Proportion Of Total Expenditure Research Articles

Which health conditions report the most spending on medical imaging? Evidence for Colombia

Medical imaging is essential for the proper diagnosis and treatment of many diseases. The literature has found that medical imaging generally accounts for a significant percentage of total healthcare spending. We analyzed a national database between 2013 and 2021, with more than 19 million patients on average, to review which health conditions account for the highest spending on medical imaging in the Colombian health system. We segmented the analysis by type of medical imaging, life cycles, health condition and sex. Our findings indicate that cardiac and mental illnesses account for the highest per capita spending on medical imaging, especially for the elderly. As a proportion of total expenditure, hypertension and tuberculosis are added, with special emphasis on the infancy-childhood life cycle.

Changes in household food grocery shopping patterns in Melbourne, Australia during COVID-19 restrictions in 2020

ObjectiveTo investigate the impact of COVID-19 restrictions in Melbourne, 2020, on food grocery purchases. MethodsGrocery purchase data for 2019 and 2020 were accessed for 1,413 Melbourne households (NielsenIQ Homescan Consumer Panel) and linked to a nutrition composition database (FoodSwitch). ResultsPer capita expenditure and dietary energy from groceries increased by 21.2% and 17.7%, respectively, during lockdowns, with marginally larger increases in expenditure and energy purchases from unhealthy products than healthy products (21.9% and 18.0% v 20.2% and 17.5%). The most socioeconomically disadvantaged households spent the least on but purchased the most energy from unhealthy products during lockdowns ($108 and 109MJ per capita per month), with the inverse found for the most advantaged households ($121 and 102MJ per capita per month). An increase in the overall proportion of total expenditure from unhealthy products during lockdowns was identified (+0.7%); however, there was no evidence of a difference in the proportion of energy purchased from unhealthy products. For most quintiles of household socioeconomic disadvantage/advantage, there were no statistically significant changes in the contribution of unhealthy products to total expenditure and energy purchases. ConclusionsThere was no substantial deterioration in the healthiness of grocery purchases during COVID-19 lockdowns in Melbourne. However, any additional purchases of unhealthy products are a concern. Further research on other sources of foods and drinks is also required to ascertain impacts on broader dietary patterns. Implications for public healthThe increase in energy purchased may have implications for overweight and obesity as a risk factor for COVID-19 and chronic diseases. Governments and retailers may need to consider measures to encourage improved diet quality during future crises.

Components of Out-of-Pocket Expenditure and Their Relative Contribution to Economic Burden of Diseases in India

High out-of-pocket expenditure (OOPE) on health in India may limit achieving universal health coverage. A clear insight on the components of health expenditure may be necessary to make allocative decisions to reduce OOPE, and such details by sociodemographic group and state have not been studied in India. To analyze the relative contribution of drugs, diagnostic tests, doctor and surgeon fees, and expenditure on other medical services and nonmedical health-related services, such as transport, lodging, and food, by sociodemographic characteristics of patients, geography, and type of illness. A population-based cross-sectional health consumption survey conducted by the National Sample Survey Organisation in 2018 was analyzed in this cross-sectional study. Respondents who provided complete information on costs of medicine, doctors, diagnostics tests, other medical costs, and nonmedical costs were selected. Data were analyzed from August through September 2021. Mean and median share of components (ie, medicine, diagnostic tests, doctor fees, other medical costs, and nonmedical costs) in total health care expenditure and income were calculated. Bivariate survey-weighted mean (with 95% CI) and median (IQR) expenditures were calculated for each component across sociodemographic characteristics. The proportion of total expenditure and income contributed by each cost was calculated for each individual. Mean and median were then used to summarize such proportions at the population level. The association between state net domestic product per capita and component share of each health care service was graphically explored. Health expenditure details were analyzed for 43 781 individuals for inpatient costs (27 272 [64.3%] women; 26 830 individuals aged 25-64 years [59.9%]) and 8914 individuals for outpatient costs (4176 [48.2%] women; 4901 individuals aged 25-64 years [54.2%]); most individuals were rural residents (24 106 inpatients [67.0]; 4591 outpatients [63.9%]). Medicines accounted for a mean of 29.1% (95% CI, 28.9%-29.2%) of OOPE among inpatients and 60.3% (95% CI, 59.7%-60.9%) of OOPE among outpatients. Doctor consultation charges were a mean of 15.3% (95% CI, 15.1%-15.4%) of OOPE among inpatients and 12.4% (95% CI, 12.1%-12.6%) of OOPE among outpatients. Diagnostic tests accounted for a mean of 12.3% (95% CI, 12.2%-12.4%) of OOPE for inpatient and 9.2% (95% CI, 8.9%-9.5%) of OOPE for outpatient services. Nonmedical costs accounted for a mean of 23.6% (95% CI, 23.3%-23.8%) of OOPE among inpatients and 14.6% (95% CI, 14.1%-15.1%) of OOPE among outpatients. Mean share of OOPE from doctor consultations and diagnostic test charges increased with socioeconomic status. For example, for the lowest vs highest monthly per capita income quintile among inpatients, doctor consultations accounted for 11.5% (95% CI, 11.1%-11.8%) vs 21.2% (95% CI, 20.8%-21.6%), and diagnostic test charges accounted for 10.9% (95% CI, 10.6%-11.1%) vs 14.3% (95% CI, 14.0%-14.5%). The proportion of mean annual health expenditure from mean annual income was $299 of $1918 (15.6%) for inpatient and $391 of $1788 (21.9%) for outpatient services. This study found that nonmedical costs were significant, share of total health care OOPE from doctor consultation and diagnostic test charges increased with socioeconomic status, and annual cost as a proportion of annual income was lower for inpatient than outpatient services.

