Private Health Care Expenditure Research Articles

Association Of Health Care Expenditure With Results Of Allogeneic HSCT For Adults With ALL: An Analysis From Acute Leukemia Working Party Of The EBMT

BackgroundResults of allogeneic hematopoietic stem cell transplantation (aloHSCT) depend on many patient-, donor- and procedure-related factors. In recent years, in a setting of AML we demonstrated that also socio-economic status of a country and center experience may influence outcome. The goal of the current analysis, focused on patients with acute lymphoblastic leukemia (ALL), was to evaluate specific effects on non-relapse mortality (NRM) related to health care expenditure (HCE) of a country as well as distribution of transplant centers in addition to previously studied human development index (HDI) and center activity. Patients and methodsResults of myeloablative alloHSCT from HLA-identical siblings performed between 2004-2008 for adults with ALL in CR1 were analyzed. Among 983 individuals treated in 27 European countries the median age was 35 (18-55) years and the interval from diagnosis to alloHSCT – 158 (42-831) days. TBI was used for conditioning in 820 (83%) cases and peripheral blood was a source of stem cells in 656 (67%) cases. The following factors were studied for their impact on outcome: current HCE, HCE as % of gross domestic product, public HCE, private HCE, no. of teams per country area and population, HDI and center activity (no. of alloHSCT for ALL in a study period). All variables were categorized by medians. The median follow-up was 34 months. ResultsIn a univariate analysis the probability of day 100 NRM was increased for countries with lower current HCE (p=0.06), lower HDI (p=0.02) and for centers with lower experience (p=0.04). Also overall NRM was affected by current HCE (p=0.09), HDI (p=0.03) and center activity (p=0.07). In a multivariate model adjusted for recipient age, interval from diagnosis to HSCT, source of stem cells, type of conditioning, and donor/recipient gender, the variables of interest were included separately due to strong internal correlations. The best predictive model for day 100 NRM included HDI < median (HR = 2.38, 95%CI = 1.3-4.35, p=0.005). The overall NRM was most strongly predicted by current HCE < median (HR = 2.56, 95%CI = 1.41-4.76, p=0.002). In a univariate analysis lower values of HDI and current HCE were also associated with decreased probability of the overall survival (p=0.004 and p=0.006, respectively). ConclusionBoth macroeconomic factors and the socio-economic status of a country influence strongly non-relapse mortality and overall survival after alloHSCT for adults with ALL. Our findings should be considered in interpretation of clinical studies in the field of alloHSCT. Disclosures:No relevant conflicts of interest to declare.

Utilización de remesas de migrantes en California para atención a la salud de sus dependientes en México

This paper focuses on public and private healthcare utilization among dependents living in Mexico of Mexican migrants in California, analyzing the link between remittances and enrollment in Seguro Popular, a social health insurance plan. We surveyed 1353 migrants who visited the Mexican consulate of Los Angeles in 2010. 53.9% sent remittances; 72.2% of households receiving remittances used a share of remittances for health care and 74.4% of them were covered by Seguro Popular. The annual median with private health care expenditure was USD 825, compared to USD 293 for public providers. The main predictors remittances utilization for healthcare were having a sick dependent, purchase of prescription drugs, experiencing problems paying for health care and time of U.S. residence. Seguro Popular increases healthcare utilization with public providers, which provides an opportunity to reallocate the use of migrant's remittances for health purposes.

Testing the Convergence Hypothesis of Health Care Expenditure: Empirical Evidence from Korea

This research explores the convergence of health care expenditure in Korea with different income groups and the world level by applying different concepts of convergence, including growth rates, trends, differences as well as rationality and statistical variation of health care expenditure. The empirical evidence shows that, in general, the health care expenditure in Korea seems to be on the right track in terms of both level and difference, given the fact that convergence exists with the expenditures of the high income group and the world level. It is also worth mentioning that the Korean public health care system has been performing much better than its private health care counterpart. Such a result suggests that the private health care system has to be more elaborately and systematically managed through the establishment of an operational policy to stimulate an increase in private health care expenditure.

