Expenditure Categories Research Articles

Improving healthcare systems and services in the face of population ageing: policy considerations for low- and middle-income countries.

Worldwide, the proportion and absolute numbers of over 60-year-olds in the population is rising: it was 1 billion in 2019 and is expected to get to 1.4 billion in 2030 and 2.1 billion by 2050, with the progression being more pronounced in developing countries. Degenerative and non-communicable diseases are more common with ageing, which means they would become the major disease problems for countries. Long-term care poses financial risks to individuals/families and governments. These warrant urgent policy and structural adjustments of health systems in low- and middle-income countries to cater for the probable change in health needs and make their society more age-sensitive. There is the need for policymakers to begin to change focus from traditional models of healthcare delivery and give more attention to aged care and create separate financing mechanisms/programmes for the elderly, most of whom are already unemployed, to protect them from the effects of cream-skimming by private health insurers. Informed decisions on healthcare purchasing can be made using Economic Evaluation, as well as Programme Budgeting and Marginal Analysis, a presentation of discrete categories of healthcare expenditure (specialties, disease-groups, etc.) and the resources appropriated to each as an aid to reviewing subsequent resource allocation. Reforms in healthcare financing should pay particular attention to the elderly considering that technical efficiency concerns of the private sector may mean that they are discriminated against. There is need for retraining/reorientation of health workers on identification and comprehensive management of NCDs, including palliative care, in a culturally competent way, on the essence of shifting from an acute care model to a chronic care model, and on providing services to people within defined catchment areas.

КОНЦЕПТУАЛЬНІ ПІДХОДИ ДО ФОРМУВАННЯ ДЕРЖАВНИХ ВИДАТКІВ

The article analyzes the concept of "public expenditures" in an evolutionary aspect. The approaches to the formation of this concept in different periods, as well as the peculiarities of the types and components of the formation of public expenditures, which are characterized by multifacetedness, are determined. Paying special attention to the economic component of this category, it is worth noting that the legal aspect and public nature of this issue are equally important. It is noted that this category is an organizational part of the financial activity of the state, especially in the field of management of state funds. The relevance of this analysis in the implementation of state economic policy somewhat shifts the emphasis from solving current issues in the country's economic system to macroeconomic policy aimed at implementing structural changes. It is the expenditure component, as one of the tools of fiscal policy, that is of great importance in the implementation of the stabilization policy of the state. Solving issues that arise in budgetary relations very often acquire a strategic nature in the economic growth and economic development of the country. Therefore, constant attention to the activities of state institutions and control of public expenditures does not lose its relevance. It is noted that in the domestic literature there is no unity in the approaches to determining public expenditures, but it is clear that public expenditures are determined by state needs, which are the result of the latter. Public expenditures are determined by the general direction of the entire state policy. In financial law, public expenditures are defined as the planned use of funds by the state for the purpose of fulfilling its tasks and functions, strictly regulated by legal norms. Undoubtedly, budget expenditures are a complex category, which led to the discovery of a variety of approaches to its understanding. The evolution of scientific views on the formation of the category of public expenditures is studied through the prism of such concepts as state finances, the state budget, the budget system, which allows to systematize and reveal one of the most important categories in the country's financial system.

Evolution of Public Health Expenditure Financed by the Romanian Social Health Insurance Scheme From 1999 to 2019.

The Romanian health system is mainly public financed (80.45%) through the following sources: Social Health Insurance (65%), State and Local Authorities Budget (15.45%), while the private sources (voluntary health insurance and out of pocket) adds an additional 19.55% to the public funds. The shares of the types of expenditure reflect the importance of each sector in the overall health system, and trends in expenditure show the impact of financing on the health sector's structural changes. We analyzed the 20-year trend of the Social Health Insurance budget, from 1999 to 2019. The influences of the different allocations, subcategories, and new budget categories appearing over time were adjusted to reveal relevant trends. Of the 14 medical service categories and the stand-alone Administrative expenditure category, six expenditure categories including Hospital services, Total drugs, and Primary care showed stationary 20-year trends; five including Medical devices, Dialysis, and Homecare services showed ascendant trends; and four including Dentistry and Emergency services showed descendant trends. Stationary trends imply no structural changes in the health sector of relevant magnitude to impact the financing shares of major categories: hospitals, drugs, or primary care. Emerging trends related to the impact of different reforms were revealed only in the low share of expenditures categories. The allocation methodology and statistical analysis of the trends reveal a new perspective on the evolution of health sector in Romania.

