Capita Spending Research Articles

Tipos de análisis de costos de la economía en salud

La importante demanda y aumento en los costos en salud ha generado a nivel mundial y sobre todo en países en vías de desarrollo la generación de evaluaciones económicas para apoyar la toma de decisiones y ofrecer el mayor beneficio al paciente en relación a sus costos. El aumento de la población y la inversión de la pirámide poblacional, así como el aumento del gasto per cápita en salud ha generado que muchos países, sobre todo países en vías de desarrollo, cada vez más invierten en el sector salud, como aquellos que existen en Australia, Canadá e Inglaterra, siendo estos los que a nivel mundial mayor ingreso per cápita invierten.

Spending Patterns Among Medicare ACOs That Have Reduced Costs.

This study aimed to examine whether specific cost categories were disproportionately affected by accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) achieving overall spending reductions, and whether there were demonstrable differences in spending patterns between "low"- or "high"-cost ACOs. Using financial data obtained from the Centers for Medicare & Medicaid Services for ACOs launched between 2012 and 2015, and employing a cross-sectional study design, we determined which cost categories were associated with overall reductions in ACO spending. Linear regressions were conducted to discern whether reductions in inpatient and skilled nursing facility (SNF) costs were driven by reductions in the number of admissions or in the cost per admission. Results showed that ACOs that reduced total per capita spending saw the largest percentage decreases in inpatient (-9%), hospice (-11%), and SNF (-16%) per capita costs, compared to ACOs that were unable to decrease costs between 2014 and 2015 (p < .05). Reductions in SNF and inpatient spending were driven by declines in the number of patients admitted, not the cost per hospitalization or SNF admission (p < .05). In 2015, ACOs in the highest decile of per capita spending spent more than double on each beneficiary compared to ACOs in the lowest decile ($16,672 versus $8,030, respectively; p < .05). ACOs in the lowest-cost decile spent more proportionally on outpatient and physician/supplier costs (p < .05). Thus, we determined that initial success in reducing the cost of care has been driven by reductions in inpatient costs due to a decline in the volume of patients admitted. Future studies should further investigate specific interventions that allow high-performing ACOs to achieve these cost reductions.

Health Care Spending Under Employer-Sponsored Insurance: A 10-Year Retrospective.

Using a national sample of health care claims data from the Health Care Cost Institute, we found that total spending per capita (not including premiums) on health services for enrollees in employer-sponsored insurance plans increased by 44percent from 2007 through 2016 (average annual growth of 4.1percent). Spending increased across all major categories of health services, although the increases were not uniform across years or categories. Growth rates for total per capita spending generally slowed after 2009 but increased between 2014 and 2016. Spending on outpatient services grew more quickly (average annual growth of 5.7percent) compared to spending on the other types of services. However, the overall distribution of spending across categories remained largely unchanged. In the context of the dramatic economic and policy events that have taken place since 2007-including the Great Recession, the Affordable Care Act, and numerous medical innovations-this assessment of ten-year spending trends provides insights into how the largest insured population in the US contributes to health care spending growth.

Inequalities in Brazilian families' income commitment to out-of-pocket spending on dental care

The study aimed to investigate inequalities in the commitment of family income to private expenditures on dental care in Brazil. Data were analyzed from 55,970 Brazilian households that participated in the nationwide Family Budgets Survey in 2008-2009. The commitment of family income to private spending on dental care was calculated by dividing the mean annual per capita household spending on dental care by the mean annual per capita income, classified in four categories: > 0%, ≥ 5%, ≥ 10%, and ≥ 20%. Analysis of income commitment only included households with positive spending. Only 2,961 households (7%) reported positive spending on dental care. Mean annual per capita spending was BRL 42.19 (USD 12.78) overall and BRL 602.47 (USD 182.57) among those with positive spending. Households with the highest absolute expenditures on dental care were those from urban areas and the wealthiest quintile. Meanwhile, households with the highest proportional income commitment were from rural areas and the poorest quintile. Among those that reported positive spending, 55% of the households in the poorest quintile committed ≥ 20% of their income to dental care. The proportion was only 6% in the wealthiest quintile of the population. The poorest households in the wealthiest regions of Brazil (Central, South, and Southeast) showed the highest income commitments. There were striking socioeconomic inequalities in spending and income commitment to dental care. The evaluation of these inequalities is relevant for the evaluation and orientation of public health policies.

