Capita Health Spending Research Articles

Population assessment of health system performance in 16 countries.

To demonstrate how the new internationally comparable instrument, the People's Voice Survey, can be used to contribute the perspective of the population in assessing health system performance in countries of all levels of income. We surveyed representative samples of populations in 16 low-, middle- and high-income countries on health-care utilization, experience and confidence during 2022-2023. We summarized and visualized data corresponding to the key domains of the World Health Organization universal health coverage framework for health system performance assessment. We examined correlation with per capita health spending by calculating Pearson coefficients, and within-country income-based inequities using the slope index of inequality. In the domain of care effectiveness, we found major gaps in health screenings and endorsement of public primary care. Only one in three respondents reported very good user experience during health visits, with lower proportions in low-income countries. Access to health care was rated highest of all domains; however, only half of the populations felt secure that they could access and afford high-quality care if they became ill. Populations rated the quality of private health systems higher than that of public health systems in most countries. Only half of respondents felt involved in decision-making (less in high-income countries). Within countries, we found statistically significant pro-rich inequalities across many indicators. Populations can provide vital information about the real-world function of health systems, complementing other system performance metrics. Population-wide surveys such as the People's Voice Survey should become part of regular health system performance assessments.

Creating the vaccination improvement potential index

BackgroundNumerous social and behavioral factors have been implicated in vaccination coverage. There is no single measure that describes a country's ability to improve or maintain its immunization coverage. MethodsWe estimated the “Vaccination Improvement Potential” (VIP) by taking the geometric mean of 13 different indicators on health financing, vaccine confidence, and socio-demographics for more than 200 countries across 30 years. Potential VIP Index values range from 0 to 1, with a higher score indicating greater potential to improve or maintain high vaccination rates. FindingsIn 1990, the mean VIP score was 0.49 (range = 0.13 to 0.86). In 2019, the mean score was 0.59 (range = 0.25 to 0.84). Consistent high performers included countries in Western Europe and high-income North America and East Asia. Important differences in subcomponents of the index drove major trends including vaccine hesitancy in Western Europe and Asia as well as lower levels of per capita health spending and development assistance in sub-Saharan Africa. InterpretationThe VIP Index is a first-of-its-kind tool for understanding the capacity that exists in a country to realize improved immunization rates. It is a new resource that can guide researchers, policymakers, and health officials to more effectively deploy resources to realize improvements in vaccination coverage, assess the impact of those improvements, and identify countries that might require additional support to improve vaccine coverage. FundingMerck Sharp & Dohme Corp.

Air, land, and water pollutants and public health expenditures: Empirical data from selected EU countries in the transport sector

The increase in economic activity, particularly in transport, leads to a significant increase in emissions of pollutants, such as ammonia, arsenic and cadmium, at the European Union (EU) level. This can seriously impact human health and, consequently, public health spending. Based on data from 15 European Union countries from 1992 to 2020, a panel co-integration approach is used to study these pollutants’ short- and long-term co-movements and per capita health expenditure. The results show a long-term relationship between ammonia, arsenic and cadmium emissions and per capita health spending, as they are panel-cointegrated. Ammonia and cadmium emissions exert a statistically significant positive effect on health expenditure in the short run, and arsenic emissions have a statistically significant positive impact in the long run. The forecast assessment of reductions in health spending resulting from policies to reduce emissions of air, land and water pollutants, such as ammonia, arsenic and cadmium, from the transport sector supports investments in its policies that reduce pressure on health spending. The reduction in annual healthcare expenditure is greater when these reductions are made sooner and more severely. Indeed, varying the reduction in emissions for each pollutant by 10% and 100%, respectively, from the first year for all countries over a 3-year period results in an average annual reduction in health spending of 2.05% and 51.02%, respectively. However, if we wait until the third year, the annual reduction is only 0.77% and 17.63% respectively.

The burden of acute lymphoid leukemia among adolescents and young adults in the Western Pacific Region: evidence from Global Burden Disease 2019.

