Increase In Health Expenditure Research Articles

The Trade-off between Household Expenditures and Smoking Expenditure: Pre and Post Smoking Awareness Ordinance in Pakistan

AbstractThe Government of Pakistan introduced smoking ordinance about health warning in 2009. This ordinance exhibits, prohibit smoking in public places, put restrictions on advertisements, and prohibits sale of cigarettes to minors. This study is to find out the impact of smoking expenditures on food, health, educational, recreational, and electronic expenditures using HIES dataset for 2010–11 and 2015–16. The findings show that share of food and health expenditure increase by 91 and 92% respectively. On the other hand, education and recreation expenditure decrease by 6 and 98% respectively. This is further verified using SUEST test to compare two datasets regressions. The result reveals that food, health, and recreational coefficient are statistically different while education and electronics expenditure remain similar.

Certificate of need laws: a systematic review and cost-effectiveness analysis

BackgroundCertificate of Need (CON) laws, currently in place in 35 US states, require certain health care providers to obtain a certification of their economic necessity from a state board before opening or undertaking a major expansion. We conduct the first systematic review and cost-effectiveness analysis of these laws.MethodsWe review 90 articles to summarize the evidence on how certificate of need laws affect regulatory costs, health expenditures, health outcomes, and access to care. We use the findings from the systematic review to conduct a cost-effectiveness analysis of CON.ResultsThe literature provides mixed results, on average finding that CON increases health expenditures and overall elderly mortality while reducing heart surgery mortality. Our cost-effectiveness analysis estimates that the costs of CON laws somewhat exceed their benefits, although our estimates are quite uncertain.ConclusionsThe literature has not yet reached a definitive conclusion on how CON laws affect health expenditures, outcomes, or access to care. While more and higher quality research is needed to reach confident conclusions, our cost-effectiveness analysis based on the existing literature shows that the expected costs of CON exceed its benefits.

Does Universal Health Insurance Act as a Driver of Increased Life Expectancy? Evidence from Selected Emerging Economies

Background: The world currently has experienced an unimaginable increase in life expectancy rate (LER). There are many factors that influence LER, including faith and forgiveness. However, an ongoing argument among scholars is whether health insurance is partly ascribed to the historical forces that drive the surge in LER among emerging countries. The study seeks to investigate the long-run effect of universal health insurance (UHI) on LER among 15 selected emerging countries spanning from 2000 to 2015. Methods: Using the panel unit root, panel cointegration, panel fully modified least squares (FMOLS), and employing the Dynamic ordinary least square (DOLS) as a robust check, the study analyzed connections between the study variables. Results: The outcome of the results showed that UHI, physician ratio, healthcare expenditure, and educational factors are positive contributors to increasing life expectancy, while economic growth remained negatively significant in the selected emerging economies. Conclusion: This study showed that improved education, increased physician ratio, increasing health expenditures, and universal insurance coverage were correlated with increased life expectancy in emerging economies. In order to promote healthy lives of its citizens, a move toward UHI coverage is suggested since it increases the life expectancy rate among emerging nations.

A net present value approach to health insurance choice

In light of increasing health expenditure and following an economic crisis, the ADSE system (a health insurance system exclusive for the Portuguese civil servants) introduced a new policy where members were allowed to leave the system, and also for new employees to opt out. This decision, however, was permanent, and, as it will be shown, far from trivial. The aim of this study is to provide some indications on the total costs of both the ADSE and a private health insurance plan over the working life of an individual, taking into account certain life-changing events such as marriage and children. The choice is made based on the net present value of these total costs, and it is rational from a financial perspective. Because such a permanent decision is highly dependent on the assumptions made, a sensitivity analysis to certain variables, in particular, income, prices of medical treatments and frequency of use, is performed in order to discover the break-even point, that is, the value at which the individual would be indifferent between the two options.

Choosing Wisely: The Korean Perspective and Launch of the 'Right Decision in Cancer Care' Initiative.