Intergenerational Justice in Public Finance: A Canadian case study

This study examines whether Canadian governments have adapted budgets for the ageing population in accordance with norms of intergenerational justice. Public finance data in 2016 are analysed compared to 1976 in light of three constructs: the elderly/non-elderly ratio of social spending change, intergenerational reciprocity, and ability to pay. Findings include that (i) governments increased per capita spending for seniors 4.2 times faster than for those under the age of 45; (ii) public finance requires younger Canadians to contribute 22%-62% more in income taxes for the elderly now by comparison with 1976; and (iii) the contemporary ageing population has a greater ability to pay than cohorts immediately before and after them.

High Spending Growth Rates For Key Diseases In 2000-14 Were Driven By Technology And Demographic Factors.

We introduce a new source of detailed data on spending by medical condition to analyze US health care spending growth in the period 2000-14. We found that thirty conditions, which represented only 11.5percent of all conditions studied, accounted for 42percent of the real growth rate in per capita spending during this period, even though they accounted for only 13percent of overall spending in 2000. Primary drivers of spending growth included the use of new technologies, a shift toward the provision of preventive-type services, and an aging and more obese population. The health benefits of many new technologies appeared to outweigh the associated expenditures on treatment, which indicates that these are cost-effective and provide a net value to society. However, while these technologies may be of value, new treatments are often more expensive than older ones.

PEMODELAN PENGELUARAN PER KAPITA DAN PERSENTASE PENDUDUK MISKIN DI JAWA TENGAH MENGGUNAKAN REGRESI BIRESPON SPLINE TRUNCATED

The Central Bureau of Statistics states that the average per capita spending (Y1) of Central Java Community in 2016 is around 27.808 rupiah per day. This value is still considered low, because it covers all the needs of an individual's life. The low expenditure per capita indicates the low level of welfare. Another indicator that can be used to measure community welfare is the percentage of poverty (Y2). Through this variable can be known how proportion of people who still difficult to meet their needs. Many factors are suspected to affect welfare, one of which is the average variable of school length (X). This study aims to get the best model and know the goodness of the model. Approach is done by nonparametric regression that is regres biresponse spline truncated. Nonparametric approach is done when data function does not show certain pattern. The best spline truncated biresponse model is highly dependent on determining the order and location of the optimal knot point that has a minimum Mean Square Error (MSE) value. In this study, the best model is obtained when order of Y1 is 2 and order of Y2 is 2 with five knots. The location of the knot point obtained is 7,05; 7,17; 7,32; 9,82 and 10,29 with MSE value of 662634,2. The goodness of the model is measured based on R-Square and MAPE, R-Square=43,21%, means the variance of response variables that can be explained by the predictor variable are 43,21% while the rest is influenced by other variables and MAPE=14,25%. Based on the value of MAPE can be said that the model had a good performance. Keywords: Welfare, Expenditure, Percentage of Povery, Birespon Spline, Truncated, MSE

Revisiting out-of-pocket requirements: trends in spending, financial access barriers, and policy in ten high-income countries

BackgroundCountries rely on out-of-pocket (OOP) spending to different degrees and employ varying techniques. The article examines trends in OOP spending in ten high-income countries since 2000, and analyzes their relationship to self-assessed barriers to accessing health care services. The countries are Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.MethodsData from three sources are employed: OECD statistics, the Commonwealth Fund survey of individuals in each of ten countries, and country-specific documents on health care policies. Based on trends in OOP spending, we divide the ten countries into three groups and analyze both trends and access barriers accordingly. As part of this effort, we propose a conceptual model for understanding the key components of OOP spending.ResultsThere is a great deal of variation in aggregate OOP spending per capita spending but there has been convergence over time, with the lowest-spending countries continuing to show growth and the highest spending countries showing stability. Both the level of aggregate OOP spending and changes in spending affect perceived access barriers, although there is not a perfect correspondence between the two.ConclusionsThere is a need for better understanding the root causes of OOP spending. This will require data collection that is broken down into OOP resulting from cost sharing and OOP resulting from direct payments (due to underinsurance and lacking benefits). Moreover, data should be disaggregated by consumer groups (e.g. income-level or health status). Only then can we better link the data to specific policies and suggest effective solutions to policy makers.