Comparison of diagnostic methods for hemodynamic treatment in unborn and pre-term infants using the measurement of vena cava, lactate, and clinical criteria

Introduction: There is no single criterion available to assess the hemodynamic state of new-born infants and preterm infants and the different variables in the group of newborns, such as gestational age, birth weight, and periods of birth. Methods: This is an epidemiological, cross-sectional, descriptive observational study with two patient cohorts. Newborn-to-term and preterm neonates assisted at the Neonatal Unit of the Pablo Arturo Suarez Hospital participated during the months between November 2019 to January 2020. Results: Ultrasound measurement of the vena cava (FVC) flow is useful for the management treatment of hemodynamically unstable neonatal patients. The sample was made up of 110 newborns treated in the Pablo Arturo Suarez Hospital's neonatology service from November 2019 to January 2020. Quito, Pichincha, Ecuador. The variables low birth weight and moder-ate prematurity have a statistically significant value for inotropic use. The other variables do not present statistically significant values. Heart rate, urinary output, mean blood pressure, lactic acid, capillary filling, upper vena cava flow, and lower vena cava flow had statistically significant values. FVCI and FVCS comparisons with heart rate, urinary output, mean blood pressure, lactic acid, and capillary filling had statistically significant values, except for capil-lary filling> 3 sec in FCVI. Multivariate analysis of categorical main components (CATPCA) was used to characterize the hemodynamic state and inotropic state, which were significant in the bivariate analysis. Dimension, one of the two-dimensional graphs, discriminates the use or not of inotropics and the categories of hemodynamic parameters TAM <35 mmHg, lactic acid, capillary filling, FVCI, and FVCS. Dimension II discriminates between the categories of urinary expenditure and HR. Conclusion: In term and preterm infants with low weight and adequate birth weight with hemodynamic instability in general, who were evaluated with ultrasonography to measure the flow of the vena cava, the agreement between the clinical criteria and the ultrasound assessment of the flow was 0.4 cm/sec in both methods. This situation means that the measurement of venous cava flows by echo sonography is useful for assessing neonatal patients' hemodynamic status.

Military Spending Composition and Economic Growth

ABSTRACT In the large literature on military spending and growth, the heterogeneity of the categories of expenditure is seldom considered. Military spending is used to pay for a variety of things, including salaries, large weapon systems, and physical infrastructure, along with ongoing operations, training, and readiness - each of which might be expected to have different implications for economic growth. One reason for the focus on aggregate spending is the lack of disaggregated cross-country data, but there are some data available from NATO and the EU that break military spending into personnel, equipment, infrastructure and other expenditures (primarily operations and maintenance). This paper uses these data, available for 34 countries, for as many as 49 years, to investigate whether the composition of military budgets affects economic growth. Estimating standard growth models with this data it finds that as expected there is considerable heterogeneity in the effects of the different components. Specifically, the negative correlation between military spending and growth found in recent studies is primarily driven by personnel expenditures, and - slightly less clearly - by operating expenditures.

High value health care is low carbon health care.

We are in a health emergency precipitated by climate change.1 As well as physical health threats, climate change and its effects are adversely affecting Australians' mental health,2 and worsening the health inequities suffered by vulnerable populations. In response, the Australian health care community must both adapt to increased demand and to deteriorating environmental conditions, and mitigate the carbon footprint of health care, currently 7% of our national carbon emissions.3 Using economic data from 360 sectors, Malik and colleagues3 estimated carbon emissions by Australian Institute of Health and Welfare categories of health care expenditure, finding that the hospital and pharmaceutical sectors had the largest footprints, together accounting for 63% of health care emissions.