Government healthcare expenditure is rising in Korea, and the costs incurred by patients in Korea exceed those incurred by patients in other Organization for Economic Co-operation and Development countries. Despite the increasing health expenditure, patient demand for services is increasing as well, so it is now becoming recognized that cancer care needs to be balanced. The most important measure in cancer care optimization is to provide high-quality care while keeping costs sustainable. The Korean Cancer Association considers the current situation of cancer therapy in Korea the foremost issue, which has led to the implementation of the nationwide ‘Right Decisions in Cancer Care’ initiative. This initiative is based on the concepts of medical professionalism in that it should be led by physicians working in the field of oncology, that education should be offered to patients and clinicians, and that it should influence healthcare policy. In this article, we introduce the nationwide ‘Right Decision in Cancer Care’ initiative and highlight the five initial items on its agenda. The agenda is open to expansion and update as the medical environment evolves and additional clinical evidence becomes available.

Evaluating HIV/Aids prevalence and sustainable development in sub-Saharan Africa: the role of health expenditure.

The sub-Saharan Africa (SSA) present the highest prevalence of HIV/AIDS worldwide; resulting to a significant development challenges at country, region and global level. The previous studies explain at least in part, the impact of the epidemic, however the impact of HIV/AIDS in long-term economic behavior were not yet clear. There is clearly few or absence of studies on the impact of the impact of the epidemic on sustainable development. This study focused on macroeconomic analysis of the HIV/AIDS impact on sustainable development in SSA. The study utilized a panel dataset covering 23 countries from 1993 until 2016, and employed Panel ARDL/PMG. Our findings reveals a stable long-run relationship between sustainable development and HIV/AIDS prevalence. The error correction coefficient was statistically significant and conclude that HIV/AIDS prevalence has long-run impact on sustainable development. The main implication of our study is that, achieving a sustainable development in the presence of high prevalence of HIV/AIDS in SSA is very challenging and as such, the responsiveness of HIV/AIDS to sustainable development should be maintained at minimum which would require more efforts on HIV/AIDS control programs and increase health expenditure.

Job loss, disability insurance and health expenditure

We analyse the causal effect of job loss on disability insurance enrolment on a five-year horizon and the implications on health expenditure. Using administrative panel data from Hungary, we follow individuals displaced due to a mass lay-off and compare their labour force status to non-laid-off individuals with similar employment and health history. According to our estimates, being laid off increases the transition probability to disability 1.5-fold (or by 1.4% points) in four years, and half of the excess transitions occur within the first year. The four-year mortality rate increases 1.7-fold (or by 0.4% point).Total outpatient, inpatient and pharmaceutical expenditure increase threefold when a laid-off individual takes up disability benefit, and decrease slightly afterwards, but do not reach the pre-disability levels. The medium term increase in health expenditure corresponds to 20−25% of the additional disability payments. Detailed medication data show that physical health shocks, the diagnosis of chronic physical conditions, such as hypertension or diabetes, and the deterioration of mental health all contribute to the observed surge in health expenditure.

Assessment of Medication Related Problems in Geriatrics Unit of Nigerian Tertiary Hospital

Medication related problems are prevalent especially in the geriatric populationandcancause considerable patient morbidity and in some cases death as well as increased health expenditure. The elderly population is at increased risk for medication related problems as a result of age – related physiological changes and the presence of multiple chronic diseases. Aim: This study aimed to assess medication related problems (MRP) in University of Port Harcourt Teaching Hospital, with the objective to identify and categorize the MRP according to types as well as identify the most frequent MRP encountered and interventions made by the pharmacists. Method: The study was a retrospective study carried out among 200 geriatric patientsrandomly sampled, over 18months period (January 2018 to June 2019). Data extracted include patients’ demographic information, prescribed medication and number, medical condition, and pharmacist’s intervention (where available) using data collection form. Information collected were categorized and analyzed statistically. Result: showed that female geriatric patients (64.4%) were more than male (35.5%). Most (43%) of the studied population were in the range of 60yrs – 70yrs. Out of the 200 patients assessed, 157 (78.4%) had medication related problems. Drug- drug interaction was the most frequently (64.4%) occurred MRP, as most (62.5%) of the studied group had 6 -10 medications in one prescription, and 12.5% had more than 10 medications in one prescription. Following drug interaction was incorrect drug administration (18.5%). Of the population studied, 56.5% of the patients were using their medication inappropriately. The major contributing factors responsible for these MRPs were comorbidities, poly-pharmacy, and medication non- adherence. Conclusion: The study identified categories of medication related problem in the geriatric Unit of the hospital and the need for pharmacists’ interventions.

