Healthcare Share Research Articles

The Impact of Integrating Mental and General Health Services on Mental Health's Share of Total Health Care Spending in Alberta

In April 2003 the Alberta government integrated specialized mental health services, formerly organized independently, with the health regions, which are responsible for general health services. The objective of this article is to determine whether the transfer was associated with an increase or decrease in the share of resources in the region allocated to mental health care relative to total spending for health care. The measure of the share for mental health care is the total costs for mental health care resources as a percentage of total health care spending. Resources and spending examined were those that were actually or potentially under the regions' control. Annual costs for mental health services in the province were obtained for a seven-year period (fiscal year [FY] 2000 through FY 2006) from provincial utilization records for all residents in the province. Unit costs were assigned to each visit. The trend in the share measure was plotted for each year. The share for mental health care increased overall from FY 2000 (7.6%) to FY 2003 (8.2%), but returned to pre-FY 2003 levels in the three years after the transfer (7.6%). Despite concerns expressed before the transfer by federal and provincial reports over the level of expenditures devoted to mental health care, the integration of mental health services with other health services did not result in an increase of the share for mental health care.

Covering the uninsured: how much would it cost?

To provide benchmarks for evaluating the costs of alternative proposals to provide insurance coverage for the uninsured, this study presents two sets of cost estimates derived from medical spending patterns of lower- or middle-income people with private insurance plans and those of people with public insurance coverage during 1996-1998. The analysis suggests that the uninsured would use dollar 33.9-dollar 68.7 billion (in 2001 dollars) in additional medical care if they were fully insured. An increase in medical spending of this range would increase total health care spending by 3-6 percent and would raise health care's share of GDP by less than one percentage point.

Further Refinements of Canadian/U.S. Health Cost Containment Measures

Critics of the Canadian health care system have argued that the lower health care share of gross national product (GNP) in Canada relative to the United States is more likely to be associated with a relatively more rapid growth in GNP in Canada than with the ability of the Canadian single-payer system to contain costs. In this article the authors use both the level and the average annual growth rate of health care's share of GNP to provide an assessment of cost containment for the United States and Canada. They conclude that the suggestion that the success of the Canadian system has been an illusion created by its more rapid growth in GNP is not supported once the appropriate adjustments are made to the data.

Prospects for using DRGs in Swedish hospitals

Overall cost-containment seems satisfactory in Swedish health care. Health care's share of the Gross Domestic Product (GDP) has thus decreased from 9.7% to 9.1% between the years 1982 and 1986. A recent study indicates, however, a decreasing productivity, measured by traditional output measures. It may be argued that these measures are not adequate as they do not reflect the changing patterns of medical technology, case-mix and quality. The Swedish Planning and Rationalization Institute of the Health and Social Services (Spri) has started a project which aims at evaluating whether the Diagnosis Related Group (DRGs) could be used for planning, budgeting and follow-up in the Swedish health care system. The interest in these matters is at present great in Sweden. The feasibility and adequacy of DRGs in the Swedish context are being tested using more than 500000 discharges from 6 counties. All the necessary variables for DRG assignment are already routinely collected in the Swedish discharge abstracts. In a comparison with an American database concerning individual DRGs, Swedish and American lengths of stay correlate rather well ( r = 0.83). There is a difference in the number of diagnoses on each discharge record in the two databases. On average 1.4 diagnosis codes are used for each patient in the Swedish hospital sample compared to 2.8 codes in the United States database. This may indicate a systematic difference in coding practice of complications and co-morbidities.