Mobile Crowd-sensing Applications: Data Redundancies, Challenges, and Solutions

Conventional data collection methods that use Wireless Sensor Networks (WSNs) suffer from disadvantages such as deployment location limitation, geographical distance, as well as high construction and deployment costs of WSNs. Recently, various efforts have been promoting mobile crowd-sensing (such as a community with people using mobile devices) as a way to collect data based on existing resources. A Mobile Crowd-Sensing System can be considered as a Cyber-Physical System (CPS), because it allows people with mobile devices to collect and supply data to CPSs’ centers. In practical mobile crowd-sensing applications, due to limited budgets for the different expenditure categories in the system, it is necessary to minimize the collection of redundant information to save more resources for the investor. We study the problem of selecting participants in Mobile Crowd-Sensing Systems without redundant information such that the number of users is minimized and the number of records (events) reported by users is maximized, also known as the Participant-Report-Incident Redundant Avoidance (PRIRA) problem. We propose a new approximation algorithm, called the Maximum-Participant-Report Algorithm (MPRA) to solve the PRIRA problem. Through rigorous theoretical analysis and experimentation, we demonstrate that our proposed method performs well within reasonable bounds of computational complexity.

Exploring the Optimal Allocation Decision-Making of Expenditure Budget in Hospitals Under Multi-Objective Constraints: Evidence from Urban Public Hospitals, China

Hospitals in many countries face the need for balancing different categories of expenditures to achieve multiple goals within a limited budget. This study established a two-stage fuzzy linear programming (FLP) estimation model to explore the optimal allocation decision-making of expenditure budget under the multi-objective constraints. Taking all urban public hospitals in Henan province of China as a sample, the optimal allocation decision-making of total expenditure budget was tested with the human resources expenditures (HE) as the dependent variable. And the outcome was compared with the actual expenditure data of these hospitals between 2010 and 2016. The study found that when the HE achieves the maximum and minimum feasible scale, the expenditure scales of the budget allocation categories including pharmaceutical expenditures, medical supplies expenditures, and other expenditures were all within a reasonable range. Among them, the observed promoting space for HE was 3.78 billion yuan. The results show that the FLP method can help urban public hospitals to make better total expenditure budget allocation decisions, which can maintain their reasonable expenditure structure under the hospitals’ development goals and the government’s regulatory requirements.

Understanding the financial burden of incomplete abortion: An analysis of the out-of-pocket expenditure on postabortion care in eight public-sector health care facilities in Dakar, Senegal

ABSTRACT Timely access to treatment is essential for women when they experience abortion complications. Out-of-pocket (OOP) expenditure is a known barrier to health care access. In 2018, we assessed the financial burden of accessing postabortion care (PAC) borne by women in Dakar, Senegal, where studies estimate that half of poor women with complications obtain PAC. We interviewed 729 women following discharge from PAC. Women reported expenditures on transportation, admission, treatment, family planning, hospitalisation, complementary tests, prescriptions, other medicines and materials. We compare women’s OOP on PAC by expenditure category, type of treatment and facility type, and use multiple generalised linear regression analysis to explain variation in overall OOP and forecast it under alternate scenarios. The average OOP was USD $93.84. At health centres it was $65.47 and at hospitals it was $120.47. The average cost of PAC using dilation and curettage was $112.37, manual vacuum aspiration was $99.84, and misoprostol $61.80. Overall OOP on PAC amounts, on average, to 15% of the average monthly salary for women living in Dakar. Strategies that emphasise timely access to misoprostol for treating complications in primary care settings will address the contribution of OOP costs to Senegal’s appreciable unmet need for PAC among the poor.

Outsourcing and public expenditure: an aggregate perspective with regional data

ABSTRACT Although the theoretical impact of outsourcing on public spending is ambiguous ex-ante, previous cross-country comparisons point towards a positive impact on aggregate. We build a novel database that allows us to explore the association between outsourcing and public spending among Spanish regions between 2002 and 2018. This approach greatly reduces unobserved heterogeneity and limits concerns about bias in the estimates. Our baseline results point towards a positive association between outsourcing and expenditure. However, our analysis also unmasks important divergences among expenditure categories and economic conditions. The results are robust to the inclusion of efficiency indicators and several controls.

