Capita Health Spending Research Articles

Barriers to Reducing Useless Exams in Ionizing Medical Imaging: An Overview

Appropriateness in imaging studies is recognized as an important feature in National Health Services, especially in those nations where per capita health spending has been substantially increased. This is important in view of the projected spectacular rise of ionizing imaging tests in next years; yet their explosive growth in performance is challenging to be interpreted as it may represent an added value when appropriate, and an added cost when inappropriate or overused (Picano, 2009). In order to define this, over the past thirty years researchers have conducted several studies to examine the relationship between risks and perceived usefulness, attitudes, and the usage of ionizing examinations, embracing the risk-benefit relation as a suggested policy for improving health services. However, until relatively recently, little had been done on these issues, and even now, both patients and physicians generally ignore the potential harmful effects of the inappropriate use of diagnostic medical procedures. So, the aim of this review is to discover, basing on the literature, why inappropriateness is still so high and to show that many of the difficulties faced by National Health Services in the reduction of inappropriateness are caused by a lack of awareness of, and training in, communication strategies.

PUBLIC PROGRAMS PARE POVERTY: EVIDENCE FROM CHILE

This study examines the effect of government health care and education programs on the poor in Chile from 2000 to 2006. Results are obtained from a country-wide provincial level panel data-set with information on poverty and indigence head-count ratios, measures on the severity of poverty as captured by the Foster-Greer-Thorbecke P2 statistic, per capita public expenditures on health and education, as well as other variables that are thought to influence well-being. We use fixed-effects techniques to correct for time-invariant province-specific characteristics that may affect program placement. Our analysis demonstrates that per capita public health and education expenditures significantly reduce the incidence of poverty and indigence in Chile. In particular, for a 10,000 pesos (about $23) increase in provincial per capita health spending, the poverty head-count ratio decreases by 0.48%. Per capita education expenditures are particularly important to reducing the severity of poverty. Our results indicate that for a 10,000 pesos increase in education spending, the severity of poverty declines by as much as 1.53%. Furthermore, we provide evidence that public spending in Chile is non-random. In particular, government education expenditures may be allocated in keeping with compensatory motives.

Health care financing and utilization of maternal health services in developing countries

The Millennium Development Goals call for a 75% reduction in maternal mortality between 1990 and 2015. Skilled birth attendance and emergency obstetric care, including Caesarean section, are two of the most important interventions to reduce maternal mortality. Although international pressure is rising to increase donor assistance for essential health services in developing countries, we know less about whether government or the private sector is more effective at financing these essential services in developing countries. We conducted a cross-national analysis to determine the association between government versus private financing of health services and utilization of antenatal care, skilled birth attendants and Caesarean section in 42 low-income and lower-middle-income countries. We controlled for possible confounding effects of total per capita health spending and female literacy. In multivariable analysis, adjusting for confounders, government health expenditure as a percentage of total health expenditure is significantly associated with utilization of skilled birth attendants (P = 0.05) and Caesarean section (P = 0.01) but not antenatal care. Total health expenditure is also significantly associated with utilization of skilled birth attendants (P < 0.01) and Caesarean section (P < 0.01). Greater government participation in health financing and higher levels of health spending are associated with increased utilization of two maternal health services: skilled birth attendants and Caesarean section. While government financing is associated with better access to some essential maternal health services, greater absolute levels of health spending will be required if developing countries are to achieve the Millennium Development Goal on maternal mortality.

What Should A Country Spend On Health Care?

Per capita health spending across countries ranges by more than 100 to 1, leading many people to ask, "What should a country spend on health care?" This paper discusses four approaches to this question and demonstrates how each approach, in effect, answers a slightly different question, all of which are important to public policy decisions regarding health care spending. The paper also addresses a commonly cited World Health Organization statement that countries should spend 5 percent of national income on health care services.

Leading the Elephant Out of the Corner

I will break with tradition and address a topic that is more political and social than scientific—the future of health care. Although I will focus initially on the growing healthcare crisis in this country, I will cite similar concerns and trends elsewhere in the world and suggest fundamental principles for change that are relevant throughout our global society. Of the 192 member states of the World Health Organization in 2003 (Figure 1), 85 countries spent less than $100 per capita each year on health care.1 Another 85 countries spent between $100 and $2000 per capita. Only 22 countries, or 11.5%, spent more than $2000 per capita. Most of us are privileged, as we work in one of these 22 countries (Table 1). Figure 1. Pie diagram showing the distribution of the 192 member states of the World Health Organization based on per capita health spending in 2003. Only 22 countries, or 11.5%, spent more than $2000 per capita. Based on data from the World Health Organization.1 View this table: TABLE 1. World Health Organization Member Statistics With Per Capita Health Spending Greater Than $2000 The recent growth in healthcare expenditures is an issue in many of these countries, including the United States. In the United States, federal government spending on Medicare and Medicaid continues to accelerate (Figure 2). These 2 items now comprise almost 21% of the budget, equal to Social Security.2 Along with other mandatory items and interest payments, these nondiscretionary expenditures now approach 61% of the total federal budget (Figure 3). Of the remaining 39%, 20% goes to defense, leaving 19% of the federal budget for all other discretionary spending. Figure 2. Growth in federal government spending on Medicare and Medicaid from 2003 to 2006. The Medicaid spending does not include the contribution from the states. Based on …