How much does Australia spend on prevention and how would we know whether it is enough?

How much does Australia spend on prevention and how would we know whether it is enough?

Regional differences in the health status of Chinese residents: 2003–2013

Health inequality is an increasing concern worldwide. Using the coefficient of variation, Theil index, exploratory spatial data analysis, and spatial panel econometric model, we examined the regional inequality, spatio-temporal dynamic patterns, and key factors in the health status of Chinese residents from 2003 to 2013. We found that China’s residential health index (RHI) decreased from 0.404 to 0.295 in 2003–2013 at an annual rate of 2.698%. Spatially, resident health status, based on the RHI, has improved faster in the western region than in the eastern and central regions. Inequality in resident health status continued to increase between 2003 and 2013; inequality between regions decreased, but health status inequality expanded within regions. Furthermore, disparities in health status grew faster in western regions than in the eastern and central regions. The spatial distribution of resident health status formed a “T-shaped” pattern across China, decreasing from east to center then to the west with a symmetric decrease north and south. Using the change in Moran’s I from 2003 to 2008 and 2013, we found that the distribution of resident health status across China has narrowed. All the hot spots and cold spots have decreased, but they are also stable. Resident health status formed a stable cold spot in the western regions, while the east coastal area formed a stable hot spot. Selected explanatory variables have significant direct impacts on resident health status in China: increasing per capita GDP, per capita spending on health, and urbanization, and improving environmental quality all lead to better resident health status. Finally, we highlight the need for additional research on regional inequality of resident health status across multiple time, spatial, and factor domains.

Child Mortality Trends, 1961–2010

Letters Health AffairsVol. 37, No. 4: Culture Of Health, The ACA & More Child Mortality Trends, 1961–2010Cyprian M. Mostert AffiliationsUniversity of Witwatersrand Johannesburg, South AfricaPUBLISHED:April 2018Free Accesshttps://doi.org/10.1377/hlthaff.2018.0108AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSMortalityCosts and spendingMortality ratesI thank Ashish Thakrar and colleagues (Jan 2018) for analyzing child mortality trends in the United States and nineteen other high-income countries in the Organization for Economic Cooperation and Development (OECD) over a fifty-year period. The authors report that “the United States has poorer child health outcomes than other wealthy nations despite greater per capita spending on health care for children.”I submit that national wealth and health spending are not key factors that explain improvement in infant mortality. Take Cuba, for example. Since 1999 until at least 2015 it has had better infant mortality outcomes than the US,1 despite being a developing country and having lower health spending per capita.2 In fact, Cuba’s infant mortality rates have improved more than those for an average of OECD countries.1 Two factors have been identified as key enablers of fast improvement in infant mortality: good governance and women’s political and socioeconomic participation.3Thakrar and colleagues’ analysis would have been more beneficial if it had compared US infant mortality rates with those of other countries that have similar governance and women’s political and socioeconomic participation, instead of focusing on health spending and country wealth.NOTES1 IndexMundi. Mortality rate, infant (per 1,000 live births) [Internet]. Charlotte (NC): IndexMundi; [last updated 2016 Jun 30; cited 2018 Jan 18]. Available from: https://www.indexmundi.com/facts/indicators/SP.DYN.IMRT.IN/compare#country=cu:oe:us Google Scholar 2 IndexMundi. Health expenditure per capita (current US$) [Internet]. Charlotte (NC): IndexMundi; [last updated 2016 Jun 30; cited 2018 Jan 18]. Available from: https://www.indexmundi.com/facts/indicators/SH.XPD.PCAP/compare#country=cu:oe:us Google Scholar 3 Kuruvilla S, Schweitzer J, Bishai D, Chowdhury S, Caramani D, Frost Let al. Success factors for reducing maternal and child mortality. Bull World Health Organ. 2014;92(7):533–44B. Crossref, Medline, Google Scholar Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 2 April 2018 Information© 2018 Project HOPE—The People-to-People Health Foundation, Inc.PDF download

Has development assistance for health facilitated the rise of more peaceful societies in sub-Saharan Africa?

