0Iron deficiency features12.6P.Falciparum5.0Macrocytosis4.0Neutrophils appear normal3.6Polychromasia3.3Target cells2.0Oval macrocytes1.3 Conclusions:Routine peripheral blood film examination in a sub-Saharan African context provides a high yield of diagnostic information with minimal extra equipment requirement. A small number of common findings account for the majority of reports, suggesting that focussed training to identify these common abnormalities could have substantial benefits and could be implemented in a brief training programme. The variable compliance with the standard operating procedure suggests that staff confidence and enthusiasm may be the most important barriers to the incorporation of film reporting into routine practice. Disclosures:No relevant conflicts of interest to declare.

Informing the Debate: Rates of Kidney Transplantation in Nations With Presumed Consent

The kidney is the most common transplanted organ, accounting for almost all living donor transplantations and most deceased donor organ transplantations. The organ shortage has caused policymakers in many nations to debate the merits of adopting presumed consent legislation as a way to increase donor organ donation from deceased donors. To compare characteristics and kidney transplantation rates for countries with presumed consent for deceased organ donation with countries with explicit consent. A longitudinal study of international kidney transplantation from 1997 to 2007. 44 nations performing kidney transplantation. Recipients of deceased and living kidney donor transplants. Rates of transplantation of kidneys from deceased and living donors. National characteristics, such as population size, proportion of the population self-identified as Catholic, per capita gross domestic product, health expenditures, and physician density, varied widely for the 22 nations with presumed consent and the 22 nations with explicit consent. Deceased donor kidney transplantation rates were higher in nations with presumed consent (median, 22.6 transplantations per million population [pmp]; interquartile range [IQR], 9.3 to 33.8) versus nations with explicit consent (median, 13.9 transplantations pmp; IQR, 3.6 to 23.1). Living donor kidney transplantation rates were lower in nations with presumed consent (median, 2.4 transplantations pmp; IQR, 1.7 to 4.3) versus nations with explicit consent (median, 5.9 transplantations pmp; IQR, 2.3 to 12.2). The findings were consistent when nations were classified according to per capita gross domestic product, health expenditures, and physician density. As with any observational study, associations may not be causal. Nations with presumed consent have higher rates of deceased donor kidney transplantation than nations with explicit consent. Any nation deciding to adopt presumed consent should carefully consider and reduce any negative effect on rates of living donation. Canadian Institutes of Health Research and Lawson Health Research Institute.