Determinants Of Health Care Expenditure Research Articles

Projecting a long‐term healthcare expenditure in the United States: Do climate change, globalization, and technological innovation play a major role?

AbstractRecognizing the paramount importance of health, the United Nations Development Program has outlined sustainable development goals, emphasizing Goal 3, which focuses on ensuring and promoting healthy lives and well‐being for all. Consequently, this study delves into the determinants of healthcare expenditure (HCE), specifically focusing on financial development (FDV), tourism (TOR), technological innovations (TINs), economic growth (EG), and climate change in the United States. The investigation utilizes data spanning from the first quarter of 2000Q1 to the fourth quarter of 2020Q4. To achieve this objective, we employed innovative quantile‐based methodologies, including wavelet quantile regression and quantile‐on‐quantile Granger causality. These approaches facilitated a comprehensive exploration of the dynamic interactions between HCE and its influencing factors across various quantiles and periods. The wavelet quantile regression and quantile‐on‐quantile regression analysis findings consistently indicate a positive impact of CO2, TOR, EG, globalization, FDV, foreign direct investment, and TIN on HCE in the United States. Furthermore, the results obtained from the quantile‐on‐quantile Granger causality demonstrate that CO2 emissions, TOR, EG, globalization, FDV, foreign direct investment, and TIN significantly predict HCE across all quantiles. These insights have informed the formulation and implementation of various policies addressing the complex interplay between healthcare spending and its driving factors.

The Determinants of Health Care Expenditure in Egypt

Abstract Health care sector is one of the most important sectors that affect the economies of all countries. On the one hand, it affects the productivity of labor force, on the other hand, it affects the spending of the households and the allocation of income among the various aspects of spending. In addition, the case of Egypt is characterized by some peculiarity in terms of The large population and the existence of a development gap between the cities of the north and the cities of the south, and the volume of out of pocket expenditure on health care which exceeds its counterpart in most countries of the world. In addition, health care service providers in Egypt are represented in the public sector, the private sector and the cooperative or community sector, where the three sectors provide health care services with different quality and prices. Therefore, this study aimed to identify the determinants of health care expenditure in Egypt through an econometric model. The results showed that spending on health care in Egypt was affected by percapita GDP and population over 65 years old while the econometric model shows no significance for variables such as hospital beds and number of medical doctors.

Under-spending, over-spending or substitution among services? Spatial patterns of unexplained shares of health care expenditures

Using individual-level administrative data, we investigate the spatial patterns of unexplained shares of health care expenditures (HCE) at the municipality level. The focus is on the elderly population in the Italian Region Friuli-Venezia Giulia observed over the period 2017-2019. The empirical analysis comprises two steps. First, random-effects two-part models are estimated to analyze the effect of age, morbidity, and death on the probability and amount of positive individual total HCE and its components. Second, the unexplained shares of HCE at the municipality level are examined to identify areas with under- or over-spending and substitution among services. Results confirm the existing findings on the determinants of HCE and reveal geographic patterns in the unexplained shares of expenditures. We identify clusters of municipalities with observed HCE higher than predicted for each type of service and clusters with substitution between home care and all other services. These findings are associated with the degree of urbanization of these areas and, consequently, with the ease of access to health care. This is crucial from a policy perspective, as it indicates specific policy targets for public health intervention.

Determinants of Healthcare Expenditures among People with Aphasia: Importance of Race, Sex, Residence, and Aphasia Type

ABSTRACT Introduction Roughly 30% of stroke survivors suffer from aphasia—a communication disorder that affects the ability to communicate effectively—but little is known about their healthcare expenditure or how it varies between aphasia subtypes. This study evaluates the relative differential in healthcare expenditure of anomic, Broca’s, Wernicke’s and Conduction aphasia and assesses expenditure between demographic cohorts Methods Individual level data from the 2010 Moss Aphasia Psycholinguistic Project Database was matched with the 2010 Medical Expenditure Panel Survey using a propensity score algorithm based on functional, health, and demographic characteristics. Multilevel, generalized, nonlinear regression models were applied to the resulting data set to assess the correlation between annual healthcare expenditure, time post onset (tpo), sex, race, family size, marital status, income, education, aphasia type, and region of residence. Results were used to predict expenditure by aphasia subtype, race, and sex. Multiple distributional specifications tested the sensitivity and ensured the robustness of estimates. Results Regression results indicate that individuals with Broca’s aphasia had statistically higher healthcare expenditures paying an average of $10,896.45 annually when compared to anomic ($7,927.60), Wernicke’s ($7,096.22), and Conduction ($9,447.19) aphasias. Additionally, healthcare expenditure increased with each year of age (β=0.004, SE=0.005), but decreased with each year after stroke (β=-0.002, SE=0.001). Females (β=0.358, SE=0.131) and Blacks (β=0.103, SE=0.200) paid significantly more annually compared to males and Whites, respectively. Neither region of residence, income, nor level of education were significantly correlated with healthcare expenditure. Conclusion This study showed that, while individuals with Broca’s aphasia had higher average healthcare expenditure than other subtypes, the differential was not statistically significant. Sex and race cohorts did, however, show statistically significant differences in healthcare expenditures. While causality is outside the scope of this analysis, additional work is needed to determine the best strategy to mitigate these disparities.