ABSTRACTGrowing evidence suggests that health aid can serve humanitarian and diplomatic ends. This study utilised the Fragile States Index (FSI) for the 47 nations of the World Health Organizations’ Africa region for the years 2005–2014 and data on health and non-health development aid spending from the United States (US) for those same years. Absolute amounts of health and non-health aid flows from the US were used as predictors of state fragility. We used time-lagged, fixed-effects multivariable regression modelling with change in FSI as the outcome of interest. The highest quartile of US health aid per capita spending (≥$4.00 per capita) was associated with a large and immediate decline in level of state fragility (b = −7.57; 95% CI, −14.6 to −0.51, P = 0.04). A dose–response effect was observed in the primary analysis, with increasing levels of spending associated with greater declines in fragility. Health per-capita expenditures were correlated with improved fragility scores across all lagged intervals and spending quartiles. The association of US health aid with immediate improvements in metrics of state stability across sub-Saharan Africa is a novel finding. This effect is possibly explained by our observations that relative to non-health aid, US health expenditures were larger and more targeted.

A Volunteer and Partnership Baseline for Municipal Forestry Activity in the United States

Communities cultivate citizen support of municipal forestry operations through volunteers and partnerships. Through a national census and survey of urban forestry activity in over 660 municipalities in the United States, researchers found two-thirds of all responding communities involve volunteers in tree activities. This increases from half of small communities (2,500 to 4,999 people) to all large communities (one million or more people) involving volunteers. When tabulated for the United States, a mean national estimate of 345,466 (195,754 SEM) people volunteered 1,484,204 (665,460 SEM) hours with municipal tree activities. This equates to 714 (320 SEM) full-time equivalent (2,080 hour-base year) positions. Overall, volunteers completed nearly 5% of municipal tree care activities. Nearly 80% of the municipalities train their volunteers. Tree planting (85% of communities) was the most common activity, followed by tree watering (40%), awareness/education programs (39%), tree pruning (28%), and fundraising (20%). Findings were contrasted with U.S. census population groups to disaggregate if volunteerism varied by community size. Volunteers were more commonly involved in communities with a greater urban-forestry capacity derived from a sustainability index score. Six attributes of municipal forestry program had either positive (+) or negative (-) effect on volunteer participation in urban forestry activities. These included adequate budget (-), per capita spending (-), tree board (+), outreach (+), strategic plan (+), and total employment (+).

Lean and Green Hand Surgery.

Health care in the United States is both expensive and wasteful. The cost of health care in the United States continues to increase every year. Health care spending for 2016 is estimated at $3.35 trillion. Per capita spending ($10,345 per person) is more than twice the average of other developed countries. The United States also leads the world in solid waste production (624,700 metric tons of waste in 2011). The health care industry is second only to the food industry in annual waste production. Each year, health care facilities in the United States produce 4 billion pounds of waste (660 tons per day), with as much as 70%, or around 2.8 billion pounds, produced directly by operating rooms. Waste disposal also accounts for up to 20% of a hospital's annual environmental services budget. Since 1992, waste production by hospitals has increased annually by a rate of at least 15%, due in part to the increased usage of disposables. Reduction in operating room waste would decrease both health care costs and potential environmental hazards. In 2015, the American Association for Hand Surgery along with the American Society for Surgery of the Hand, American Society for Peripheral Nerve Surgery, and the American Society of Reconstructive Microsurgery began the "Lean and Green" surgery project to reduce the amount of waste generated by hand surgery. We recently began our own "Lean and Green" project in our institution. Using "minor field sterility" surgical principles and Wide Awake Local Anesthesia No Tourniquet (WALANT), both surgical costs and surgical waste were decreased while maintaining patient safety and satisfaction. As the current reimbursement model changes from quantity to quality, "Lean and Green" surgery will play a role in the future health care system.