Acute lymphoblastic leukemia (ALL) is a type of blood cancer that affects white blood cells. Here, we use data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, to estimate the burden and incidence rate changes in adolescents and young adults (AYA) ALL in the Western Pacific Region and to reveal potential risk factors of incidence- and mortality rates. The GBD 2019 study data was stratified by sex, age, country, and territory. We calculated the Estimated annual percentage changes (estimated APC) in mortality and incidence rates for each of the 25 countries and territories of the western Pacific region from 1990 to 2019. This study found global AYA ALL incidence rates had increased while the mortality rates had decreased between 1990 and 2019. Moreover, healthcare access and quality (HAQ), and government per capita health spending were identified as country-level risk factors of AYA ALL incidence rates, while HAQ, male education, and sex were identified as mortality rate predictors in 25 Western Pacific Region countries. To address and reduce the burden of incidence and mortality among AYA, various regions around the world, particularly developing countries, could revise their AYA prevention and treatment strategies.

Future disease-specific health spending and burden of disease in Norway, 2019 to 2040

The expected increase in the proportion of elderly, with increasing rates of chronic diseases, presents a challenge to the Norwegian healthcare system. In this study, we project the future burden of disease and health spending by health conditions from 2019 to 2040; and explore the importance of 1) population growth, 2) population composition, and 3) future epidemiological development for these projections. We find that total, and per capita, health spending is projected to increase in three scenarios (reference, better and worse health) from 2020 to 2040 for communicable diseases, non-communicable diseases, and injuries. The increased proportion of elderly drives the increase in health spending. When keeping the age composition constant (and by this account for the increased proportion of elderly), we find that per capita health spending decreases in the reference and better health scenario but not in the worse-health scenario. If Norway aims to provide care at current levels in the future, substantial reductions in the cost of care is needed. If not, increased health spending is inevitable, due to chronic conditions in old age.

Participatory Health Governance and HIV/AIDS in Brazil

ABSTRACTThis research note assesses participatory health governance practices for HIV and AIDS in Brazil. By extension, we also evaluate municipal democratic governance to public health outcomes. We draw from a unique dataset on municipal HIV/AIDS prevalence and participatory health governance from 2006–17 for all 5,570 Brazilian municipalities. We use negative binomial regression and coarsened exact matching with treatment effects to estimate the influence of community health governance institutions on HIV/AIDS prevalence. Municipalities with participatory health councils experience 14% lower HIV/AIDS prevalence than other municipalities, all else equal. Family Health Program coverage, municipal state capacity, and municipal per capita health spending are also associated with systematically lower HIV/AIDS prevalence. We conclude that participatory health governance may combat HIV and AIDS through municipal spending, education, and community mobilization. Municipal health councils can facilitate these strategies and offer opportunities for improving well-being around the world.

Health and income: analyzing the impacts on life expectancy in Argentina, Brazil and Mexico

This article intends to discuss the correlation that the income inequality and health expenses variables present in the life expectancy of the population of Brazil, Argentina and Mexico in the period from 2000 to 2018, with the countries chosen by the highlight of the Gross Domestic Product they have in relation to other Latin American countries. For this purpose, Pearson's correlation, multiple regression and ANOVA were used as methods of quantitative analysis based on data collected from the World Bank and the World Health Organization. Among the main results found, there is a strong correlation between life expectancy and per capita health expenditures, as well as with the Gini coefficient that measures income inequality. Such behaviors are justifiable because, according to the literature, the lower the income inequality, the greater the life expectancy in the population. As well as the rise in per capita health spending also contributes to increasing life expectancy.