Health Status and Economic Growth in Kenya

Economic growth is important as it measures the prosperity of a nation which indeed increases the output per person and factors like human capital, physical capital and technological change which are the main drivers towards achieving economic growth. Kenya’s Vision projected an economic growth rate of 10 per cent per annum from 2008 to 2030 which has not been achieved to date. The purpose of this study was to analyze the impact of health status on economic growth in Kenya. The specific objectives of the study were to determine the effect of: nutrition status and life expectancy on economic growth in Kenya. The study adopted the endogenous growth theory and incorporated key health status into the model as a function of human capital. Research design employed was explanatory research design and relied on secondary data from World Bank from 1985 to 2018. Applying regression model, the results revealed that coefficient of life expectancy was 1.1556, which was positive and significant at 5 percent level. This implied that for every one percent increase in coefficient of life expectancy, GDP growth rate could increase by 1.1556 percent. Coefficient of nutrition status was -1.143, which was negative and insignificant at 5 percent level. This implied that for every one percent increase in coefficient of nutrition status, GDP growth rate would fall by 1.143 percent. Considering that increased life expectancy had direct effect on increase in economic growth rate, Kenya government could put in place policies promoting citizen’s health. Suitable social sector policies and government interventions are required to increase life expectancy and consequently economic growth rate. Further, there is also a need for involvement of health human force in macro and micro policy-makings and critically examine other determinant of health care expenditure

The 'Red Herring' Hypothesis: Some Theory and New Evidence.

The ‘red herring’ hypothesis (RHH) claims that apart from income and medical technology, proximity to death rather than age constitutes the main determinant of healthcare expenditure (HCE). This paper seeks to underpin the RHH with some theory to derive new predictions also for a rationed setting, and to test them against published empirical evidence. One set comprising ten predictions uses women’s longer life expectancy as an indicator of the difference in time to death in their favor. Out of 28 testing opportunities drawn from the published evidence, in the case of no rationing seven out of eleven result in full and two in partial confirmation; in the case of rationing, twelve out of 17 result in full and one in partial confirmation. The other set, containing 35 testing opportunities, concerns the age profile of HCE. In the case of no rationing, seven out of twelve result in full and four in partial confirmation; in the case of rationing, eleven out of 23 in full and nine in partial confirmation. There are but ten contradictions in total. Overall, the new tests of the RHH can be said to receive a good deal of empirical support, both from countries and settings with and without rationing.

Determinants of Health Care Expenditure in the United States

The rapid increase in health expenditure has become a major concern for both households and governments in the United States. This paper investigates the long-run dynamics of health care expenditure in the United States over the period 1991-2014 using the National Health Expenditure Data from the Centers for Medicare & Medicaid Services. We use an Auto Regressive Distributed Lag (ARDL) technique to estimate the long-run dynamics and short-run adjustment of health care expenditure to changes in government insurance enrollment, controlling for income, health, uninsured, and trend to account for technological changes. The results indicate that the instance and type of insurance affect per capita expenditure; in particular, increases in Medicaid enrollment lead to higher per capita expenditure levels relative to other insurance groups and uninsured, while increases in Medicare enrollment lead to lower per capita expenditure levels.

Sociodemographic determinants of health care expenditure: micro level evidence of a fast-growing developing country

PurposeThe objective of this study is to examine the sociodemographic factors that are associated with health care expenditure among households in Malaysia.Design/methodology/approachThis study examines health care participation decision and amount of expenditure using the exponential Type 2 Tobit model. A dataset of a large sample (n = 14,838) that is nationally representative is used.FindingsThe results suggest that household size, location of residence as well as age, education and marital status of the household heads are significantly associated with household expenditure on health care. Health care expenditure increases with the age and educational attainment of household heads, whereas those who are being employed and residing in rural areas have lower health care expenditure. Although larger households are more likely to consume health care than smaller households, they spend less on health care. Furthermore, marital status does not affect the participation decision of health care expenditure, but the variable is associated with the decision on the amount of the expenditure.Practical implicationsThe results provide insights into groups of population that can be targeted for healthcare intervention programmes and policy design.Originality/valueThis study is the first to our knowledge to use a microeconometric approach to analyse the health care participation as well as its level of expenditure among households in Malaysia.

