Estimates Of Health Expenditures Research Articles

Trends and outcomes in primary health care expenditures in low-income and middle-income countries, 2000–2017

IntroductionAs the world responds to COVID-19 and aims for the Sustainable Development Goals, the potential for primary healthcare (PHC) is substantial, although the trends and effectiveness of PHC expenditure are...

Health expenditures by services and providers for 195 countries, 2000–2017

IntroductionNational Health Accounts are a significant source of health expenditure data, designed to be comprehensive and comparable across countries. However, there is currently no single repository of this data and...

정부 보건지출 추정에 기반한 건강보험 재정제도 정비 방안

정부 보건지출 추정에 기반한 건강보험 재정제도 정비 방안

Evidence from the Kaduna State Health Accounts on the pattern of sub-national health spending in Nigeria, 2016.

Health accounts provide accurate estimates of health expenditure, which are important for effective resource allocation and planning in the health sector. In Nigeria, four rounds of health accounts have been conducted at the national level. However, the national estimates do not necessarily reflect realities at the subnational level and may only provide limited information for decision making at that level. This study highlights the pattern of health spending in Kaduna State from the 2016 Health Accounts, with a view to providing more reliable evidence for decision making in the state.Health accounts expenditure surveys were administered to government, donors, non-governmental organizations (NGOs), private health insurance organisations and employers in the health sector for the reference year 2016. Household health expenditure was derived from a household survey administered across a representative sample of 1024 households selected from six local government areas across the three senatorial districts in the state. We estimated disease expenditure by deploying a health provider survey across a sample of 100 health facilities. Analysis was conducted using Microsoft Excel, Stata and the Health Accounts Production Tool.Findings show that current health expenditure (CHE) accounted for only 7% of the total health expenditure in 2016. Out-of-pocket spending among households was about 81% of CHE, compared with a national average of 71.5% of CHE between 2010 and 2014. The health expenditure findings highlight several policy imperatives for the Kaduna State Health System. Primary among these is the heavy dependence on out-of-pocket financing for health, which has negative implications on vulnerable households. A shift to pooled prepaid mechanisms would reduce the financial burden on the most vulnerable households in Kaduna State. In addition, considering the government’s current contribution to health expenditure, there is a strong need for increased government prioritisation of the Kaduna State health sector.

What Are Governments Spending on Health in East and Southern Africa?

Progress toward universal health care (UHC) in Africa will require sustained increases in public spending on health and reduced reliance on out-of-pocket financing. This article reviews trends and patterns of government spending in the East and Southern Africa regions and points out methodological challenges with interpreting data from the World Health Organization’s (WHO) Global Health Expenditure Database (GHED) and other sources.Government expenditure for health has increased for most countries, albeit at a slower rate than gross domestic product (GDP). In most countries there has been a prioritization away from health in government budgets, putting the onus on the private sector and donors to fill the gap. Donor support is important in the region but reliance on external spending is not consistent with countries’ stated ambitions of universal health coverage.A number of methodological challenges with estimating health expenditures are identified. Capturing health expenditures adequately across agencies and levels of decentralization can be challenging, and off-budget funds and arrears are evasive. Measurement error can be significant because actual expenditure information can be hard to come by and is often dated and unreliable. Furthermore, how external financing is captured will affect government health expenditure estimates. These factors have contributed to differences in expenditure estimates between the WHO GHED and country-specific public expenditure reviews and complicate interpretation. The article concludes that it is critical to strengthen national data capacity and international efforts to promote quality and consistency of data. The GHED is an invaluable resource for monitoring and benchmarking health expenditures. It is best used in combination with deep dive country expenditure assessments.

John Hugh Kelsey

<h3>Introduction</h3> National Health Accounts are a significant source of health expenditure data, designed to be comprehensive and comparable across countries. However, there is currently no single repository of this data...

Medical consumption over the life-cycle

In this paper we construct life-cycle profiles of U.S. health care spending using data from the Medical Expenditure Panel Survey (MEPS). We separate pure age effects on health expenditure from time effects (i.e. productivity effects, business cycle effects, etc.) and cohort effects (i.e. initial condition effects) by estimating a seminonparametric partial linear model. After controlling for time and cohort effects, we find that medical expenditure-age profiles follow an upward trend. Time and cohort effects introduce a significant estimation bias into predictions of health expenditures per age group. It is demonstrated that failing to adequately control for time and cohort effects results in an overprediction of the effect of age on health expenditures, especially for agents older than 60. Cohort effect biases dominate time effect biases in estimates of health expenditures that do not adequately control for both effects. Estimation biases introduced by cohort effects increase monotonically with age while time effects are non-monotone.