보건의료비의 사회후생 증대효과 비교분석: 주성분분석을 중심으로

본 연구는 주성분분석을 활용하여 1995-2009년 동안의 보건의료비 지출을 소득수준별로 일인당 지출, 민간부문 지출, 공공부문 지출 및 총지출로 구분하여 사회후생 증대 효과를 분석하였다. 분석결과에 의하면 소득수준별 보건의료비 지출의 사회후생 증대효과는 세계전체 소득과 우리나라의 경우 부문별 지출에 따라 편차가 크고, 중간소득 국가에서 가장 크게 나타났으며, 고소득 국가, 저소득 국가, EU 국가 및 OECD 국가는 낮은 수준의 유사한 형태를 보이고 있다. 한편, 보건의료비 지출을 부문별로 살펴보면 일인당 지출은 소득수준과 무관하게 사회후생 증대효과가 낮은 것으로 나타났고, 민간부문 지출은 부문별 지출 중에서 사회후생 증대효과가 가장 크게 나타났다. 공공부문 지출과 총지출의 경우 중간소득 국가가 크게 나타났으며 소득수준별로 편차가 큰 특징을 나타내고 있다. 결과적으로 보건의료비 지출의 효율성을 제고하여 사회후생 증대에 기여할 수 있는 방안을 모색하는 것이 가장 중요한 현안이라 하겠다. 이를 위해서는 무엇보다도 보건의료비 지출이 공공성의 특성을 벗어나 시장기능에 의한 자원배분을 할 수 있는 제도적 지원 방안이 모색되어야 할 것이다. Health care expenditure might be understood as a core source of social welfare. It is mainly due to the fact that the health care expenditure is closely related to the level of social welfare. And, therefore, the paper is basically designed to investigate the effect of social welfare improvement resulted from an increasing in per capita, private, public, and total health care expenditures during 1995-2009 periods. Empirical evidence reveals that the improvement of social welfare in middle income group reveals the highest improvement in social welfare, and the other income groups maintain a quite similar pattern in improvement of social welfare. As far as category of health care expenditure concerns, the effect of social welfare improvement by per capita health care expenditure is in general lower in all case. And, private sector achieves the highest improvement of social welfare in comparing with public and total health care expenditures. To this end, it could be tentatively concluded that the private health care expenditure has to be substituted for the public sector to induce market-oriented operational system. Accordingly, it would be better to build an institutional basis more elaborately in setting up the market system.

Growth in private payments for health care by Canadian households

IntroductionDespite first-dollar public coverage for hospital and physician services, Canadians spend more privately on health care than citizens of most other developed countries. We quantified recent growth in private payments by Canadian households for health care. MethodsUsing data from 163,081 respondents to Statistics Canada's annual Survey of Household Spending from 1998 to 2009, we calculated inflation-adjusted per-household spending on private health insurance premiums and out-of-pocket payments on six types of health care services. Further, we estimated the prevalence and some socio-economic determinants of households spending over 10% of after-tax income on health care using logistic regression. ResultsWe found that Canadian households spent $19.8 billion on private payments for health care in 2009. This represents an average of $1523 per household—a 37% increase over 1998. The top three spending categories in 2009 were private health insurance premiums ($5.9 billion), dental ($4.9 billion) and prescription drugs ($4.2 billion). Even after adjusting for inflation, expenditure on every category of health care spending increased between 1998 and 2009. The proportion of households spending more than 10% of after-tax income on health care increased by 56% (from 3.3% to 5.2%). Households including a senior, with a low income, and in British Columbia or the Atlantic Provinces were significantly more likely to reach this threshold. InterpretationOver the period studied, the burden of private health care expenditures increased substantially for Canadian households. As direct charges reduce the use of necessary health care services, investigation into the health consequences of these increases is warranted.

Is Health Care Expenditure Really a Luxury Good? A Reassessment and New Evidence Based on OECD Data

The aim of the paper is to present new evidence on the relationship between income and health care expenditure allowing for (i) substitution and complementary relationships between private and public health care expenditure, (ii) presence of structural breaks in the dependent variables, and (iii) presence of heterogeneous institutional setting (country-specific health systems). Our results show that income elasticity is quite sensitive to the inclusion of technology variables and to health system heterogeneity, complementary and substitution relationships play an important role in determining public and private health care expenditure and, finally, public and private health care expenditures are both related with a cyclical indicator of the economic activity.