Determinants of Healthcare Expenditures in GCC Countries: A Panel Data Analysis

Determinants of Healthcare Expenditures in GCC Countries: A Panel Data Analysis

An empirical study on the determinants of health care expenses in emerging economies

BackgroundEmerging countries continue to suffer gravely from insufficient healthcare funding, which adversely affects access to quality healthcare and ultimately the health status of citizens. By using panel data from the World Development Indicators, the study examined the determinants of health care expenditure among twenty-two (22) emerging countries from the year 2000 to 2018.MethodsThe study employed cross-section dependence and homogeneity tests to confirm cross-sectional dependence and to deal with homogeneity issues. The Quantile regression technique is employed to test for the relationship between private and public health care expenses and its determinants. The Pooled mean group causality test is used to examine the causal connections among the variables.ResultsThe outcome of the quantile regression test revealed that economic growth and aging population could induce healthcare costs in emerging countries. However, the impact of industrialization, agricultural activities, and technological advancement on health expenses are found to be noticeably heterogeneous at the various quantile levels. Unidirectional causality was found between industrialization and public health expenses; whereas two-way causal influence was reveled amongst public health expenditure and GDP per capita; public health expenditure and agricultural activities.ConclusionIt is therefore suggested that effective and integrated strategies should be considered by industries and agricultural sectors to help reduce preventable diseases that will ultimately reduce healthcare costs among the emerging countries.

Socio-Economic, Demand and Supply-Driven Determinants of Health Care Expenditures in Sub-Sahara Africa

This study examined the real determinants of health care expenditure in Sub-Sahara Africa. Considering the determining factors from socio-economic, demand and supply sides, data for the study were sourced from World Health Organization and World Development indicators published by World Bank. The study employed Westerlund Error-correction Based Panel Cointegration test to examine the relationship between the determining factors of health expenditure and the health expenditure itself. Findings from the study confirmed that there are long-term co-movements between the determining factors of health expenditure and health expenditure itself. Also, the study revealed that all variables from socio-economic, demand and supply sides have significant impacts on health expenditure in both short and long- run. In addition, most variables in the demand and supply sides have negative and significant impacts on health expenditure while all variables from socio-economic side have positive and significant impacts on health expenditure in both short and long-run in the selected Sub-Sahara African countries. Keywords : Health Expenditure, Socio-economic Side, Demand Side, Supply Side, Panel Unit Root test, Error Correction Based Panel Cointegration. DOI: 10.7176/RHSS/10-10-07 Publication date: May 31 st 2020

The relationship between air pollutants and healthcare expenditure: empirical evidence from South Korea.

This study analyzes the relationship between air pollutants (represented as the air quality index or AQI) and healthcare expenditure. It uses balanced monthly panel data that provides information about the healthcare expenditure, concentration of air pollutants, and regional characteristics. It considers all the variables for 16 cities and provinces in Korea for the period January 2010 to September 2017. It uses the panel data methodology to estimate the effects of air pollutants on healthcare expenditure conditional on controlling for different determinants of healthcare expenditure. The important determinants of variations in healthcare expenditure that this study identifies include the following: five air pollutants' quality indices, personal income, population share of the elderly and the young, per capita registered and operated cars, the number of industries, and atmospheric factors. Results indicate that air pollutants, NO2, O3, and PM10 exert a positive effect on healthcare expenditure. The study also sheds light on the socially optimal allocation of future healthcare resources in South Korea and shows that South Korea could reduce its healthcare expenditure by following the World Health Organization's air quality standards. The findings have three implications: developing health-conscious air quality standards; design and implementation of location-specific customized policies; health benefits of improved air quality standards. This research also provides useful evidence for policymakers to address current environmental problems.

CO2 Emissions, Environmental Degradation, and Healthcare Expenditure: Evidence from Australia

Environmental degradation (measured, for example) by CO2 emissions has an adverse effect on public health, leading to the need for a higher level of healthcare expenditure. The level of per capita income, which has been identified as a major determinant of healthcare expenditure, is associated with environmental degradation as represented by the environmental Kuznets curve. The results presented in this study show that when a country, like Australia, falls on the declining sector of the Environmental Kuznets Curve (EKC), healthcare expenditure is negatively related to environmental degradation. Although this proposition sounds counterintuitive, it is justified theoretically and supported empirically.

