National Expenditure Research Articles

Impact of foreign aid on economic growth with reference to Pakistan

This study examines how foreign aid impacts Pakistan's economic growth from 1990 and 2022, emphasizing on significant indicators such GDP, GNE (government national expenditure), inflation, labor force participation, and FDI (foreign direct investment). Regression analysis, unit root tests, and co-integration tests are used in the research to look at the complex relationships between various variables. Important results show that GDP and foreign aid are positively correlated; highlighting the significance that economic growth plays in drawing in outside funding. Furthermore, GNE exhibits a strong positive correlation with foreign aid, indicating the significance of public spending in obtaining outside funding. Foreign aid is negatively impacted by inflation, underscoring the need for stable economic circumstances.

Access to DTP-Based Combination Vaccines in Asia-Pacific Countries between 2019 and 2022.

The Asia-Pacific countries are highly diverse in health and economic conditions that may impact vaccine access and uptake. Our study aimed to characterize patterns of health access to DTP-based combination vaccines in 10 countries from 2019 to 2022 using the IQVIA-MIDAS database. The availability, affordability, and accessibility were compared across countries by national health and economic performance indicators using Spearman's rank correlation coefficient. Our findings showed that the three aspects of access to DTP-based vaccines varied substantially in the Asia-Pacific region, with higher levels in countries with better health and economic performance. Affected by the COVID-19 pandemic, vaccine accessibility fluctuates significantly in lower-income countries, with DTP coverage rates falling by more than 14% in the Philippines and Indonesia between 2019 and 2021. For availability and affordability, Singapore and Malaysia from high-income groups were largely affected, which may be related to health expenditure as a percentage of gross domestic product (Coefficient = 0.39, p = 0.03). Our study indicates that greater attention needs to be paid to national health expenditure and routine immunization services to improve vaccine disparities and increase the robustness and resilience of the vaccine supply chain during public health emergencies.

THE HOSPITAL TO HOME TRANSITION: EFFECTS OF LIFE CHANCES AND LIFE CHOICES ON UNPLANNED HOSPITAL READMISSIONS

Abstract Roughly 18% of all patients discharged from hospitals in the United States experience an unplanned hospital readmission (UR) within 30 days which can be life-threatening to patients and extremely costly for the health care system. Medicare alone paid $900.8 billion in 2021, or 21 percent of total national hospital expenditures. A promising theory for adding to our understanding of the causes for URs is Health Lifestyle Theory (HLT). It proposes that structural factors (e.g., SES, hospital procedures) affect one’s life chances and that socialization and personal experiences affect one’s life choices and the two merge to produce a person’s health lifestyle. The purpose of our study was to consider the ability of HLT to explain why some patients recover after hospital discharge while others experience URs. To accomplish our purpose, we interviewed 37 patients in their homes who had been discharged from a regional hospital in north Texas roughly 30 days prior to being interviewed. All the patients had been admitted for various serious illnesses. Fourteen of the patients had experienced an UR. Qualitative analyses included open and focused coding. Data from those experiencing an UR and those avoiding an UR were analyzed separately. We found the HLT to provide sound reasons for patients experiencing recovery or URs. Those who experienced an UR were found to have similar life chances caused by structural factors and similar life choices based on their socialization and personal experiences. Specific structural factors and personal experiences associated with life chances and life choices are presented.

SOCIALIZING CARE FOR OLDER PEOPLE ACROSS THE COUNTRIES: A COMPARATIVE STUDY OF THE LOCATION OF CARE

Abstract As more people are likely to prefer to age in their own place, where and how the care in later life is provided become more important. This paper aims to compare the degree of socialization in care for older people among different countries, especially focusing on the location of care (i.e., home care and institutional care). We applied the Fuzzy-set Ideal Type Analysis to classify the countries depending on how the formal care is provided between home and institutional settings. Measures of socialization in home care include the national expenditure on home care and the number of formal care workers at home, whereas formal care workers and the number of beds in residential LTC facilities are indicators for socialization in institutional care. The four different types of formal care will be classified: HI where both home and institutional cares are highly socialized; Hi where home care is highly socialized but institutional care is not; hI where institutional care is highly socialized but not home care; and hi where neither are socialized. Results show that Denmark, Australia, and the Netherlands belongs to HI; Japan to Hi, New Zealand, Switzerland, and Germany to hI; and Korea and the United States to hi. Findings suggest that countries with high level of socialization of home care are likely to have a care management system for coordinating and monitoring services. This study provides implications for considering the unique cultural, institutional, and policy contexts among the countries in regards to the degree of socialization of care.