How time horizons of autocrats impact health expenditure: a mixed methods research

BackgroundA country’s spending on healthcare significantly improves its population health status. No comparative study has examined how the threat perceived by leaders influences health expenditure and cross-national analyses of authoritarian regimes. The objectives of this study are to examine how time horizons of autocrats influence health expenditure.MethodsWe designed a mixed methods research approach. First, the study used panel data from 1995 to 2010 covering 95 countries (n = 1208) and applied fixed effects regression models. As a proxy for time horizons, the study generated the predicted survival time for each regime-year using parametric survival analysis and the predictors to model regime failure. Second, we chose Chad, Rwanda and Ivory Coast to apply synthetic control methods for comparative case studies. Armed conflict had significant effects on regime duration and was used for an intervention. We constructed a synthetic version of each country, combining counties that did not or did experience armed conflict to resemble the values of health expenditure predictors for the actual country prior to the intervention.ResultsWe found that an increase in the natural log form of survival time by 1 resulted in a 1.14 percentage point increase in health expenditure (% of GDP) (1.14, 95% CI = 0.60–1.69). Furthermore, we found that the difference in health expenditure between the actual Chad and its synthetic version starts to grow following the civil war in 2004 (in 2004, actual: 5.72%, synthetic: 5.91%; in 2005, actual: 3.91%, synthetic: 6.74%). Similarly, a large health expenditure gap between the actual Rwanda and its synthetic control resulted after the peace deal was signed in 2002 (in 2002, actual: 4.18%, synthetic: 4.77%; in 2003, actual: 6.34%, synthetic: 5.03%). In Ivory Coast, the two series diverge substantially during the civil war from 1999 to 2005 (in 1998, actual: 7.30%, synthetic: 7.11%; in 2002, actual: 4.47%, synthetic: 7.43%; in 2007, actual: 6.35%, synthetic: 6.50%).ConclusionsThe findings suggest that health expenditure decreases as regime time horizons shrink, and reducing armed conflict is a way to promote regime stability.

Economic Growth and Human Capital Accumulation across Countries: Evidence from WAEMU Region

Development policies often focus on health as human capital and require increased health expenditure in developing countries. This paper analyses the extent to which health expenditure is explained by growth in the West African Economic Monetary Union (WAEMU) zone for the period of 2000–2015. Integrated economies were assumed where an increase in gross domestic product per capita (named income) in one country leads to a change in fiscal revenues and hence public spending in that country (direct effect) as well as neighbouring countries (indirect effect). Spatial econometric models were used to test for the existence and estimate the magnitude of spatial externalities. The panel causality results highlight externalities at the WAEMU regional level. Applying the Hausman test, Akaike information criterion, and Wald test to the data permits estimation of a dynamic spatial Durbin model with individual and time fixed effects. Decomposing the results of the model into both short- and long-term direct and indirect (spillover) effects shows that only the short-term effects were significant. The income elasticity of health spending was equal to 1 for the direct effect of economic growth in WAEMU countries. Therefore, health is a necessity at the country level in the WAEMU zone. Income elasticity was greater than 1 for growth spillover effects. Health is a luxury at the regional level. These findings underscore the need for more involvement of national governments in the health sector to redistribute healthcare resources. In addition, health and growth policies must be coordinated in WAEMU countries.