Assessing the determinants of healthcare expenditures in single-person households

BackgroundThe study documents a direct relationship between individuals’ health and patterns of healthcare expenditure by isolating single-person households and creating a new reference group in which household healthcare expenditure is based on one person’s expenditure patterns in accordance with his or her own state of health.MethodThe study matched two surveys using Propensity Score Matching based on single-person household, age, and gender. Structural Equation Modeling (SEM) explores paths of relation between the population’s income and socioeconomic level and its health self-assessment and expenditure.ResultsSingle-person households’ health expenditure increases with age and the differences in most expenditure categories are significant. The current study looks into the direct and indirect effects of income, gender, and SES on health insurance and other out-of-pocket health expenses among single-person households. A direct link exists between income, gender, and socioeconomic status (SES) and several aspects of health expenditure, depending on the specific age group. The indirect effects are attested via health status assessment, in which a negative correlation is found between self-assessed health status and various health-expenditure categories.ConclusionsThe last-mentioned result may support the general perception that single-person households who feel that they are doing better than their near-equals enjoy better health. This line of inquiry yields a better examination of how a single-person household’s state of health affects expenditure patterns without assuming ab initio that expenditure patterns attest to state of health.

Healthcare Expenditure on Childbirth in India: Two Part Model Analysis

The aim of the study is to estimate the extent and determinants of healthcare expenditure of inpatients on childbirth in India. The study is based on sample of 14510 women who gave birth to a child (whether live or still-birth, vaginal or caesarean). To estimate the determinants two-part models has been utilised. The results indicate that women spent on average around INR 9103 per childbirth in hospitals. There are also wide variations in the spending pattern of women on childbirth. Household size, economic status, occupation, religion, and caste impact the expenditure on childbirth in hospitals. There are also wide-variations in the spending of women belonging to different geo-graphical locations of India. Surgeries/caesarean or utilisation of facilities like special room and diagnostic tests etc. also significantly increase the expenditure. Women opting for public health facilities or having insurance spend less as compared to others. Government of India should increase investment in health to strengthen its current infrastructure. There is dire need to improve the quality of public health facilities, to reduce the regional imbalances in health facilities, to improve the coverage of health insurance in India for equitable and pro-people health facilities.

The determinants of individual health care expenditures in the Italian region of Friuli Venezia Giulia: evidence from a hierarchical spatial model estimation

This work investigates the determinants of health care expenditures, such as drug prescriptions, inpatient care, and outpatient care, of the resident population of the Region of Friuli Venezia Giulia (Italy). The phenomenon of interest is examined here by considering a cross-sectional register-based dataset on individual expenditures exhibiting a cross-classified hierarchical structure. In fact, patients (about 1,000,000) are grouped by general practitioners and municipalities. Does the evidence in individual data analyses support the results of the micro- and macroeconomic literature? The adoption of disaggregated data allows us to disentangle the role of the micro- and macroeconomic determinants of the expenditures. Moreover, the degree of interdependence between neighbouring municipalities is measured by accounting for the spatial correlation in the error convolution. A feasible two-stage Heckit method has to be adapted to encompass the zero-inflation issue, to consider the hierarchical structure of data and to study the spatial diffusion process of the expenditures in the sample selection model framework. The main results on the determinants of health care expenditures at the macro-level are confirmed in our analysis on disaggregated data. On the contrary, however, the substitution effect, which is typically observed in aggregated data, has not been confirmed by the present research. Moreover, the selection process appears to be relevant in drug prescriptions and outpatient care expenditures and a significant spatial correlation in both the selection and the outcome equations emerges from the structure of error components.

An initial investigation and analysis of healthcare expenditures in Hong Kong

ABSTRACTHong Kong is a special administrative region of the People’s Republic of China, governing with a high degree of autonomy since its handover from British rule in 1997. Like its legal, economic, and political systems, it has a unique system of healthcare. But the determinants of healthcare expenditure in Hong Kong, for all their complexities, have not been studied in the literature. This paper will make an attempt at quantifying the effects of these determinants. The latest data is used from the World Development Indicators and local government bureaus, departments, and offices. Ordinary least squares regressions are run with a model, constructed from widely-used models, based on the gross domestic product, the unemployment rate, supply and demand factors of healthcare, and research and development (R&D). Significant coefficients are found for all covariates, depending on the specification. Infant mortality rate and R&D, moreover, have negative relationships with healthcare expenditure. The methodology replaces time-fixed effects as a proxy for medical technology with R&D expenditure in a non-panel dataset setting. Unemployment rate is rarely considered as a determinant, but is used in this model. Hong Kong’s healthcare income elasticity is 0.824, indicating that healthcare in Hong Kong is not a luxury good.