Equity in out-of-pocket health expenditure: Evidence from a health insurance program reform in Mexico.

The fragmentation of health systems in low- and middle-income countries (LMICs) deepens health inequities and shifts the economic burden of health care to families via out-of-pocket spending (OOPHE). This problem has been addressed by introducing public health insurance programs for poor people; however, there is a lack of knowledge about how equitable these programs are. We aimed to analyse the long-term effects of the Seguro Popular (SP) voluntary health insurance program, recently phased out and replaced by the Health Institute for Welfare (Instituto de Salud para el Bienestar (INSABI)), on OOPHE equity in the poor Mexican population. We conducted a pooled cross-sectional analysis using eleven waves of the National Household Income and Expenditure Survey (2002-2020). We identified the effect of SP by selecting households without social security (with SP or without health insurance (n = 169 766)) and matched them by propensity score to reduce bias in the decision to enrol in SP. We estimated horizontal and vertical equity metrics and assessed their evolution across subpopulations. The program's entry years (2003-2010) show a positive redistributive effect associated with a focalised stage of the program, while oversaturation could have diluted these effects during 2010-2014, with adverse results in terms of vertical equity and re-ranking among insured families. SP is more horizontally inequitable than for those uninsured. Within SP, the redistributive effect could improve up to 13% if all families with similar expenditures were spending equal OOPHE and horizontal equity was eliminated. Regarding vertical equity, SP outperforms the insured population with middle-range coverage some years after the implementation, but this progress disappears. To achieve universal health coverage, health authorities need to create and execute financial protection mechanisms that effectively address structural inequalities. This involves implementing a more comprehensive risk-pooling mechanism that makes social insurance sustainable in the long-run by increasing the social-economic influx of resources. It is essential to monitor oversaturation and financial sustainability to achieve optimal results. The replacement of the SP with INSABI highlights the complexity of maintaining a social insurance program where the ideology of different governments can influence the program structure, regulation, financing, and even its existence.

Economic effects of dietary salt reduction policies for cardiovascular disease prevention in Japan: a simulation study of hypothetical scenarios.

Reducing dietary salt intake is an essential population strategy for cardiovascular disease (CVD) prevention, but evidence on healthcare costs and outcomes is limited in Japan. We aimed to conduct a pilot economic evaluation under hypothetical scenarios of applying the salt reduction policies of England to Japan. We examined salt reduction policies in England: media health promotion campaigns, front-of-pack labeling, and voluntary and mandatory reformulation with best-case and worst-case policy cost scenarios. We assumed that these policies were conducted in Japan for 10 years from 2019. We used published data on epidemiology and healthcare expenditures in Japan and the costs and effects of salt reduction policies in England, and defined the benefits as a decrease in national medical expenditures on CVD. We developed a Markov cohort simulation model of the Japanese population. To estimate the annual net benefits of each policy over 10 years, we subtracted monitoring and policy costs from the benefits. We adopted a health sector perspective and a 2% discount rate. The cumulative net benefit over 10 years was largest for mandatory reformulation (best case) at 2,015.1 million USD (with costs of USD 48.3 million and benefits of USD 2063.5 million), followed by voluntary reformulation (net benefit: USD 1,895.1 million, cost: USD 48.1 million, benefit: USD 1,943.2 million), mandatory reformulation (worst case, net benefit: USD 1,447.9 million, cost: USD 1,174.5 million, benefit: USD 2,622.3 million), labeling (net benefit: USD 159.5 million, cost: USD 91.6 million, benefit: USD 251.0 million), and a media campaign (net benefit: USD 140.5 million, cost: USD 110.5 million, benefit: USD 251.0 million). There was no change in the superiority or inferiority of policies when the uncertainty of model parameters was considered. Mandatory reformulation with the best-case cost scenario might be economically preferable to the other alternatives in Japan. In future research, domestic data on costs and effects of salt reduction policies should be incorporated for model refinement.