Child Mortality In The US And 19 OECD Comparator Nations: A 50-Year Time-Trend Analysis.

The United States has poorer child health outcomes than other wealthy nations despite greater per capita spending on health care for children. To better understand this phenomenon, we examined mortality trends for the US and nineteen comparator nations in the Organization for Economic Cooperation and Development for children ages0-19 from 1961 to 2010 using publicly available data. While child mortality progressively declined across all countries, mortality in the US has been higher than in peer nations since the 1980s. From 2001 to 2010 the risk of death in the US was 76percent greater for infants and 57percent greater for children ages1-19. During this decade, children ages15-19 were eighty-two times more likely to die from gun homicide in the US. Over the fifty-year study period, the lagging US performance amounted to over 600,000 excess deaths. Policy interventions should focus on infants and on children ages15-19, the two age groups with the greatest disparities, by addressing perinatal causes of death, automobile accidents, and assaults by firearm.

National Health Care Spending In 2016: Spending And Enrollment Growth Slow After Initial Coverage Expansions.

Total nominal US health care spending increased 4.3percent and reached $3.3trillion in 2016. Per capita spending on health care increased by $354, reaching $10,348. The share of gross domestic product devoted to health care spending was 17.9percent in 2016, up from 17.7percent in 2015. Health spending growth decelerated in 2016 following faster growth in 2014 and 2015 associated with coverage expansions under the Affordable Care Act (ACA) and strong retail prescription drug spending growth. In 2016 the slowdown was broadly based, as spending for the largest categories by payer and by service decelerated. Enrollment trends drove the slowdown in Medicaid and private health insurance spending growth in 2016, while slower per enrollee spending growth influenced Medicare spending. Furthermore, spending for retail prescription drugs slowed, partly as a result of lower spending for drugs used to treat hepatitis C, while slower use and intensity of services drove the slowdown in hospital care and physician and clinical services.

An analysis of the French healthcare system in the context of geriatric care

The geriatric population occupy a progressively greater portion of the Canadian demographic spectrum. They often present with multiple comorbidities and utilize a disproportionate amount of healthcare resources per capita. Keeping current Canadian healthcare practices may become unsustainable in the long run, and comparison with the French healthcare system may help with the identification of current shortfalls. The Canadian healthcare system lags behind the French counterpart in several key healthcare indicators, including per capita spending, growth in expenditure, and specialist wait time. The French healthcare system is characterized by a mix of public and private healthcare choices, greater emphasis on preventative health and an nationwide integration. All of these may have contributed to the French healthcare system’s better fiscal spending practices and healthcare outcomes. The Canadian healthcare system should take note of these differences and integrate positive elements to create a model better prepared for geriatric care in the foreseeable future. More in-depth studies may be needed to better assess the extent of adaptation for each of the aforementioned areas.

Risk of Diabetes Mellitus Among Medicaid Beneficiaries in Hawaii.

IntroductionMedicaid is the largest primary health insurance for low-income populations in the United States, and it provides comprehensive benefits to cover treatment and services costs for chronic diseases, including diabetes. The standardized per capita spending on diabetes by Medicare beneficiaries enrolled in the fee-for-service program in Hawaii increased from 2012 to 2015. We examined the difference in odds of diabetes between Medicaid and non-Medicaid populations in major racial/ethnic groups in Hawaii.MethodsWe used data from 2013 through 2015 from the Hawaii Behavioral Risk Factor Surveillance System in this cross-sectional study to compare the difference in risk for self-reported diabetes between Medicaid (n = 1,889) and non-Medicaid (n = 17,207) beneficiaries. We used multivariate logistic regression models that could accommodate the complex sampling design to examine the difference in odds of diabetes between the 2 populations.ResultsIn Hawaii, the Medicaid population was younger, was less educated, had more health impairments, and was more likely to be obese and Native Hawaiian/Other Pacific Islander (NH/OPI) than the non-Medicaid population. The unadjusted prevalence of diabetes in the Medicaid population in Hawaii was higher than that for the non-Medicaid population (10.3% vs 8.9%, P = .02). After adjusting for confounding variables, the odds of diabetes in the Medicaid population was still significantly higher than those in the non-Medicaid population (adjusted odds ratio [AOR] = 1.75; 95% confidence interval [CI], 1.33–2.31). Adjusted analysis stratified by race/ethnicity showed that non-Hispanic Asian (AOR = 2.23; 95% CI, 1.31–3.78) and NH/OPI (AOR = 3.17; 95% CI, 1.05–9.54) Medicaid beneficiaries had significantly higher odds of diabetes than their non-Medicaid counterparts.ConclusionThe odds of diabetes was significantly higher among the Hawaii Medicaid population than among the non-Medicaid population. Diabetes prevention programs should address the challenges and barriers that the Medicaid population faces. Our findings can be used to promote culturally competent diabetes education programs.