The effects of public and private health care expenditure on health status in sub-Saharan Africa: new evidence from panel data analysis

BackgroundHealth care expenditure has been low over the years in developing regions of the world. A majority of countries in these regions, especially sub-Saharan Africa (SSA), rely on donor grants and loans to finance health care. Such expenditures are not only unsustainable but also inadequate considering the enormous health care burden in the region. The objectives of this study are to determine the effect of health care expenditure on population health status and to examine the effect by public and private expenditure sources.MethodsThe study used panel data from 1995 to 2010 covering 44 countries in SSA. Fixed and random effects panel data regression models were fitted to determine the effects of health care expenditure on health outcomes.ResultsThe results show that health care expenditure significantly influences health status through improving life expectancy at birth, reducing death and infant mortality rates. Both public and private health care spending showed strong positive association with health status even though public health care spending had relatively higher impact.ConclusionThe findings imply that health care expenditure remains a crucial component of health status improvement in sub-Saharan African countries. Increasing health care expenditure will be a significant step in achieving the Millennium Development Goals. Further, policy makers need to establish effective public-private partnership in allocating health care expenditures.

Quasi-market and cost-containment in Beveridge systems: The Lombardy model of Italy

In the very recent past, the Lombardy health care system – established in 1997 on the quasi market model – has caught the interest of researchers and politicians in different OECD countries 1 1 See for example the Wall Street Journal, Tuesday, April 13, 2010, R2. . Its merits, compared to other Italian regional systems, are the control of health care spending and the balanced budget, in a frame of good quality of services and patient choice. From the theoretical point of view, an appealing aspect of the Lombardy model is its gradual shift from a quasi market (QM) to a “quasi administered” system, which maintains all the typical features of the QM orientation – separation between purchasers and providers, the co-presence of public, not for profit and public providers, and patient free choice – but has deliberately sacrificed competition in order to control health expenditure. Another aspect of the Lombardy model is the sharp presence of private providers: the evidence that private sector is mainly concentrated in the long term care, where risks of complications are lower and financial remuneration is higher, suggests that a closer control should be exerted on hospital activity. Furthermore, possible distortions such as cream skimming and cherry picking by the private providers need more consideration. Another concern is linked to health spending control: equity issues could arise when observing a still relatively high share of private (out of pocket) health care expenditure. The paper stems from a literature review and tries to analyse the evolution of this regional system, the institutional path that brought to the implementation of the model, its theoretical basis, its merits and criticism. The period considered ranges from 1997, when the reform was enacted, to 2010.

Trade-linked Canada–United States household environmental impact analysis of energy use and greenhouse gas emissions

We compare energy use and greenhouse gas (GHG) emissions associated with total household expenditures and activities in Canada and US in 1997, the first detailed estimate of environmental burdens for Canadian households. We estimate direct burdens from published government data and indirect burdens using an industry-by-commodity, bi-national economic input–output life cycle assessment model developed in this study. Comparing 30 expenditure and two activity categories, per capita US household expenditures were 70% higher, while per capita household energy use and GHG emissions were only 10% and 44% higher, respectively. Energy use/dollar of expenditure was higher in most Canadian categories, while the average ratio of GHG emissions/energy use was higher in the US (65 vs 50 kg Eq. CO 2/GJ) due largely to a higher proportion of electricity from nonrenewable sources. Indirect environmental burdens represented 63–69% of total burdens and 62–70% of total burdens were associated with household operation and transportation. Key drivers of differences between energy profiles were: higher per capita electricity use by Canadian households, and higher US household private health care expenditures and motor fuel use. Energy-intensive production for export represented a higher proportion of Canadian production, resulting in less agreement between consumption and production-based analyses for Canada than US.

The Relative Efficiency of Public and Private Health Care

A health care system is efficient when an increase in spending results in significant improvements in the health of a population. We test the relative efficiency of public and private health care spending in reducing infant and child mortality using cross-national data for 163 countries. There are two remarkable ?ndings: First, an increase in public funds is both, significantly correlated with a lower mortality and signi?cantly more e¢ cient in reducing mortality than private health care expenditure. Second, private health care expenditure is in all estimations associated with higher, not lower, mortality, although this association is often not statistically significant. The results suggest, holding total health care expenditure constant, a potential decrease in total infant mortality in the 163 countries from 6.9 million deaths (2002) to 4.2-5.3 million deaths for completely publicly financed health care systems, but an increase to 9.0-10.0 million deaths for completely privately financed health care. We can explain some of the estimated difference in the efficiency of public and private health care expenditure by geographies and socioeconomic factors such as HIV prevalence, sanitation standards, corruption, and income distribution. However, the efficiency dfference remains large and statistically significant in all regressions.