PROGRESSIVE HEALTH SPENDING AND MALARIA OUTCOMES IN NIGERIA: UNVEILING THE IMPACT

This study delves into the relationship between progressive health spending and malaria outcomes in Nigeria, aiming to uncover the impact of financial investments on disease management. Malaria remains a significant public health challenge in Nigeria, with substantial resources allocated to combat the disease annually. However, the effectiveness of health spending in curbing malaria incidence and mortality rates remains unclear. Through a comprehensive analysis of healthcare expenditure trends and malaria outcomes, this research seeks to elucidate the extent to which progressive health spending influences malaria prevention, treatment, and control measures. Drawing upon national health expenditure data and malaria surveillance statistics, the study employs quantitative methods to examine the association between health expenditure patterns and malaria incidence and mortality rates over time. The findings shed light on the effectiveness of financial investments in mitigating the burden of malaria and inform evidence-based policy decisions aimed at improving disease management strategies in Nigeria.

Determinants of poverty among Indigenous people in Mexico's Guerrero Mountain Region

AbstractMotivationThe eradication of poverty is one of Mexico's greatest challenges. This challenge is even greater for Indigenous communities, where seven out of 10 people were living in poverty in 2018. Despite the economic, social, and cultural impacts on Indigenous people, there has been scant literature addressing the determinants of Indigenous poverty in Mexico, while studies on the Guerrero Mountain Region (GMR) are scarcer still.PurposeThis study aims to identify the socioeconomic and contextual determinants of income and multidimensional poverty in the GMR, one of the poorest regions in Mexico and Latin America, inhabited primarily by Indigenous people.Methods and approachWe use data on 989 individuals in the GMR, collected during the 2018 Socioeconomic Conditions Module of Mexico's National Household Income and Expenditure Survey. To examine the main determinants of individual poverty, we use Bayesian logistic regression (BLR), which allows us to use the data to update information about the parameters and evaluate their distributional properties. The method simplifies multi‐causal elements by classifying them into categories of well‐being that incorporate more than economic factors.FindingsThe income‐poor population is also multidimensionally poor. Education helps to reduce poverty as households that spend more on schooling are less likely to be poor. Households with many members, those with high dependency ratios, and those with members living with disability all tend to be poor. Households with access to landlines and the internet are less likely to be poor.Policy implicationsMore diagnosis of poverty is needed. This should consider overlapping vulnerabilities (institutional, socioeconomic, environmental, and sociocultural) in this region for each Indigenous group. Public policies need to be monitored for performance.

Increase of catastrophic and impoverishing health expenditures in Mexico associated to policy changes and the COVID-19 pandemic.