Variations in catastrophic health expenditure estimates from household surveys in India

To assess the comparability of out-of-pocket (OOP) payment and catastrophic health expenditure (CHE) estimates from different household surveys in India. Data on CHE, outpatient and inpatient OOP payments and other expenditure from all major national or multi-state surveys since 2000 were compared. These included two consumer expenditure surveys (the National Sample Survey for 2004-05 [NSS 2004-05] and 2009-10 [NSS 2009-10]) and three health-focused surveys (the World Health Survey 2003 [WHS 2003]; the National Sample Survey on Morbidity, Health Care and the Condition of the Aged 2004 [NSS 2004]; and the Study on Global Ageing and Adult Health 2007-08 [SAGE 2007-08]). All but the NSS 2004-05 and the NSS 2009-10 used different questionnaires. CHE estimates from WHS 2003 and SAGE 2007-08 were twice as high as those from NSS 2004-05, NSS 2009-10 and NSS 2004. Inpatient OOP payment estimates were twice as high in WHS 2003 and SAGE 2007-08 because in these surveys a much higher proportion of households reported such payments. However, estimates of expenditures on other items were half as high in WHS 2003 as in the other surveys because a very small number of items was used to capture these expenditures. The wide variations observed in CHE and OOP payment estimates resulted from methodological differences. Survey methods used to assess CHE in India need to be standardized and validated to accurately track CHE and assess the impact of recent policies to reduce it.

The Effect of Vitamin D Supplementation on Glycemic Control and Body Mass Index in the Obese, Vitamin D Deficient Adult with Type 2 Diabetes Mellitus: A Systematic Review Protocol

The Effect of Vitamin D Supplementation on Glycemic Control and Body Mass Index in the Obese, Vitamin D Deficient Adult with Type 2 Diabetes Mellitus: A Systematic Review Protocol

Triangulating Health Expenditure Estimates from Different Data Sources in Developing Countries

This article deals with the accuracy of statistical records used for political decision making and international comparative analysis. In developing countries, even major macroeconomic indicators can include data inadequacies and methodological differences in data generation between statistical agencies. Existing data show that total health expenditure as a percentage of GDP is about 50% lower in Pakistan than in other low-income countries (LIC). To determine whether these results reflect the actual situation in Pakistan or whether they are due to statistical error, Pakistan produced National Health Accounts (NHA) for the first time in 2009 to assess health spending in 2005-6. Improved NHA estimates are also being made for 2007-8, which will be based on the following: public expenditure data published with time lags; survey results for 2007-8; and multivariate analyses of data from 2010 and 2011 surveys on health-specific out-of-pocket (OOP) expenditure, healthcare providers, non-profit institutions and census data on autonomous bodies and large hospitals. Since these data are not yet available, a best estimate of health expenditure has to be made to support policy decision making and to provide a point of comparison for future NHA results. Health expenditure data are available from different data sources and estimates have been made by applying different methods, leading to a range of health spending estimates. As a result of this diversity of estimates and data, each with its own inaccuracies or gaps, there was a clear need to triangulate the available information and to identify a best possible estimate. This article compares estimates of household health expenditure from different sources, such as the Household Integrated Economic Survey, the Family Budget Survey and National Accounts (NA). The analysis shows that health expenditure figures for Pakistan have been underestimated by both WHO and the NHA. An adjusted estimate shows OOP spending to be twice as high as previously thought. Previous per capita total health expenditure estimates ranged from $US16 to $US19. The revised estimate showed per capita total health expenditure to be $US33, based on NA data. This puts Pakistan in a different position in international comparisons, with health expenditure exceeding the level of India ($US32.5) and the average of all LIC ($US24.5). Methodological differences in estimating expenditure and the multiple and conflicting estimates might cause stakeholders to make potentially adverse or even erroneous policy decisions on the allocation of resources. Because policy makers make decisions based on the estimates provided, the provision of a best estimate, made following a review of the advantages and limitations of existing sources and methods, is key.

Health Expenditures in Pakistan: Cross-Checking Household Expenditure Data on Health for NHA and Adjustment with National Accounts

According to hitherto available data, health expenditures in Pakistan are relatively low in international comparison. Data1F published by the World Health Organization (WHO) for the year 2005 shows a lack of Pakistani health expenditures in most indicators, compared to other low-income countries (LIC). To answer the question whether these results reflect the real situation in Pakistan or whether they exist due to statistical problems, Pakistan, for the first time, developed its National Health Accounts (NHA) in 2009. Only the availability of good estimates of health expenditures allows for evidence-based policy-making and therefore good governance.The results clearly indicate that the situation in Pakistan is better than what was earlier estimated; however, the total health expenditure (THE) is still low compared to neighboring countries and other LIC. As a result, it is clear that the WHO health expenditure figures for Pakistan are understated, because they mainly comprise public and household out-of-pocket expenditures on health. Expenditures of many other entities, like military, cantonment boards, autonomous bodies, private hospitals, and so on, have not been taken into account in earlier estimations. Therefore, expenditure figures of NHA Pakistan are higher than those of WHO. Overall, the official NHA results show that THE is 27 percent higher than the WHO figure.Furthermore, this paper cross-checks NHA results with other already available data sources on household expenditure. This comparison includes preliminary results of the Family Budget Survey (FBS), which also includes health items as well as National Accounts (NA) data. In line with this comparison, we calculate a raising factor that can be used for the adjustment of NHA results according to NA. The raised NHA result shows 102 percent higher out-of-pocket (OOP) spending on health; this would result in OOP health expenditures of $25.15 USD per capita (compared to only $12.45 USD per capita in the NHA estimation). This result, based on the NA figure with $33 USD THE per capita, leads to a different evaluation in international comparison, since it nearly reaches the level of India, with $37.5 USD and more than the average of all LIC with $27 USD.