Assessing the Risk of Car Crashes in Road Networks

Worldwide, thousands of people die annually in highway-related crashes and millions are injured. Hence, car wrecks have very high direct social costs but also relevant indirect economic effects such as an adverse impact on the burden of hospitalization and an increased health expenditure. The analysis of car crash data has long been used as a basis for influencing highway and vehicle designs but also, and perhaps more importantly, to support local authorities in allocating resources aimed at improving road safety and making political decisions to mitigate road risks in the most exposed areas. In this paper, we show how a range of information collected from open data sources concerning the structure of the road network (road typology, traffic lights, pedestrian crossings, etc.), socio-demographical dimensions and crash history can be proficiently used for this aim. We adopt a dynamic Zero Inflated Poisson (ZIP) regression model to define two indexes. The first index, derived from the counting component of the ZIP model, measures how prone to crash risk a segment is. The other, derived by the zero component of the ZIP model, represents a measure of the likelihood of segments to not be exposed to crashes. Focussing on the city of Milan (Northern Italy), we found that the most relevant determinant of road risk proneness is crash history and that structural characteristics of the road are much more relevant than demographic information. Finally, we show how this information can be spatialized to produce maps of crash proneness and predict future spatial risk indexes.

The effects of health expenditure on infant mortality in sub-Saharan Africa: evidence from panel data analysis

IntroductionAlthough health expenditure in sub-Saharan African countries is the lowest compared with other regions in the world, most African countries have improved their budget allocations to health care over the past 15 years. The majority of health care sources in sub-Saharan Africa are private and largely involve out-of-pocket expenditure, which may prevent healthcare access. Access to healthcare is a known predictor of infant mortality. Therefore the objective of this study is to determine the impact of health care expenditure on infant mortality in sub-Saharan Africa.MethodsThe study used panel data from World Bank Development Indictors (WDI) from 2000 to 2015 covering 46 countries in sub-Saharan Africa. The random effects model was selected over the fixed effects model based on the Hausman test to assess the effect of health care expenditure on infant and neonatal mortality.ResultsBoth public and external health care spending showed a significant negative association with infant and neonatal mortality. However, private health expenditure was not significantly associated with either infant or neonatal mortality. In this study, private expenditure includes funds from households, corporations and non-profit organizations. Public expenditure include domestic revenue as internal transfers and grants, transfers, subsidies to voluntary health insurance beneficiaries, non-profit institutions serving households or enterprise financing schemes as well as compulsory prepayment and social health insurance contributions. External health expenditure is composed of direct foreign transfers and foreign transfers distributed by government encompassing all financial inflows into the national health system from outside the country.ConclusionHealth care expenditure remains a crucial component of reducing infant and neonatal mortality in sub-Saharan African countries. In the region, where health infrastructure is largely underdeveloped, increasing health expenditure will contribute to progress towards reducing infant and neonatal mortality during the Sustainable Development Goals (SDGs) era. Therefore, governments in the region need to increase amounts allocated to health care service delivery in order to reduce infant mortality.

A CROSS SECTIONAL STUDY OF HEALTH SEEKING BEHAVIOUR AND OUT OF POCKET EXPENSES AMONG ELDERLY IN THE RURAL POPULATION IN INDORE.

Background: Population ageing is global phenomenon. In India, size and share of elderly population is growing fast. The elderly due to increased morbidity from chronic disease have long term health care needs. The cost of the health care during old age appears to be very high.
 Objectives: 1. To determine health seeking behaviour of elderly rural population of Indore. 2. To assess their out of pocket expense.
 Methods: A Cross sectional study was conducted at Field practice area of Index Medical College, Indore in November 2017 to February 2018. A semi structured questionnaire was administered using the interview technique. Sample Size calculated was 250 by Simple Random Sampling. Elderly 60 years of age and above were included in the study. Study variables included sociodemographic parameters such as age, sex, education, occupation, socioeconomic status, and marital status. Data entry and statistical analysis used SPSS version 20.0. 
 Results: Out of 250 participants 139 were males and 111 were females.76.2% elderly suffering from chronic illness were on regular treatment, Prevalence of chronic illness (75.9%) was highest in participants who were above 80 years. The reason for not taking regular treatment in 57.7% elderly was expensive medicines and 29.6% showed ignorance towards health seeking in terms of treatment prescribed, 62% participants get the money from their children or other family members for their health care needs.
 Conclusions: Out of the total expenditure on health care, nearly half of it is towards medicines. Treatment cost for chronic morbidities is also quite high. When older persons are economically dependent, increasing health expenditure adds to the economic burden on the family. Elderly patients should be encouraged to visit government health setups and avail the benefits of various government health policies.
 Keywords: Ageing, elderly, rural, health seeking, out of pocket expenses.