Health care expenditures and gross domestic product: the Turkish case

Our study examines the long-term relationship among per capita gross domestic product (GDP), per capita health expenditures and population growth rate in Turkey during the period 1984-2006, employing the Johansen multivariate co-integration technique. Related previous studies on OECD countries have mostly excluded Turkey-itself an OECD country. The only study on Turkey examines the period 1984-1998. However, after 1998, major events and policy changes that had a substantial impact on income and health expenditures took place in Turkey, including a series of reforms to restructure the health and social security system. In contrast to earlier findings in the literature, we find that the income elasticity of total health expenditures is less than one, which indicates that health care is a necessity in Turkey during the period of analysis. According to our results, a 10% increase in per capita GDP is associated with an 8.7% increase in total per capita health expenditures, controlling for population growth. We find that the income elasticity of public health expenditures is less than one. But, in the case of private health care expenditures, the elasticity is greater than one, meaning that private health care is a luxury good in Turkey.

Privatising Healthcare in Malaysia: Power, Policy and Profits

This article examines the hypothesis that interest groups are behind the increasing privatisation of healthcare services in Malaysia. The evidence supports the instrumentalist argument that powerful interest groups seeking profits, rather than real concerns for allocative efficiency, have been the prime drivers of healthcare privatisation in Malaysia . Not only have private healthcare expenditures risen more swiftly than government healthcare expenditure but, from 1982, public funds have also been used to purchase private services from public hospitals However, unlike simple class analyses, class contention manifesting through alliances between politicians, bureaucrats and capitalists has been a major force behind healthcare privatisation in Malaysia. The source of these developments can be traced to power wielded by the government to quicken the creation of a Bumiputera capitalist class that began to gain momentum from the late 1970s.

Tests of stationarity and cointegration of health care expenditure and gross domestic product

This study examines the long-run relationship among the per capita private, public, and total health care expenditure and per capita gross domestic product and population growth of Turkey. We find some evidence of multivariate cointegrating relationships among the health care expenditure and gross domestic product, and population growth. We further find a bivariate cointegrating relationship between private health care expenditure and per capita gross domestic product. Accordingly, a 10% increase in gross domestic product would translate into a 21.9% increase in total health care expenditure while controlling population growth. The income elasticity of health expenditure is found to be greater than 1, implying that health care is a luxury good in Turkey. Finally we note that there exists one-way causality running from per capita gross domestic product to various definitions of health care expenses.

Determinants of medicine use in a Swedish primary health care practice population

Pharmaceuticals represent an increasing share of private and public health care expenditures. The aim of this study was to characterise users and to determine the pattern of uses of prescribed medicines and to identify determinants of medicine use in a multi-ethnic Swedish general practice population. The study was performed in 1055 of 1442 consecutive adult patients visiting the Jordbro Health Centre (JHC) in Stockholm, Sweden. In a regression analysis adjusted for the influence of confounders, subjects reporting 10-30 complaint symptoms, subjects with chronic disease and subjects that had a cost limitation card all reported a higher number of used medicines than subjects with a few (0-10) symptoms and those without chronic disease and a cost limitation card. In a Poisson's regression analysis, high age, female gender, not working, more than 10 symptoms, chronic disease and having a cost limitation card were related to use of prescribed medicines. All included variables predicted 19% of the explanation. Marital status, multi-symptomatology, chronic disease and having a cost limitation card were related to polypharmacy in a logistic regression analysis. A high number of complaint symptoms, chronic disease and having a cost limitation card were all significantly and independently related to use of medicines and polypharmacy.

Private medical insurance and saving: evidence from the British Household Panel Survey

This paper uses the British Household Panel Survey for the years 1996–2000 to investigate the relationship between saving and private medical insurance in the UK. Because the National Health Service (NHS) gives comprehensive health coverage and is generally free at source, one would not expect private medical insurance to crowd-out saving. However, the NHS being characterised by long waiting lists and generally poor quality, many people prefer to use private health services. In such circumstances, those individuals who are not covered by private medical insurance, and who are therefore more exposed to facing unexpected out-of-pocket private health care expenditures or income losses while waiting for public treatment might save more for precautionary reasons than those who are covered. According to our findings, which are based on a wide range of econometric specifications, there is a positive association between insurance coverage and saving, suggesting that private medical insurance does not generally crowd-out private saving. However, we found some evidence of crowding-out in those areas where the quality of medical facilities is perceived as poor, and in rural areas, characterised by fewer NHS providers.