Trends in the Concentration and Distribution of Health Care Expenditures in the US, 2001-2018

The concentration of health care expenditures has important implications for managing risk pools, drug benefit design, and care management. To examine trends in the concentration of health care spending in different population groups and expenditure categories in the US between 2001 and 2018. This study is a cross-sectional analysis of Medical Expenditure Panel Surveys (MEPS) collected between 2001 and 2018. The MEPS is a household survey of medical expenditures weighted to represent national estimates in the US. Respondents were a nationally representative sample of the US civilian noninstitutionalized population. Data analysis was performed from December 2020 to February 2021. The main outcome is the concentration of health care expenditures as measured by the cumulative percentage of health expenditure vs percentage of ranked population. This study reports trends in the distribution of populations across 4 concentration curve parameters: top 50% expenditure (high spenders), next 49% expenditure (medium spenders), next 1% expenditure (low spenders), and nonspenders. The mean sample size of the MEPS surveys used in the analysis was 34 539 individuals, and the sample size varied between 30 461 and 39 165 individuals over the years studied. On the basis of data from 30 461 MEPS respondents (15 867 women [52.1%]; mean [SD] age, 38.9 [24.0] years) in 2018, the top 4.6% (95% CI, 4.3%-4.9%) of the US population by spending accounted for 50% of health care expenditures. Although this fraction varied across population groups or expenditure categories, it remained remarkably stable over time with one exception: the concentration of spending on prescription drugs. In 2001, one-half of all expenditures on prescription drugs were concentrated in 6.0% (95% CI, 5.6%-6.4%) of the US population, but by 2018, this proportion had decreased to 2.3% (95% CI, 2.1%-2.5%). This change does not appear to be associated with a change in the overall share of prescription drug expenses, which increased by only a small amount, from 20.4% in 2001 to 24.8% in 2018. The overall concentration of health care expenditures remained stable between 2001 and 2018, but these findings suggest that there has been a sharp increase in the concentration of spending on prescription drugs in the US. This coincides with the genericization of many primary care drugs, along with a shift in focus of the biopharmaceutical industry toward high-cost specialty drugs targeted at smaller populations. If this trend continues, it will have implications for the minimum scale of risk-bearing and drug management needed to operate efficiently, as well as the optimal cost-sharing features of insurance products.

Examination of Consumption Expenditure Distribution among NUTS-2 Regions in 2007-2018 with GINI Coefficient

In this study, the distribution of 12 main expenditure categories included in the consumer price index (CPI) among NUTS-2 (Nomenclature of Territorial Units for Statistics-2) regions is examined. The study covers the years 2007-2018. In the study, interregional consumption expenditure rates are identified with the Gini coefficient, which is a measure of inequality and the obtained consumption expenditure rates through the years are interpreted. The coefficients calculated for each expenditure category are important in terms of revealing the course of consumption behavior of households in Turkey over the years and reflecting the best and worst distribution at the NUTS-2 level. Findings regarding the expenditure categories show that the consumption behavior in Turkey in the relevant period is far from equal at the regional level. According to the findings, the expenditure category with the highest inequality at the NUTS-2 level is the food and non-alcoholic beverages category with an average Gini coefficient of 0.3031. The expenditure category with the highest equal distribution, on the other hand, is the education category with a Gini coefficient of 0.2307 according to the findings.