Can healthy ageing moderate the effects of population ageing on economic growth and health spending trends in Mongolia? A modelling study

Background Population ageing will accelerate rapidly in Mongolia in the coming decades. We explore whether this is likely to have deleterious effects on economic growth and health spending trends and whether any adverse consequences might be moderated by ensuring better health among the older population.Methods Fixed-effects models are used to estimate the relationship between the size of the older working-age population (55–69 years) and economic growth from 2020 to 2100 and to simulate how growth is modified by better health among the older working-age population, as measured by a 5% improvement in years lived with disability. We next use 2017 data on per capita health spending by age from the National Health Insurance Fund to project how population ageing will influence public health spending from 2020 to 2060 and how this relationship may change if the older population (≥ 60 years) ages in better or worse health than currently.Results The projected increase in the share of the population aged 55–69 years is associated with a 4.1% slowdown in per-person gross domestic product (GDP) growth between 2020 and 2050 and a 5.2% slowdown from 2020 to 2100. However, a 5% reduction in disability rates among the older population offsets these effects and adds around 0.2% to annual per-person GDP growth in 2020, rising to nearly 0.4% per year by 2080. Baseline projections indicate that population ageing will increase public health spending as a share of GDP by 1.35 percentage points from 2020 to 2060; this will occur slowly, adding approximately 0.03 percentage points to the share of GDP annually. Poorer health among the older population (aged ≥ 60 years) would see population ageing add an additional 0.17 percentage points above baseline estimates, but healthy ageing would lower baseline projections by 0.18 percentage points, corresponding to potential savings of just over US$ 46 million per year by 2060.Conclusions Good health at older ages could moderate the potentially negative effects of population ageing on economic growth and health spending trends in Mongolia. Continued investment in the health of older people will improve quality of life, while also enhancing the sustainability of public budgets.

Relationship between Household Income, Region and Household Healthcare Expenditure——Empirical research based on the data of China Family Tracking Survey (CFPS)

China's economy has been rapid development in recent years, the residents income is also rising, China's household per capita disposable income growth, the corresponding family health spending also presents the fast growth, while at the same time family per capita health spending continues to grow, but nearly 10 years of family health spending growth is greater than the household disposable income growth, today, After housing and food, medical expenses have become the biggest consumption expenditure of most Chinese households. The medical expenditure caused by diseases is an important factor affecting family happiness, and the aggravation of medical burden decreases family happiness. The differences between urban and rural areas and different regions not only affect the income of families, but also affect the medical expenditure of families from the aspects of medical service quality and health awareness. In addition, the implementation of medical insurance policy also alleviates the medical burden of families to a certain extent. This paper selects microscopic data of CFPS surveyed in 2016 and 2018, and conducts empirical analysis on data of tens of thousands of families with different living conditions in various regions. The results show that income is an important factor affecting family medical expenditure, and family size and health care focus will also affect family medical expenditure. Urban and rural residents and residents in different areas also show differences in medical expenditure

Global, regional and national trends in statin utilisation in high-income and low/middle-income countries, 2015–2020

ObjectivePrior studies have reported inequitable global access to essential medicines for cardiovascular disease (CVD) prevention, especially statins. Here we examine recent trends and disparities in statin utilisation at the income...

Effect of economic uncertainty on public health expenditure in Economic Community of West African States: Implications for sustainable healthcare financing.

This study investigates the dynamic effect of economic uncertainty on public health expenditure in the Economic Community of West African States region. The investigation is motivated by the recent volatilities in the global economy in the face of increasing demand for adequate funding of health systems in the region, and the need to fill the existing gap in the literature. The study employs the panel autoregressive distributed lag model to express the theoretical relationship between public health expenditure per capita, economic uncertainty and population growth rate, and estimates the model parameters using the mean group and the pooled mean group estimators, after accounting for stationarity and cointegration. Results reveal that on the aggregate, economic uncertainty and population growth are significant determinants of per capita health spending in the long run. When the countries are disaggregated by income groups, evidence suggests that in low‐income countries, economic uncertainty is negatively associated with health spending in the short run, while a growing population reduces health spending per capita in the long run. In lower‐middle‐income countries, economic uncertainty increases health spending in the short run, but reduces it in the long run as uncertainty persists, while population growth negatively impacts health spending in the long run. We conclude that the dependence on public funding of the health system in the region appears unsustainable. Thus, health financing policies need to explore alternative funding mechanisms that entrench cost‐sharing between the public and private financiers.