Population ageing in healthcare – a minor issue? Evidence from Switzerland

ABSTRACTOur study shows that population ageing is a relevant determinant of healthcare expenditure (HCE). This conclusion supports the popular, but recently strongly contested, view that the coming population ageing will threaten the fiscal sustainability of health systems. We contribute to this debate, first by estimating the determinants of Swiss HCE with outlier-robust dynamic regressions, and second, by projecting Swiss HCE based on the estimates produced and new population scenarios. Medical advances and GDP per capita also play a decisive role. Governments can mitigate HCE growth by improving the health status of the population and by stimulating cost-effective and productive medical advances.

Pure, White and Deadly… Expensive: A Bitter Sweetness in Health Care Expenditure.

This paper analyses the impact of sugar availability/intake on diabetes expenditure and on total health care expenditure. Building this macroeconomic analysis upon the literature on the determinants of health care expenditure, we estimate a dynamic panel data model over a sample of 156 countries for the period 1995-2014. After controlling for the traditional determinants of health care spending, we find that an increase in sugar availability/intake leads to a significant rise in diabetes expenditure (per capita and per diabetic) and in the growth rate of total health care expenditure per capita. Moreover, we show that this causal relation is present in both developed and developing countries. Copyright © 2016 John Wiley & Sons, Ltd.

Modeling Determinants of Health Expenditures in Malaysia: Evidence from Time Series Analysis.

The purpose of this paper is to model the determinants of health care expenditures (HCE) and investigate the short-run, long-run equilibrium dynamic causal relationship between health care and income per capita within the time series framework from 1981 to 2014 in Malaysia. For appropriate model specification and forecasting accuracy, different econometric diagnostic tests were applied. Ordinary least square (OLS) method was used to estimate the long run parameters. Long run co-integration was investigated by Auto-Regressive Distributed Lag Model (ARDL) Bound approach, whereas, for causality analysis the Engle-Granger method was used. Income, population structure, and population growth was identified as the significant contributing factors to explain variations in HCE. The estimated income elasticity for HCE was found 0.99 < 1 showing health care was a necessity. The results confirmed a feed-back hypothesis between health expenditure and income per capita. Money spending and health care expenditure relationship has long been established (Getzen, 2014). Better health has been identified as an important factor to raise economic growth and increased productivity. A healthy population of any country is of important importance and has positive connections to economic growth (Sachs, 2002; Khan et al., 2015). However, rapidly growing HCE is a matter of grave concern for policy and decision makers across countries in the world. The fast growth rate of health care spending exerts pressure on various sectors of the economy, which might slow down the economic growth sustainability (Jakovljevic and Milovanovic, 2015; Jakovljevic, 2016) create poverty trap, as more out-of-pocket health expenditure hugely affects household income (Khan et al., 2015). Health care expenditure and the Malaysia case Malaysia with a total land area of 329,758 square kilometers is one of the leading and fast growing high middle-income economies in the Southeast Asian countries. The total population of the country is approximately 29,717 million which is distributed within 14 states, with a per capita gross national income of US $22 (international PPP); and life expectancy rate ranging from 72 to 76 years at birth of male and female respectively. It spends US$ 938 billion total on health with a growth rate of more than 4.49% on HCE (WHO, 2013). Malaysia, a rapidly fast growing developing economy in the Southeast Asian countries, spent 2.94, and 4.49% of GDP on its total health expenditure, in 1997 and 2012, respectively. The overall per capita spending over the same period was US $223 and US$463, respectively. In 2012, the sector-wise share of health care financing expenditure was: Ministry of health 44%; out-of-pocket 37%; private insurance 7%; other federal agencies 4% (MOH, 2014). The health expenditure growth rate of 4.49%, when compared to the annual GDP growth rate of 6%, shows the persistent rise in growth of health expenditure which might cause slowing down growth process of economy to a snail's pace. This might exert burden on country's GDP in the form of deficit budget, provision of health care services, and patients out of pocket finances. Thus, it is needed to model and forecast determinants of health care expenditure and future trends in the health care spending, in order to devise appropriate policies to control the rapidly growing HCE growth, equitable health care services provision, and affordable treatments to the people of Malaysia. This paper aims at, modeling the determinants of health care expenditure (HCE) and the effects of contributing factors of increased health care spending on economic growth by using annual data ranging from 1981 to 2014 in Malaysia.