In 2003, the Mexican Congress approved a major reform to provide health care services to the poor population through the public insurance scheme Seguro Popular. This program was dismantled in 2019 as part of a set of health system reforms and substituted with the Health Institute for Welfare (INSABI). These changes were implemented during the initial phases of the coronavirus (COVID-19) pandemic. We aimed to examine the impact of these reforms and the COVID-19 pandemic on financial risk protection in Mexico between 2018 and 2020. We performed a population-based analysis using cross-sectional data from the 2018 and 2020 rounds of the National Household Income and Expenditures Survey. We used a pooled fixed-effects multivariable two-stage probit model to determine the likelihood of catastrophic health expenditure (CHE), impoverishing health expenditure (IHE), and excessive health expenditure (EHE) among Mexican households. We also mapped the quintiles of changes in EHE in households without health insurance by state. The percentage of households without health insurance almost doubled from 8.8% (three million households) in 2018 to 16.5% (5.8 million households) in 2020. We also found large increases in the proportion of households incurring in CHE (18.4%; 95% confidence interval (CI) = 6.1, 30.7) and EHE (18.7%; 95% CI = 7.9, 29.5). Significant increases in CHE, IHE, and EHE were only observed among households without health insurance (CHE: 90.7%; 95% CI = 31.6, 149.7, EHE: 73.5%; 95% CI = 25.3, 121.8). Virtually all Mexican states (n/N = 31/32) registered an increase in EHE among households without health insurance. This increase has a systematic territorial component affecting mostly central and southern states (range = -1.0% to 194.4%). The discontinuation of the Seguro Popular Program and its substitution with INSABI during the first stages of the COVID-19 pandemic reduced the levels of health care coverage in Mexico. This reduction and the pandemic increased out-of-pocket expenditure in health and the portion of CHE and EHE in the 2018-2020 period. The effect was higher in households without health insurance and households in central and southern states of the country. Further studies are needed to determine the specific effect both of recent policy changes and of the COVID-19 pandemic on the levels of financial protection in health in Mexico.

Adverse childhood experiences, social participation and multimorbidity risk in Europe

Abstract Background Adverse childhood experiences (ACEs) are linked to multimorbidity, but evidence from longitudinal research on potential macro and micro-level protective factors is lacking. We investigated the associations between ACEs, social participation, national health expenditure, and their interactions, with the risk of developing multimorbidity in later life. Methods Data from 25,885 adults aged 50+ from 15 countries in the Survey of Health, Ageing and Retirement in Europe (SHARE) were analyzed. ACEs (separation from parents, household dysfunction, hunger, property loss) and social participation (community, political, religious, or charity participation) were measured in Waves 3 (2009) and 4 (2011), respectively. Multimorbidity was defined as the simultaneous presence of two or more conditions (diabetes, cancer, heart disease, stroke, depression) in Waves 5-8 (2013-2019). Country-level health expenditure per capita (2011) was included. Multilevel logistic regression models nested within countries tested associations and interactions in unadjusted and adjusted (n = 14,478) analyses. Results 16.3% developed multimorbidity, 19.3% reported ACEs, and 47.7% were socially active in their communities. ACEs, social participation, and health care expenditure were each uniquely associated with the odds of incident multimorbidity, and results held when adjusting for sociodemographic and lifestyle factors (OR = 1.32, 95% CI = 1.18,1.47; OR = 0.86, 95% CI = 0.78, 0.94; OR = 0.9998, 95% CI = 0.9997,0.9999, respectively). Multiple imputation for missing covariates demonstrated similar results. No significant interactions were found. Conclusions ACEs were associated with increased multimorbidity risk, and although social participation and health expenditure were associated with lower risk, they did not mitigate the impact of ACEs. Policies aimed at preventing ACEs and promoting social participation among older adults may be beneficial in reducing the risk of multimorbidity in later life. Key messages • ACEs are associated with an increased risk of multimorbidity in later life. • While social participation and greater national health expenditure are associated with lower multimorbidity risk, these factors do not mitigate the impact of ACEs.

The Political Costs of Austerity

Abstract Using a novel regional database covering over 200 elections in several European countries, this paper provides new empirical evidence on the political consequences of fiscal consolidations. To identify exogenous reductions in regional public spending, we use a Bartik-type instrument that combines regional sensitivities to changes in national government expenditures with narrative national consolidation episodes. Fiscal consolidations lead to a significant increase in extreme parties' vote share, lower voter turnout, and a rise in political fragmentation. We highlight the close relationship between detrimental economic developments and voters' support for extreme parties by showing that austerity induces severe economic costs through lowering GDP, employment, private investment, and wages. Austerity-driven recessions amplify the political costs of economic downturns considerably by increasing distrust in the political environment.