Health Spending By State Of Residence, 1991–2004

Differing trends in health spending by state underlie national spending trends. To shed light on the complexities of health spending patterns among state residents, we present updated per capita health spending estimates by state of residence for 1991-1998 and new estimates for 1999-2004, and we offer summaries of trends exhibited during these time periods. These statistics provide the opportunity for further analysis, such as examination of variations in state-level spending in Medicare, Medicaid, and total personal health care spending, which can yield new perspectives on recent state health spending trends and provide context for policy discussions.

Health Care Spending And Use Of Information Technology In OECD Countries

In 2003, the United States had fewer practicing physicians, practicing nurses, and acute care bed days per capita than the median country in the Organization for Economic Cooperation and Development (OECD). Nevertheless, U.S. health spending per capita was almost two and a half times the per capita health spending of the median OECD country. One proposal for both lowering health spending and improving quality is the adoption of health information technology (HIT). The United States lags as much as a dozen years behind other industrialized countries in HIT adoption--countries where national governments have played major roles in establishing the rule, and health insurers have paid most of the costs.

The Aggregate Effects of Health Insurance: Evidence from the Introduction of Medicare

This paper investigates the effects of market-wide changes in health insurance by examining the single largest change in health insurance coverage in American history: the introduction of Medicare in 1965. I estimate that the impact of Medicare on hospital spending is over six times larger than what the evidence from individual-level changes in health insurance would have predicted. This disproportionately larger effect may arise if market-wide changes in demand alter the incentives of hospitals to incur the fixed costs of entering the market or of adopting new practice styles. I present some evidence of these types of effects. A back of the envelope calculation based on the estimated impact of Medicare suggests that the overall spread of health insurance between 1950 and 1990 may be able to explain about half of the increase in real per capita health spending over this time period.

Does the aging of the population really drive the demand for health care?

In the debate on health policy, it is widely believed that the aging of the U.S. population is a major driver of the annual growth in the demand for health care and in national health spending. This essay draws on the research literature and on data from the Medical Expenditure Panel Surveys (MEPS) to debunk that myth. Although in any year per capita health spending for people age sixty-five or older tends to average three to five times that for younger Americans, the aging of the population is too gradual a process to rank as a major cost driver in health care.

Rabies epizootics among raccoons vary along a North-South gradient in the Eastern United States.

The characteristics of rabies epizootics among raccoons were investigated in 11 eastern states along a North-South gradient from New York to North Carolina. Epizootics were defined as discrete intervals of time of at least 5 months in duration, when reported cases of raccoon rabies from an individual county exceeded the median value of raccoon rabies cases reported by that county over the entire period rabies was present among raccoons in the county. Over the approximately 20-year study period, 35,000 cases of raccoon rabies were reported, and epizootics were detected from 251 (64.4%) of 390 counties. The median annual incidence was 0.14 epizootics per year. During the first defined epizootic in a county, the median total number of raccoons reported rabid was 47, with a median monthly incidence of rabies in raccoons of 3.1. The median lag time from the first report of a rabid raccoon in a county to the beginning of the first epizootic was 4 months. Significant differences in the annual incidence of epizootics and monthly incidence of rabid raccoons during epizootics were observed among different states. Although human population density and per capita health spending within counties were positively associated with increasing magnitude of epizootics, a significant difference in the characteristics of rabies epizootics in northern and southern states was apparent. We hypothesize that environmental conditions and perhaps human influence resulted in rabies epizootics in southern states that were smaller, less-frequent, and lacking in well-defined temporal structure compared with those in northern states.

Is Post‐Communist Health Spending Unusual?

What factors determine a country's spending on health? And what factors determine the share of spending financed by the public sector? Taking these factors into account, is post‐communist health spending unusual? For the OECD economies, we find that per capita health spending is strongly related to per capita income, with an elasticity of about 1.5. The elasticity for developing economies is close to one. Spending is also positively related to the elderly dependency rate, but the relationship is weaker than a static comparison of spending by the elderly and non‐elderly would suggest. Even though health spending as a share of GDP in the post‐communist countries of eastern and central Europe is below the OECD average, there is evidence of above normal health spending in most countries when we control for income and demographics. For Hungary, the ‘excess’ spending reached over three percentage points of GDP in 1994. For the OECD sample, four development indicators account for half the variation in the public sector share of total health spending. Political variables help explain the remainder. If the post‐communist countries converge to the market economy pattern, the share of public financing will fall, yet still remain well above half.