Health care expenditure and environmental pollution: a cross-country comparison across different income groups.

This paper investigates the long-run dynamics between health care expenditure and environmental pollution across four global income groups. The analysis uses data from 178 countries, spanning the period 1995-2017. Panel estimations are employed with unobserved heterogeneity, temporal persistence, and cross-sectional dependence using a model with common correlated effects. The findings document that the health care expenditure is a necessity for all sub-groups. We established that a 1% increase in national income increased health expenditure by 7.2% in the full sample, and 9.3%, 8.6%, 6.8% and 2.9% for low, low-middle, upper-middle and high-income groups, respectively, while a 1% increase in CO2 emissions increased health expenditure by 2.5% in the full sample, and 2.9%, 1.2%, 2.3% and 2.6% across these four income groups. We recommend that coordinated approach is needed in setting policy goals both in energy and health sectors in mitigating the negative effects of pollution. Our findings indicate that low-carbon emissions and energy efficient health care services will significantly reduce future health care expenses.

Referans Bir Çocuk Hastanesine Zehirlenme Şikayeti İle Başvuran Çocuk Hastaların Analizi

INTRODUCTION: Although it has different mortality and morbidity rates all over the world, childhood poisoning has an important place among childhood health problems. The increase in health expenditures, retention time and loss of labor caused by poisonings cause the problem not only to be medical but also social aspects. METHODS: In addition to demographic data of 1043 pediatric patients admitted to our hospital with poisoning complaints, pre-admission intervention, place of poisoning, admission time, agent and time of poisoning, time elapsed after poisoning, admission findings, hospitalization period, diagnostic tests applied and treatment modalities were evaluated retrospectively with their prognosis. RESULTS: Of the 1043 cases, 54.5% were female. Female ratio increased to 82% in 139 suicides. When the causes of poisoning is examined, 47.2% were related to drugs, 41.5% were industrial and 5.4% were agricultural products, 2.7% due to CO, 2.6% were depending on the food,0.5% due to unknown factors and 0.2% occured with animal bites. Gastric-lavage, activated-charcoal, intravenous-fluid regimen (33%) was the most common treatment. Two of the three mortal cases were due to colchicine. DISCUSSION AND CONCLUSION: Although the development in the diagnosis and treatment of poisonings is pleasing, the most accurate approach to this issue will be to increase the protective measures. In addition to these standard measures, each country should set priorities in line with its own epidemiological study. Regarding the higher mortality rate (22%) we may suggest that clinicians should be more careful and aggressive in the diagnosis and treatment of colchicine intoxications, which can be associated with mortality even at low doses.

How Do Local Government Finances Respond to the Opioid Epidemics? Evidence From Hydrocodone Rescheduling

The opioid epidemic has dramatically impacted communities across the United States. According to the Center for Disease Control statistics, more than 72,000 people died from an overdose in 2017, of which two-thirds were opioid-related. In this study, I address the effects of such an epidemic directly on the finances of local governments. Specifically, I use the exposure to hydrocodone prescriptions and the rescheduling among regulated substances by the DEA as a source of exogenous variation and compare results in three settings: standard difference-in-difference, and counterfactual created using nearest neighbors regression and generalized random forests. I find that the rescheduling led to an increase in health expenditures driven mainly by localities that are still, as of 2016, suffering the epidemics. This is consistent for the standard difference-in-difference as well as for the nearest neighbor regressions. A similar finding is obtained using generalized random forests with noisier estimates, however, heterogeneity is determined by race, education, and prevalence of rural population instead of overdose rates.