The Role of COVID-19 in Molding the Economy and Social Inequity of Mexican Households

The COVID-19 pandemic has deeply influenced the economy of all nations, and Mexico is no exception. This effect is distinct for different groups of the population, with variable socio-economic and demographic characteristics, that live in regions of contrasting features. An efficient apparatus for measuring expenditure variations and tendency is the National Household Income and Expenditure Survey performed by the National Institute of Statistics and Geography in accordance with the international standardization established at the Canberra Conference; the latter permits, every two years, for different surveys to be comparable in time and space. Hence, in Mexico, there are three surveys for 2018, 2020, and 2022. The results of the comparison indicate that different groups of the Mexican population have experienced the pandemic with multiple impacts, apparently without large proportional variation regarding expenditure but with greater variation in time-use conditions. Moreover, it became apparent that even though the lower strata of Mexico’s population have fewer proportional variations concerning income after the COVID-19 outburst, they must incorporate more family members into working activities to achieve a survival line; the latter results in the abandonment of school from various young household members that will negatively impact the quality of their lives in the long term.

Demonstrating the Value of Interventional Radiology.

While national healthcare expenditures per capita in the United States exceed those in all other Organisation for Economic Co-operation and Development (OECD) countries, measures of health outcomes in the United States lag behind those in peer nations. This combination of high healthcare spending and relatively poor health has led to attempts to identify high- and low-value healthcare services and to develop mechanisms to reimburse health care providers based on the value of the care delivered. This article investigates the meaning of value in healthcare and identifies specific services delivered by interventional radiologists that have accrued evidence that they meet criteria for high-value services. Recognizing the shift in reimbursement to high-value care, it is imperative that interventional radiology (IR) develop the evidence needed to articulate to all relevant stakeholders how IR contributes value to the system.

The Political Costs of Austerity

Abstract Using a novel regional database covering over 200 elections in several European countries, this paper provides new empirical evidence on the political consequences of fiscal consolidations. To identify exogenous reductions in regional public spending, we use a Bartik-type instrument that combines regional sensitivities to changes in national government expenditures with narrative national consolidation episodes. Fiscal consolidations lead to a significant increase in extreme parties' vote share, lower voter turnout, and a rise in political fragmentation. We highlight the close relationship between detrimental economic developments and voters' support for extreme parties by showing that austerity induces severe deconomic costs through lowering GDP, employment, private investment, and wages. Austerity-driven recessions amplify the political costs of economic downturns considerably by increasing distrust in the political environment.

Quantifying expenditure hierarchies and the expansion of global consumption diversity

Economic growth stimulates fundamental changes in consumption patterns as consumers who get rich tend to spread their spending more evenly across a wider variety of goods and services. Comparing cross sectional spending patterns across rich and poor countries, we investigate how this diversification process enables more niche patterns of spending to emerge across the global population of consumers. We use entropy measures to quantify the dispersion of household spending across goods and study how it unfolds as GDP rises. Using a gravity model to study international differences in the relative order of income elasticities, i.e. expenditure hierarchies, we show how this diversification process on the national level is correlated with cultural norms, GDP and income inequality. We find that national expenditure hierarchies are relatively similar across countries among necessities, while they are increasingly unique among luxuries. We further consider how rising affluence tends to generate more niche consumption patterns by examining how rising income is positively correlated with demand heterogeneity and income inequality is negatively correlated with market depth.

Inequitable Financial Protection in Health for Indigenous Populations: the Mexican Case.