Improving the use of pharmaceuticals through patient and community level interventions

Pharmaceuticals represent an increasing share of private and public health care expenditures. However, while most governments are interested in ensuring availability and access to drugs, the issue of adequate use of drugs remains a low priority in most third world countries. This paper summarizes the results of interventions conducted in developing countries aimed at improving patients’ compliance with the advice of health professionals and/or to decrease the unnecessary use of drugs by the general population. Forty-five studies were identified through literature searches and networking; and only about a third of them fulfilled the eligibility criteria for inclusion in the review. Given the paucity of information available and the importance of the topic the authors report on all 45 studies identified. Although much remains to be explored there are several interventions that deserve to be highlighted. The authors argue that improving the use of pharmaceuticals through interventions directed only to consumers may have a small impact and suggest that in order to obtain meaningful changes it might be necessary to design interventions to modify the behavior of all the actors in the medication cycle (manufacturers, health professionals, retailers, consumers and governments). They suggest that the extraordinary therapeutic effects of antibiotics, coupled with the problems that may arise when they are inappropriately used and with the extraordinary amount of resources spent on antibiotics worldwide justify a global effort to reduce their inappropriate use and promote their adequate administration. The complexity of this type of intervention would require the support of the pharmaceutical industry, governments, private foundations, and international organizations.

Complementarity or Substitutability between Public and Private Health Care? Evidence from Italy

This paper addresses a question that has so far been partially neglected by the literature: does public health care expenditure crowd out private health care expenditure? It shows that with an undersupply of public health, public and private health care may behave as complements even if they are substitutes. Furthermore, it proposes an indirect test for detecting the hypothesis of under(over)-supply of public services. An econometric analysis is offered in order to gauge this hypothesis with reference to Italy, by using a large panel of cross-section and time-series observations covering the twenty Italian regions over the period 1985-1992.

Changes in health financing: The Chilean experience

This paper examines the organizational and financial changes experienced by the Chilean Health System in the last 20 years. The succession of widely different political and philosophical views sponsored by the governments of Frei, Allende and Pinochet and the marked economic fluctuations experienced in the last decade have affected the organization of health care financing and the allocation of resources among the population. The trend towards a completely state financed health care system was reversed in 1973. Pinochet's government explicitely included the private sector in the provision of public health services and assigned the State a subsidiary role. Several financing mechanisms created to coopt private capital into the health system are described as well as the evolution of private and public health care expenditures. The political and economic context that shapes the allocation of limited health care resources among a population with a highly unequal income distribution may endanger the access and the quality of health care services in the country.

Cost containment--another view.

There is an emerging public consensus that in a slowly growing economy, the continuing rise in the nation's health-care costs must be moderated. Ginzberg has suggested that we can and must do this without reducing the quality of care we provide and without major changes in the structure or governance of our health-care-delivery system. He implies that we can readily identify and eliminate substantial numbers of useless health-care services. Such an approach to cost containment is almost certain to fail. A successful cost-containment program will include some or all of the following elements: caps on public health expenditures and implicit limits on the quality and accessibility of health care to be provided at public expense, much tighter government regulation of private health-care expenditures, control of the physician supply, and modification of the fee-for-service reimbursement system for physicians and hospitals. Until our society is prepared to accept these kinds of structural changes and their adverse impact, to some degree, on the quality and accessibility of health services, effective cost containment will not occur. Are we ready for these kinds of changes? Should we be? Perhaps we ought to be less concerned about cost containment and more prepared to spend 12 or 13 per cent of the gross national product on health care by 1990. What we should not do is pretend that painless cost containment is an achievable goal.

Health as an Investment

A THEORY of human capital is in the process of formulation. The primary question is "What is the contribution of changes in the quality of people to economic growth?" The academic economists first raised the question after their research showed that production in developed economies had been increasing much faster than could be explained by inputs of physical capital and additions to the labor force. But the wide interest which the question has aroused indicates much more than academic curiosity. It reflects the desires and aspirations of people throughout the world-people anxious to add weight to their demands for action against disease and illiteracy by showing that such action is not only humanitarian, but will make a major contribution to economic growth as well. Though research on the return to investment in people is barely getting started, even the most tentative conclusions have been widely quoted. Preliminary indications that the rate of return on investment in people is high have been seized upon in a growing number of countries as justification for in-