Once bitten, twice shy? Lessons learned from an experiment to liberalize price regulations for dental care

In 2012, The Netherlands established the so-called “free market experiment”, which allowed providers of dental care to set the prices for their dental services themselves. The introduction of market mechanisms is intended to improve the quality of care and to contribute to cost containment, but increasing health expenditures for citizens have been observed in this context. Using large-volume health insurance claims data and exploiting the 2012 experiment in Dutch dental care, we identified the effects of a liberalization of service prices. Using pooled regression with individual fixed effects, we analyzed changes in utilization patterns of prevention-oriented dental services in response to the experiment as well as the elasticities in demand in response to variations in out-of-pocket (OOP) prices. We found substantial increases in prices and patients’ OOP contributions for dental services following the liberalization with differences in increases between types of services. In response to the experiment, the proportion of treatment sessions containing preventive-oriented services decreased significantly by 3.4% among adults and by 5.3% for children and adolescents. Estimates of short-run price elasticities of demand for different services point towards differences in price sensitivity. One potential explanation for the observed variations in prices and utilization could be different extents of asymmetric information for first-stage and follow-on services. Price liberalization seems to have affected the composition of treatment sessions towards a decreasing use of preventive services, suggesting a shift in the reason for seeing a dental care provider from a regular-preventive perspective to a symptom-based restorative approach.

The Dynamic Analysis of the Pollutant Emissions Impact on Human Health in China Industries based on the Meta-Frontier DEA.

Environmental pollutant emissions have become increasingly serious, and the resulting human health problems have become the focus of social attention. In this study, 30 provinces in China were selected as the object of study, SO2, NOX (nitrogen oxide), and PM2.5 were taken as undesirable outputs, and a meta-frontier dynamic data envelopment analysis model was adopted to avoid the disadvantages of static analysis. In this paper, energy efficiency, environmental pollution efficiency, and human health efficiency were incorporated into a unified analysis framework by constructing a two-stage model of the production and health stages. The study shows that the total efficiency score of nine provinces and cities, including Beijing, is 1. However, the score of two-stage efficiency in most provinces, such as Anhui, is less than 1, and the score of production efficiency is higher than that of health efficiency. In the second stage, the average efficiency of health expenditure and medical staff input is low, so it is necessary to make targeted improvement. In this regard, it is necessary for the government to increase health expenditure to improve the overall level of health efficiency.

Nexus between trade, CO2 emissions, renewable energy, and health expenditure in Pakistan.

As a result of the recent energy crisis and rapid industrialization in Pakistan, significant attention has turned toward alternative energy resources, CO2 emissions, and health-related issues. The adoption of renewable energies will not only accomplish the energy demand in the economy but will also provide a healthy environment. Therefore, it is essential to understand the linkages between trade, renewable energy, CO2 emissions, and health expenditures with a special focus on an emerging economy like Pakistan. This study used time series data from the 1998-2017 period and adopted the simultaneous equation approach for empirical analysis. The results show that an increase in trade volume positively contributes to the amount of CO2 emissions and, as a result, CO2 increases health expenditures. Conversely, renewable energy has a negative association with health expenditures and CO2 emission, signifying the importance of renewable energy in enhancing environmental quality and reducing health expenditures, which are adversely affected due to CO2 emissions. The empirical findings suggest that the government of Pakistan needs proper policy guidelines for renewable energy adoption in the industrial sector and that such guidelines can be further accommodated and adjusted in other determinants of the economy.

Production intensification and animal health expenditure on dairy farms in New Zealand

Although previous studies have investigated the effects of production intensification on farm economic performance and production efficiency in the dairy sector, knowledge is currently lacking on how intensification is related to farmer activities directed toward animal health outcomes. This study addresses the gap in the literature. A fixed-effects model estimated with a panel data set from New Zealand dairy farms is used to analyze the relationship between feed use intensification and animal health expenditure, controlling for a range of confounding effects. The empirical results show that, on average, feed use intensification is associated with a statistically significant increase in health expenditure per cow, and the positive effect is due primarily to the expenditure patterns of the farmers who have adopted the most intensive farming systems. The results also indicate that profitability, as measured by cash surplus, did not appear to be significantly related to the level of animal health expenditure on New Zealand dairy farms between 2005 and 2014.