Mental health services in the health accounts: the Czech Republic

Policy makers as well as health services researchers lack information on financial flows within national mental health systems. The studies that are available use different methodologies and hence it is difficult to make any comparisons. The aim of this study was to modify the existing health accounting framework and apply it to describe and analyse the financial flows within a national mental health system. Mental health expenditures are classified by the three-dimensional methodology of OECD health accounts that is extended by two other dimensions for the purpose of the study. The framework of five-dimensional mental health accounts is introduced and applied to mental health expenditure in the Czech Republic, 2006. Mental health expenditure is estimated to be 4.14% of the total health expenditure. Mental health expenditure is classified based on its source of financing, provider industry, health-care function, cost category and diagnostic group. Health expenditure estimates present the most detailed information on resource allocation in the mental health system of the Czech Republic. The application of the standardized framework in other countries can improve the quality of international comparisons. On the national level, especially if the time series are available, mental health accounts can serve as a useful tool for strategic resource allocation decisions. This is particularly useful for the countries that plan changes in resource allocation directed from institutional to community-based care.

Medical Consumption Over the Life Cycle: Facts from a U.S. Medical Expenditure Panel Survey

In this paper we construct life-cycle profiles of U.S. health care spending using data from the Medical Expenditure Panel Survey (MEPS). We separate pure age effects on health expenditure from time effects (i.e. productivity effects, business cycle effects, etc.) and cohort effects (i.e. initial condition effects) by estimating a seminonparametric partial linear model. After controlling for time and cohort effects, we find that medical expenditure-age profiles follow an upward trend. Time and cohort effects introduce a significant estimation bias into predictions of health expenditures per age group. It is demonstrated that failing to adequately control for time and cohort effects results in an overprediction of the effect of age on health expenditures, especially for agents older than 60. Cohort effect biases dominate time effect biases in estimates of health expenditures that do not adequately control for both effects. Estimation biases introduced by cohort effects increase monotonically with age while time effects are non-monotone.

국민의료비 계정에 관한 연구 - 자료원 및 추계방법을 중심으로-

National health expenditure account describes expenditure flows both public and private within the health sector. It describes the sources and uses and channels for all funds utilized in the health sector and is a basic requirement for optimal management of the allocation of health sector resources. Constructing a national health expenditure account should begin with sound estimates. This paper thoroughly examines the sources and discusses the estimation methods, and provides the national health expenditure account of Korea by function and source of funding category The national health expenditure account produced in this parer has, however, some drawbacks and followings are proposed fur enhancing the comprehensiveness and consistency of the account. First, comparable data un health related expenditures of local government and private sector should be produced because data sets on the sectors are very limited. Second, we need further study un overall scope and boundaries of health expenditure estimates in order to improve compatibility of other main aggregates.

Developing an implicit price deflator for New Zealand's health sector

The paper develops a sectoral approach to the analysis of New Zealand's historical health expenditure statistics, establishing the feasibility of developing an implicit health‐sector price deflator. Constructing the index requires reliance on own‐price indices that do not adjust for productivity changes, and on some imputed health expenditure figures. Despite these limitations, the sectoral approach generates better insights concerning resource allocation trends in health than does the Ministry of Health's approach of generating constant‐dollar health expenditure estimates through deflation of current dollars by the consumer price index. The sectoral estimates indicate that health prices relative to prices in other parts of the economy increased during 1961–1974, and declined during 1974–1993, although price movements were volatile by sub‐period in the later years. The sectoral data also indicate that the growth rate in constant‐dollar health expenditure per capita was relatively constant during the 32 years succeeding 1961, negating the widely held view that the growth rate in per capita utilisation increased during that period. Finally, the sectoral data indicate that, while the financial burden of providing health care has been generally increasing since 1961, the real burden reflecting the allocation of resources to health started increasing only in the mid‐1970s, in the context of a decline in New Zealand's secular growth rate in gross domestic product.

Comparison of Out-of-Pocket Health Expenditure Estimates from the 1987 National Medical Expenditure Survey and the Consumer Expenditure Survey1

The 1987 National Expenditure Survey was conducted by the Agency for Health Care Policy and Research, USPHS to provide an assessment of the health care utilization, expenditures, sources of payment and health coverage of the civilian noninstitutional population. The Consumer Expenditure Survey (CEX) is sponsored by the Bureau of Labor Statistics and provides a continuous and comprehensive flow of data on the buying habits of consumers though the collection of information on the expenditures, income, and socio-demographic characteristics of customer units. It is designed to support Consumer Price Index revisions and social and economic analyses. Differences in family out-of-pocket expenditures for hospital services, physician services, services by other practitioners, lab tests and x-ray services, nursing services, eye glasses and contact lenses, dental services, prescription medicines are compared. Differences in the distributions of these expenditures are explored as are the association of differences with population characteristics.