Profiling the package traveler: An expenditure-based segmentation endeavor

An alternative to the specificities of geographic, socio-economic/demographic, and psychographic modes, expenditure-based segmentation, a behavioral approach, provides the ideal avenue for exploring tourist spending patterns and behavior. Reflecting the idiosyncrasies of a small island destination, this study explores tourists' actual spending in the course of their vacations in Cyprus. A two-step cluster analysis is utilized to develop an expenditure-based segmentation profile with the aim of exploring the spending behavior of tourists. Furthermore, econometric modeling reveals each cluster's effect on the relevant expenditure categories, and the net impact of the cost of package on spending at the destination. Noteworthy, expenditure at the destination is dissected into seven categories, thus providing a more thorough overview of tourist behavior. Findings reveal a five-cluster solution that profiles the spending behavior of package travelers, whereas segment comparisons highlight significant implications for local tourism stakeholders, on both the operational and strategic levels. • An expenditure-based segmentation profile of international package travelers is developed. • Tourist expenditure is dissected into specific categories that fall outside the cost of the travel package. • The similarities and differences of the expenditure behavior between the clusters are highlighted. • The net impact of the cost of package on spending at the destination is investigated. • Implications for industry stakeholders are discussed.

The Effects of Consuming Behaviors on Leisure Activities in Silver Market: Derivative Impacts for Related Industries

The prevention of health problems and ideas for successful aging have been major topics in many studies tue to the dramatic increase in the number of individuals age 65 and over worldwide. Despite awareness of the numerous benefits of increasing social and leisure activity levels, the association between the elders’ participation in leisure time physical activity and expenditure categories for understanding the silver market has remained largely unexplored. Therefore, in order to have a valuable information for promoting active lifestyle for the elders and gain a better insight of the effects of their monthly expenses in the current market, this study examined the responses from 1,389 Korean elders selected for 2018 Korean Longitudinal Study of Ageing (KLoSA). This study used SPSS to reveal the general tendencies and mean differences among expenses categories and implemented logistic regression to predict the significant factors influencing participation of leisure activities. The results of descriptive statistics showed that participants spent their money most on living expenses and least on family event, and the elders regularly participated in leisure activities spent more money compared to those who were not participated in leisure activities based on independent t-test. Moreover, the results of this study showed that increasing spending on eating out, medical insurance premium, and the cost of leisure was associated with an increased likelihood of participating leisure activities.

Estimating equivalence scales and non-food needs in Egypt: Parametric and semiparametric regression modeling.

This paper investigated the appropriate specifications of Engel curves for non-food expenditure categories and estimated the deprivation indices of non-food needs in rural areas using a semi parametric examination of the presence of saturation points. The study used the extended partial linear model (EPLM) and adopted two estimation methods—the double residual estimator and differencing estimator—to obtain flexible shapes across different expenditure categories and estimate equivalence scales. We drew on data of the Egyptian Household Income, Expenditure, and Consumption Survey (HIEC). Our paper provides empirical evidence that the rankings of most non-food expenditure categories is of rank three at most. Rural households showed high economies of scale in non-food consumption, with child’s needs accounting for only 10% of adult’s non-food needs. Based on semi-parametrically estimated consumption behavior, the tendency of non-food expenditure categories to saturate did not emerge. While based on parametrically estimated consumption behavior, rural areas exhibited higher deprivation indices in terms of health and education expenditure categories, which indicates the need to design specific programs economically targeting such vulnerable households.

Gender analysis of budget expenditures in the Republic of Moldova

Gender budgeting is a concept which studies, analyses and proposes approaches for inequity issues regarding the process of discrepancies of budgeting between men and women. Although it is considered a feminist policy to achieve equal opportunities for both genders, in the fields of the allocation of public resources, advocating for an advanced decision-making role for women in important issues. As indicators for gender analysis of the budget, we can use various types of correlation between data, in order to obtain the pursued result or depending on the available information. According to the GDI for 2019, Moldova has a good value of the index. However, this is due to the higher life expectation for women, longer education time, but men still contribute more to the economy. In given research, in order to analyze the budget expenditures relied on gender perspective, we analyzed the share of “gender sensitive” expenditure categories. We took as so those domains that are more appropriate to increase women opportunities. Budget expenditures tend to increase the focus on those areas, which could be considered more gender sensitive. GDI index for the Republic of Moldova is higher than neighbor countries’ one and even than Norway’s, who stands first ranked country by HDI. However, Moldova has significant gender inequity issues, which are relied with employment opportunities, house hold and children care responsibility distribution, possibility to be promoted and to obtain policy and decision making positions etc.