Management of human resources in health care: The Canadian experience

Each of Canada's ten provinces has a publicly administered system of health insurance, funded by provincial and federal taxes, that is accessible to all citizens and covers all medically necessary services provided by physicians and hospitals. Canadians spend an estimated 9.2 percent of their gross national product on health care (about 2.8 percentage points below US spending), of which three quarters is public-sector spending. According to the Organization for Economic Cooperation and Development, Canada's health status is equal to or better than that of the United States, despite lower per capita health spending. About seven percent of the Canadian labour force works in health care, and attempts to introduce coordinated planning of human resources in health care have not as yet proceeded far. The predominant policy issue here is the supply and the role of physicians. It has been argued that entrenching within the system the fee-for-service method of paying physicians has created a disincentive to the delegation of responsibility to health personnel other than doctors. It is also argued that introduction of government-run health insurance provided the opportunity for human resource planning, but that the decision by governments to act only as the payer resulted in ad-hoc planning approaches. However, governments' concern over health care costs has led to a more direct role by them in the planning of the human resources in health. They are re-examining the autonomy and jurisdictional rights of the professions that deliver health care to Canadians.

Making universal health insurance work in Massachusetts.

High U.S. health costs have been one of the main barriers to enacting universal access to care in recent decades. It is therefore surprising that Massachusetts, with the nation's highest per capita health spending, last year promised health insurance to all citizens. Declaring that “the access of residents of the Commonwealth to basic health care services is a natural, essential, and unalienable right” protected by the Massachusetts Constitution, the new health law, Chapter 23 of the Acts of 1988, legislates a promise that insurance be offered to all by 1 April 1992.The law was the product of almost three years of bargaining. One closely involved person said this was “the most controversial and heavily fought battle in the past 25 years in the Massachusetts State House.” Deals had to be struck. Perhaps the most important of the law's compromises is embodied in its title: “An Act to Make Health Security Available to All Citizens of the Commonwealth and to Improve Hospital Financing.” Obtaining the votes for the law's universal access provisions required promising Massachusetts hospitals substantially higher revenues.

International Health Care Spending

Trends in health are reviewed for the member countries of the Organization for Economic Cooperation and Development (OECD) covering the following: the basic difficulties inherent in international comparative studies; the absolute levels of health expenditures in 1984; the levels and rates of growth of the health share in the gross domestic product (GDP) and the public share of total health expenditures; the elasticities of real health expenditures to real GDP for the 1960-75, 1975-84, and 1960-84 time periods; growth in health expenditures for the largest 7 OECD countries in terms of growth in population, health prices, health care prices in excess of overall prices, and utilization/intensity of services per person. International comparisons are a problem due to differences in defining the boundaries of the health sector, the heterogeneity of data, and methodological problems arising from comparing different economic, demographic, cultural, and institutional structures. The most difficult problem in international comparisons of health expenditures is lack of appropriate measures of health outcome. Exhibit 1 contains per capita health expenditures denominated in US dollars based on GDP purchasing power parities for 21 OECD countries for 1984. Per capita health expenditures ranged from less than $500 in Greece, Portugal, and Spain to over $1400 in Sweden and the US, with an OECD average of $871. After adjusting for price level differences, there still appears to be a greater than 3-fold difference in the "volume" of services consumed across the OECD countries. To determine if per capita health expenditures are related to a country's wealth as measured by its per capita GDP, the relationship between per capita health expenditures and per capita GDP for the 21 countries were examined for 1984. The data points and the "best fitting" trend line indicate a statistically significant relationship in which each $100 difference in per capita GDP is associated with a $10.50 difference in per capita health expenditures. The calculated elasticity is 1.4 indicating that each 10% difference in per capita GDP is associated with a 14% difference in per capita health expenditures. The analysis indicates that variations in per capita GDP, alone, are associated with 7 of the variation in per capita health spending. In 1984, health spending in the 18 OECD countries (for which data were consistently available for all 6 different years) was on average 7.5% of GDP. The US had the highest GDP share (10.7%) and Greece had the lowest (4.6%). The average elasticity of 16 of the 18 countries as a group substantially exceeded 1.0 for the 1960-84 period, as well as the 1960-75 (1.6) and 1975-84 (1.3) subperiods. Thus, real health spending increased 60% faster than the real GDP between 1960-84 and between 1960-75 and 30% faster between 1975-84.