Effects of social programs on indigent population health: Evidence from results-based budgeting's impact evaluations to social programs in Peru

This article describes the experience of the MEF's impact evaluation management as one of the RBB instruments and documents the design and results obtained from three impact evaluations of the most emblematic government social programs. The Service of Visiting Families (SAF) of the National Program "Cuna Mas", conditional cash transfer Program "JUNTOS" and National Program "Pension 65" focusing on objective population's health the outcomes. Among the main results, it was found the SAF generated improvements in cognitive and communication development in children, but had no impact on mothers' child care practices or children's nutritional status. In the case of JUNTOS, there were increases in per capita spending, food expenditure, decreases in severity and poverty gap, increases in school attendance and reductions of school dropout. However, no significant results were found in most indicators of prenatal health, child health, or chronic malnutrition. In the case of Pension 65, there were increases in household consumption and improvements in elderly's emotional health (depression, self valoration); but there was no evidence of increases in the use of health services by the elderly or improvements in their physical health. Therefore, it is recommended that such programs boost their designs and inter-sectoral coordination with MINSA and subnational institutions, in order to improve contents of healthy practices and child care, and optimize the provision of health and education services, in order to meet the demands of their users.

The Fiscal Sustainability of Alberta's Public Health Care System

From 1975 to 2007, Alberta’s real per capita government health expenditures grew from $1,679 to $3,696 (in 2007 dollars), at a median annual growth rate of 3.5%. Over the same period, Alberta’s real per capita gross domestic product and real per capita total government revenues grew at median annual rates of 2.2% and 1.7%, respectively. This difference between the growth rates of health care spending on the one hand and government revenues and the economy on the other gives rise to concern about the fiscal sustainability of the province’s public health care system. This study presents projections of real per capita spending on public health care in Alberta over the medium term out to 2030. They suggest that, by then, real per capita spending could reach anywhere between $5,339 and $14,215, soaking up between 32% and 87% of total government revenues; more worrying, the high end of these ranges reflects a continuation of the policy settings that guide current provincial public health spending. Alberta is fortunate to have a wealthy economy that can support a high level of public health spending. But that support is precarious given the cyclical nature of non-renewable natural resource revenues and Alberta’s past tendency to experience periods of boom and bust. Basing the financing of key spending programs such as health care on a volatile revenue base is not advisable, for it puts them at risk should economic conditions turn unfavourable, as they have recently. Indeed, adjusting government revenues in our projections to match a more reasonable measure of what might be relied upon with a degree of certainty simply enhances the precariousness of the fiscal sustainability of the public health care system. Not all categories of provincial government health care spending — in particular, the traditional core medicare areas of physician services and hospitals — are growing faster than either the revenue base or the economy. The growth of spending on non-medicare categories such as drugs, capital, and all other health expenditures, however, is a particular source of concern. Options for sustaining provincial government health expenditures include choosing what other government programs could be allowed to grow more slowly over time, what tax rates could be increased to cause the revenue base to grow more quickly, and what health programs currently provided by the public sector instead could be provided privately. These approaches need not exist in watertight compartments, however, and a portfolio of policies that combines these solutions likely would be a pragmatic policy outcome. Such a strategy would help to ensure the fiscal sustainability of Alberta’s public health care system and responsibly provide for the future welfare of its citizens.