What drives road infrastructure spending?

AbstractIt is widely believed that basic infrastructure in the United States has been seriously underfunded in recent years. We examine this broad issue by focusing on two specific questions. First, how has subnational government spending on infrastructure changed over the last half‐century, focusing especially on transportation spending? Second, what factors have driven these spending changes? To answer these questions, we collect data on local, state, and combined state and local government spending on roads and other expenditure categories from 1957 to 2013. With these data, we first demonstrate that infrastructure spending has increased on average in real per capita terms across all states, even while it has declined significantly across all states as a percentage of government spending. Second, we also examine empirically several causal factors that help explain what has driven these changes in transportation spending over time, using several estimation methods and robustness tests. We find suggestive evidence that it is primarily changes in government spending on welfare programs that have driven these sizeable changes in transportation spending. Indeed, we calculate that, if state governments were spending the same percentage of their budgets on transportation in 2013 as they had been in 1957, then state government spending on transportation across all states would increase in total by an additional $133.5 billion in 2013, an amount equal to an additional $422 per capita.

Exploring the Relationship between Combined Household Housing and Transportation Costs and Regional Economic Activity in Virginia

Transportation is the second-largest expenditure category for households, accounting for nearly 20 cents of every dollar spent annually across the U.S. Only housing costs exceed transportation, and combined they represent a substantial burden on households. A primary economic connection between housing and transportation costs is related to the tradeoffs that households make in terms of residential location and what they have left of their household budget to spend on other needs. Families are forced to spend thousands of dollars annually on owning and operating private vehicles, forego wealth creation, and the ability to enjoy other benefits of homeownership. This analysis examines combined housing and transportation costs at the state level to regional economic performance. It contributes to the literature by testing the geographic scope of household expenditure burdens at this scale. Along with previous literature, this analysis provides evidence about the connection between the local and regional economic vitality and the burden of the combined effects of housing and transport on households. Overall, the results suggest that, from 2008 to 2018, these household cost burdens were a function of economic activity, household characteristics, and location in the state of Virginia.

The effects of universal child allowance on family expenditure in Taiwan

Current research regarding universal child allowance (UCA) programs has largely been undertaken in Western contexts, where family culture and societal norms differ significantly from Asian contexts. The UCA program implemented in Taoyuan, Taiwan in 2015 offers a unique opportunity to study its effects on family expenditure. All families with children aged under three years are eligible to receive a monthly UCA of 3000 New Taiwan Dollar (NTD). We used representative data from the Survey of Family Income and Expenditure (2011–2017) to examine the effects of UCA on household consumption and non-consumption expenditure categories using a difference-in-difference (DD) design. The DD design allows us to compare differences in outcomes before and after the policy change in Taoyuan and other counties in Taiwan. We used ordinary least squares models to estimate the policy effects and controlled for households and county characteristics, and county and year fixed effects. Our findings suggest that the UCA increased health expenditure, decreased expenditure on food at home, and increased expenditure on red/white envelopes (cash contributions for weddings, funerals, and special occasions). UCA did not influence savings rates or other expenditure categories.

Extending differences-in-differences frameworks to Granger equations: evidence from cutback management during three recessions

PurposeThe authors show how to extend difference-in-differences (DiD) frameworks to Granger (1969) equations, a technique that tests for the parallel trends assumption and measures changes in effect sizes over time. To illustrate how these equations work, they apply them to state cutback management decisions in three recessions.Design/methodology/approachThis study applies quantitative methods. The authors estimate DiD frameworks as Granger (1969) equations.FindingsAfter empirically analyzing recessions that started in 1990, 2001 and 2007, the authors find that states deepen expenditure cuts when economic declines lengthen and tend to make large cuts to specific expenditure categories instead of spreading cuts equally over all service areas.Originality/valueThe authors offer two contributions of methodological value. First, they introduce the estimation of Granger equations to the study of topics in public administration. Second, they show how this technique helps to evaluate the impact of economic declines on state spending. By instituting these contributions, they offer a unique way of analyzing cutback management decisions.