There is an important gap in the literature concerning the level, inequality, and evolution of financial protection for indigenous (IH) and non-indigenous (NIH) households in low- and middle-income countries. This paper offers an assessment of the level, socioeconomic inequality and middle-term trends of catastrophic (CHE), impoverishing (IHE), and excessive (EHE) health expenditures in Mexican IHs and NIHs during the period 2008-2020. We conducted a pooled cross-sectional analysis using the last seven waves of the National Household Income and Expenditure Survey (n = 315,829 households). We assessed socioeconomic inequality in CHE, IHE, and EHE by estimating their Wagstaff concentration indices according to indigenous status. We adjusted the CHE, IHE, and EHE by estimating a maximum-likelihood two-stage probit model with robust standard errors. We observed that, during the period analyzed, CHE, IHE, and EHE were concentrated in the poorest IHs. CHE decreased from 5.4% vs. 4.7% in 2008 to 3.4% vs. 2.9% in 2014 in IHs and NIHs, respectively, and converged at 2008 levels towards 2020. IHE remained unchanged from 2008 to 2014 (1.6% for IHs vs. 1.0% for NIHs) and increased by 40% in IHs and NIHs during 2016-2020. EHE plunged in 2014 (4.6% in IHs vs. 3.8% in NIHs), then rose, and remained unchanged during 2016-2020 (6.7% in IHs and 5.6% in NIHs). In pursuit of universal health coverage, health authorities should formulate and implement effective financial protection mechanisms to address structural inequalities, especially forms of discrimination including racialization, that vulnerable social groups such as indigenous peoples have systematically faced. Doing so would contribute to closing the persistent ethnic gaps in health.

Out of pocket and catastrophic health spending in Mexico in the face of the COVID-19 pandemic

INTRODUCTION: The measurement of the financial coverage of a health system uses key indicators such as household out-of-pocket spending as well as catastrophic health spending. Said indicators depend on the financing structure of the health system as well as quality criteria and efficiency of the system in patient care. In the case of Mexico, in recent years there have been important changes in the structure of the health system in addition to suffering from the COVID-19 pandemic events that have significantly impacted the access to health of patients. Therefore, it is relevant to quantify the impact of these events on out-of-pocket spending and catastrophic spending on health in Mexico and have a robust diagnosis of the financial coverage of the system public health in Mexico.OBJECTIVES: The main objective of this study is to quantify out-of-pocket spending and catastrophic spending on health in Mexican households for the year 2020. Comparing these estimates with previous years given the recent changes in the Mexican health system as well as the effect of the COVID-19 pandemic in these indicators.METHODS: Based on the information available in the 2020 National Household Income and Expenditure Survey (ENIGH), out-of-pocket and catastrophic spending on health were estimated following the methodology proposed by the World Health Organization. A quantile regression was estimated to assess the effect of income distribution on out-of-pocket spending.RESULTS: In Mexico in 2020, 67.7% (24.2 million) of households had an out-of-pocket health expenditure (OOHE) and 6% of these households had a catastrophic health expenditure (CHE), with respect to all households this percentage represents 4.04%. According to the classification stipulated by the World Health Organization, healthcare has six expenditure components: orthopedics, medicines, maternity, hospital, alternative medicines, and ambulatory expenses. The three main expenditure was attributable to drugs (39.9%), ambulatory (25.3%), and hospital costs (20.3%).CONCLUSION: The effect of recent modifications to the public health system in Mexico in addition to the COVID-19 pandemic has been reflected in an increase in the percentage of households with out-of-pocket spending in Mexico, as well as the percentage of households with catastrophic spending in health. The main expense item is made in medicines, ambulatory care follow-up and hospitalization. It is a priority to establish efficient financial protection schemes that allow reversing this situation in terms of efficient access to health in Mexico.

Changes in Food and Beverage Purchases Associated With the Coronavirus Disease Pandemic in Mexico