Future health spending forecast in leading emerging BRICS markets in 2030: health policy implications

BackgroundThe leading emerging markets of Brazil, Russia, India, China and South Africa (BRICS) are increasingly shaping the landscape of the global health sector demand and supply for medical goods and services. BRICS’ share of global health spending and future projections will play a prominent role during the 2020s. The purpose of the current research was to examine the decades-long underlying historical trends in BRICS countries’ health spending and explore these data as the grounds for reliable forecasting of their health expenditures up to 2030.MethodsBRICS’ health spending data spanning 1995–2017 were extracted from the Institute for Health Metrics and Evaluation (IHME) Financing Global Health 2019 database. Total health expenditure, government, prepaid private and out-of-pocket spending per capita and gross domestic product (GDP) share of total health spending were forecasted for 2018–2030. Autoregressive integrated moving average (ARIMA) models were used to obtain future projections based on time series analysis.ResultsPer capita health spending in 2030 is projected to be as follows: Brazil, $1767 (95% prediction interval [PI] 1615, 1977); Russia, $1933 (95% PI 1549, 2317); India, $468 (95% PI 400.4, 535); China, $1707 (95% PI 1079, 2334); South Africa, $1379 (95% PI 755, 2004). Health spending as a percentage of GDP in 2030 is projected as follows: Brazil, 8.4% (95% PI 7.5, 9.4); Russia, 5.2% (95% PI 4.5, 5.9); India, 3.5% (95% PI 2.9%, 4.1%); China, 5.9% (95% PI 4.9, 7.0); South Africa, 10.4% (95% PI 5.5, 15.3).ConclusionsAll BRICS countries show a long-term trend towards increasing their per capita spending in terms of purchasing power parity (PPP). India and Russia are highly likely to maintain stable total health spending as a percentage of GDP until 2030. China, as a major driver of global economic growth, will be able to significantly expand its investment in the health sector across an array of indicators. Brazil is the only large nation whose health expenditure as a percentage of GDP is about to contract substantially during the third decade of the twenty-first century. The steepest curve of increased per capita spending until 2030 seems to be attributable to India, while Russia should achieve the highest values in absolute terms. Health policy implications of long-term trends in health spending indicate the need for health technology assessment dissemination among the BRICS ministries of health and national health insurance funds. Matters of cost-effective allocation of limited resources will remain a core challenge in 2030 as well.

Forecasting Iran national health expenditures: General model and conceptual framework.

BACKGROUND:Forecasting the future trend of health expenditures is an important step toward sustainable financing of health-care systems. This study aims to develop a conceptual framework for forecasting Iran health spending growth.MATERIALS AND METHODS:At first, we concentrated on the general model and conceptual framework of health expenditure projection by reference to a broad literature review and smart classifications of the origins of health spending and indicators. At the second step, we developed a time series modeling for econometric estimation and forecasting national health expenditure without restrictive assumptions except for current laws and regulatory environment. In the third step, we tested the accuracy of model by forecasting Iran real per capita health expenditures (2017–2025).RESULTS:The results of the literature review represented a distinct classification of the origins of health spending and indicators, applicable to any health system and health spending projection model. Furthermore, the model of expenditure forecasting shows the power of certainty of no spurious estimation, assessment of the normal state of a health system, and test of the accuracy of forecasting results. The projection by the Iranian health system database showed that the real per capita health spending will grow 43 percent till 2025 in the absence of any unforeseen disturbance in the future.CONCLUSIONS:The presented model provides estimates that are compatible with actual trends of health spending and can be applied to forecast health expenditure in the near future. The forecasted image of Iran's health spending growth implies that health authorities need to concentrate more on the growth rate of the health budget and its fiscal space in the near future.

Changes in Employment Situation and Macroeconomic Indicators Linked to Mental Health Following the Recession in Spain: A Multi-level Approach.

Periods of financial crisis are associated with higher psychological stress in the population and greater use of mental health services. This paper analyses the individual and contextual factors associated with mental health in the Spanish population in 2006, 2012 and 2017. This was a cross-sectional, descriptive study at three timepoints: before (2006), during (2012) and after the recession (2017). The study population comprised individuals aged 16+ years old, polled for the National Health Survey. Dependent variable: psychiatric morbidity (PM). 1) Individual socio-economic variables: (socio-demographic and psycho-social variables) and 2) contextual socio-economic variables (financial, public welfare services and labour market indicators). Multilevel logistic regression models with mixed effects were constructed to determine changes in PM in relation to the variables studied. Among women, the risk of PM increased when per capita health spending decreased and the percentage of temporary workers increased. The risk for men and women was lower when the employment rate decreased and the unemployment rate increased. It is possible that not only unemployment but also insecure employment entails a risk to mental health and that much of the employment created no longer guarantees basic levels of security it had achieved in previous decades.

An Empirical Examination of the Inequality of Forgone Care in India

ABSTRACT Understanding how well a health system is meeting the needs of the population is critical to achieving the policy aspirations of universal health coverage. This study focuses on assessing the inequity of forgone care for priority maternal and child health services across India. We utilize data from the 4th round of the Indian National Family Health Survey (NFHS-4) to examine inequality of forgone care. Our outcomes include forgone institutional delivery, antenatal care, medical care for a child with fever or cough, and medical care for a child with diarrhea. Wagstaff’s standardized concentration indices (CIs) are computed at the national level, over urban and rural sub-populations, and by state. Regression decomposition is performed to determine the influence of specific drivers on overall inequality. There was significant variation in the national-level prevalence and CIs for forgone antenatal care (17.8%, CI: −0.423), forgone medical care for a child with fever or cough (32.4%, CI: −0.199), forgone medical care for a child with diarrhea (33.8%, CI: −0.172), and forgone institutional delivery (24.5%, CI: −0.436). For all outcomes, forgone care is disproportionately concentrated among the poor, particularly in rural areas. There is also significant heterogeneity in state-level inequalities. Decomposition analyses show that socioeconomic status, maternal education, rural status, and state-level per capita health spending are the leading drivers of observed inequalities in forgone care. Results suggest attending to both the operation and financing of India’s health care system as well as the social determinants that make poor women more likely to forgo maternal health care.

Does BMI predict the early spatial variation and intensity of Covid-19 in developing countries? Evidence from India

This paper studies BMI as a correlate of the early spatial distribution and intensity of Covid-19 across the districts of India and finds that conditional on a range of individual, household and regional characteristics, adult BMI significantly predicts the likelihood that the district is a hotspot, the natural log of the confirmed number of cases, the case fatality rate, and the propensity that the district is a red zone. Controlling for air-pollution, rainfall, temperature, demographic factors that measure population density, the proportion of the elderly, and health infrastructure including per capita health spending and the proportion of respiratory cases, does not diminish the predictive power of BMI in influencing the spatial incidence and spread of the virus. The association between adult BMI and measures of spatial outcomes is especially pronounced among educated populations in urban settings, and impervious to conditioning on differences in testing rates across states. We find that among women, BMI proxies for a range of comorbidities (hemoglobin, high blood pressure and high glucose levels) that affects the severity of the virus while among men, these health indicators are also important, as is exposure to risk of contracting the virus as measured by work propensities. We conduct sensitivity checks and control for differences that may arise due to variations in timing of onset. Our results provide a readily available health marker that may be used to identify and protect especially at-risk populations in developing countries like India.