BackgroundPublic policies to contain the spread of coronavirus disease in Mexico could have had an effect on food purchase patterns. ObjectiveThe objective of the study was to assess changes in the quantity of food and beverages purchased and proportion spent on food consumed away from home during the coronavirus disease pandemic in Mexican households. DesignThis study is a secondary analysis of cross-sectional data from the National Household Income and Expenditure Survey 2014-2020. Participants/settingThe study included 234,631 households with information on food and beverages purchases from 2014 to 2020. Main outcome measuresFood and beverage purchases were classified into six categories: basic, nonbasic energy-dense foods, prepared food for consumption at home, water, milk, and sugar-sweetened beverages. In the National Household Income and Expenditure Survey 2014-2020, expenditures on food and beverages consumed away from home are not classified into any specific items but represents more than 10% of food and beverage expenditures; therefore, the analyses included the proportion of food and beverage expenditures spent on food consumed away from home. Statistical analyses performedA two-part model was used to evaluate changes in the quantity of food purchased and the proportion spent away from home during the coronavirus disease pandemic in 2020 compared with 2018, adjusting for socio-demographic variables, gross domestic product and previous survey rounds. Results are presented at the national level, by income quintile and by place of residence. ResultsPurchases of basic food increased by 17 g/capita/day at the national level and 22.4 g/capita/day in urban areas (P < 0.001). Purchases of nonbasic energy-dense foods decreased both at the national level (–4.2 g/capita/day; P < 0.001) and by place of residence (–4.8 g/capita/day; P < 0.001 in urban areas and –2.5 g/capita/day; P = 0.001 in rural settings). Purchases of prepared food increased 16 g/capita/day (P < 0.001). In rural areas, purchases of sugar-sweetened beverages increased 7.2 mL/per capita/day (P < 0.001). For the lowest income quintile purchases of processed meat increased 2.4 g/capita/day (P < 0.001). The proportion spent on food consumed away from home decreased by –44.9% (P < 0.001). ConclusionsResults of this study show that during the coronavirus disease lockdown there was an increase in basic and prepared food purchases, whereas purchases of nonbasic energy-dense foods and the proportion spent on food consumed away from home decreased. However, findings showed an increase in sugar-sweetened beverages purchases among rural dwellers and an increase in purchases of processed meat among the lowest income quintile. Various factors such as income reductions, unemployment, mobility restrictions, or increases in prices may have led the observed changes. Future research should be conducted to analyze these potential pathways.

Comprehensive cost of illness of all diseases in Japan: Measurement of the social burden of diseases in a super-aged society

BackgroundEvaluation of the social burden of illness is important for policy decision-making. However, policy-makers find indicators traditionally used in the healthcare field difficult to use because calculation of these indicators is complex and the unit of indicators is often expressed on “years” basis. The aim of this study was to measure the burden of all diseases using the Comprehensive Cost of Illness (CCOI) method and to provide indicators that are easy to use for policy-making. MethodsUtilizing government-based nationwide statistical data, we used the CCOI method to estimate the social burden of illness from 2002 to 2017. CCOI consists of direct costs (medical direct cost and formal care cost) and indirect costs (morbidity cost, mortality cost, and informal care cost). ResultsFrom 2002 to 2017, CCOI increased from 66.5 trillion yen (12.9% of the gross domestic product [GDP]) to 90.6 trillion yen (16.6% of GDP). From 2002 to 2017, the three top-ranked diseases influencing CCOI did not change. The ranking of these diseases (from first to third) is as follows: circulatory system diseases, neoplasms, and digestive diseases. ConclusionsThe trend of CCOI is consistent with the trends of national health expenditure and disability-adjusted life years. The CCOI method is expressed in monetary terms, so the effects of aging and the development of medical technology are represented by trends in each cost and are considered valuable as the basis of health policy, instead of national health expenditure. Public Interest SummaryMeasuring the social burden of disease is important for making policy decisions. There have been indicators to measure the burden of disease in the past, but they have been complex and difficult to use because they are measured in "years". We have developed a comprehensive cost-of-illness method (CCOI) that includes the burden of long-term care by applying a method called the cost-of-illness method (COI), which expresses the burden of illness in monetary terms. Using this method, we measured the cost of illness in Japan's aging population, which in 2017 was 66.5 trillion yen (approximately US$532 billion), accounting for 12.9% of GDP. Since this method expresses the burden in monetary terms, it is expected to be a useful indicator for policy making.

Strengthening Al-Khums (Islamic Tax) towards National Economic Sustainability

Al-Khums is a tax that highlighted as a contributor to the economic growth of the country. Objectively, al-Khums is obligatory for the citizen to maintain the sustainable development of the country. This article used the qualitative method. Thus, the tax collection practiced by the government provides for tax deductions for individuals who are already qualified. Nevertheless, according to the national presentation budget, the existing taxes cannot cover the strength of the national expenditure. In this situation, the local authority must remember that Islam has been successful in practicing Al-Khums as the economic growth of the country.