Spatial Pattern of Population Ageing and Household Health Spending in India

Studies on the association between population ageing and health spending are inconclusive. Though per capita health spending has a strong age gradient, evidence from the developed countries attributes increasing health expenditure to high spending in terminal year of life. In India, though studies have examined the level, trends and determinants of health care spending, no attempt has been made on association of population ageing and per capita health spending across the districts of India. The objective of this paper was to examine the spatial dependencies and heterogeneities of population ageing and per capita health spending across 640 districts of India. Data from the Census of India (2011) and the consumption expenditure rounds of the National Sample Survey Organisation (NSSO) (2009–10 and 2011–2012) were used in the analysis. Univariate and bivariate LISA analysis, ordinary least square regression, and spatial error model were used to decipher the spatial pattern of population ageing and health spending in the districts of India. Results suggest that per capita health expenditure is positively associated with the proportion of the older adults (aged 60 years and above) in the districts of India. Districts with less than 5% older adults have an annual per capita health expenditure of ₹629 compared to ₹2432 in districts with older adults 12% or more. Districts of India also exhibit large spatial heterogeneity in household health spending. Bivariate Moran’s I statistic of proportion of older adults and per capita annual health expenditure was 0.48, suggesting spatially association of the share of the older adults and the per capita annual health expenditure in India. Results of the spatial error model confirmed that share of urban population, mean wealth score, and mean household size are significant predictors of per capita annual health expenditure in India. This study is important to monitor the progress of universal health coverage across the disadvantaged districts and to integrate age component in universal health coverage programmes.

Spend Less, Get More? Explaining Health Spending and Outcome Differences Between Canada and Italy

Canada spends more than Italy on health per capita and as a share of GDP and has a higher per capita GDP. Yet, life expectancy and infant mortality in Italy are better and have improved more over time. The implication is that the Italian health care system provides better value for money. We examine whether Italy does get better health outcomes at lower costs. Using regression analysis, we find that health spending is determined by similar drivers in both Canada and Italy. We also find that more social spending and health spending in either country do not satisfactorily explain the differences in health outcomes, suggesting the importance of broader socio-economic determinants like income and life-style choices. We conclude that while the levels of per capita health spending in Canada are higher than Italy, this partly reflects historical inertia in Canadian health spending partially attributable to the higher costs of health professionals relative to Italy.

Financing Adolescent Health in China: How Much, Who Pays, and Where It Goes

PurposeAdolescent health has been gaining increasing attention in the Sustainable Development Goals era. Data on adolescent health financing are essential for evidence-based policy planning and evaluation. Little is known on national expenditure on adolescent health in China. To inform decision-making on national strategies of adolescent health and development, this study estimated expenditure on adolescent health-care utilization in China and identified funding sources and their allocation among different health functions. MethodsWe constructed and implemented an institutional survey and collected primary financial data from health institutions in the nine selected administrative provinces in 2014. We used the collected data to generate estimate of proportion of health spending on adolescent health and its breakdowns by health-care functions, health-care financing schemes, and diseases based on primary diagnosis. We applied the proportion estimates to the 2014 national-level health expenditure data and estimated national-level estimates of spending on adolescent health and breakdowns in aforementioned areas. ResultsSpending on adolescents health in 2014 amounted to CNY82.1 billion (USD 13.4 billion) or 2.6% of the total health expenditures in the year. Per adolescent health expenditures was CNY525 (USD 85.5), less than per capita health spending (CNY2349, USD382.4). National spending on adolescent health was 73.1% on curative care and 10.3% on preventive care. Out-of-pocket spending is the major source of adolescent health financing, contributing to 57.9% of total spending on adolescent health. Spending on respiratory, digestive, injury and poisoning, genitourinary diseases, and neoplasms accounted for 59.8% of curative care expenditures on adolescents. ConclusionsCurrent financing mechanism on adolescent health stressed on curative care and imposed a large portion of financial burden on households. Future investment on adolescent health shall focus more on preventive care. Financing schemes shall be adjusted so as to reduce household out-of-pocket spending on medical care used by adolescents.

An American Disgrace

An American Disgrace