Mayors, Using Cultural Expenditure in An Opportunistic Way Improves the Chances of Re-Election, but Do Not Do It: Revisiting Political Budget Cycles

This article analyzes whether expenditure on the provision of merit goods, culture, health, education, and sports, by local governments, in medium-sized cities (between 20,000 and 100,000 inhabitants) is tied to the electoral cycle; that is, whether expenditure increases in the run up to an electoral process. Further, we analyze whether the increase in spending on Culture by local governments has any significant effect on the probability of local governments being re-elected. To answer these questions, a database of 350 medium-sized municipalities is used comprising the period 2011 to 2019, when two municipal elections were held in Spain; in 2015 and in 2019. The results confirm that both total spending and spending on culture and sports, are tied to the electoral cycle, while expenditure on other merit goods is not. Moreover, using a logit model, it is confirmed that an increase in culture expenditure has a significant effect on the probability of the government being re-elected. Specifically, a one-third increase in cultural expenditure, as a proportion of total expenditure (e.g., passing from 6% to 8%) at local government level, improves re-election chances by almost 10%.

Community-level interventions for improving access to food in low- and middle-income countries.

Community-level interventions for improving access to food in low- and middle-income countries.

Community-level interventions for improving access to food in low- and middle-income countries.

Community-level interventions for improving access to food in low- and middle-income countries.

Retail-based healthy food point-of-decision prompts (PDPs) increase healthy food choices in a rural, low-income, minority community.

This study examines the potential for point-of-decision prompts (PDPs) to promote healthier food choices among shoppers in a rural, low-income, minority community. We hypothesized that a narrowly defined PDP (focused on fresh produce) would be easier for shoppers to remember than a broadly defined PDP (focused on any healthy items), resulting in a higher proportion of healthy items purchased. PDPs were placed at the entrance to a supermarket in Mission, South Dakota, United States of America, on the Rosebud Sioux Reservation for alternating time periods, July 9–10, 2017. Sales records from 653 transactions were retrieved from the supermarket, comprising periods in which PDPs were in place and control periods. We examined the proportion of selected items and proportion of total expenditures that were a) any healthy foods and b) fresh fruits and vegetables. Data were analyzed in 2018. The narrowly defined prompt consistently resulted in a higher proportion of items and expenditures on healthy foods than either the broad prompt or the control condition. Shoppers in the narrow prompt condition purchased and spent significantly more on any healthy foods and fresh produce than shoppers in the control condition. While shoppers in the narrow prompt condition purchased more healthy foods and fresh produce than shoppers in the broad prompt condition, the differences were not statistically significant. Shoppers exposed to the narrow PDP consistently purchased more healthy foods than shoppers in a control group, while shoppers in the broad PDP did not, highlighting the importance of considering cognitive processes when designing health promotion messages.

Financial Implications of Car Ownership and Use: a distributional analysis based on observed spatial variance considering income and domestic energy costs

This paper presents a new perspective on assessing the financial impacts of private car usage in England and Wales using novel datasets to explore implications of motoring costs (principally Vehicle Excise Duty and road fuel costs) for households as part of the overall costs of their energy budget. Using data from an enhanced version of the Department for Transport ‘MOT’ vehicle test record database, combined with data on domestic gas and electricity consumption from the Department for Business, Energy and Industrial Strategy (formerly the Department of Energy and Climate Change), patterns of car usage and consequent energy consumption are investigated, and the costs of Vehicle Excise Duty and road fuel examined as a proportion of total expenditure on household direct energy consumption. Through the use of these new datasets it is possible to analyse how these vary spatially and in relation to levels of median income. The findings indicate that motoring costs are strongly regressive, with lower income areas, especially in rural locations, spending around twice as much of their income on motoring costs as the highest income areas.

Comparison of pharmaceutical policies to stimulate use of generics in Japan and Sweden

ObjectivesAmong OECD countries, the proportion of total expenditure on health spent on pharmaceuticals is highest in Japan, 20%. In Sweden, the corresponding proportion is 13%. Swedish pharmaceutical expenditures increased dramatically in the 1990s and policy changes were introduced to curb this. Both countries have introduced policy changes to increase cost containment. This study aims to compare the pharmaceutical policies regarding generic medicines in Japan and Sweden. MethodsInformation on pharmaceutical policies was collected. We compared pharmaceutical policies according to the 4E (Education, Engineering, Economics, and Enforcement) component framework developed to describe the differences in policies. Results and conclusionsIn Sweden, there were several organizational and managerial interventions within the Engineering class. Japan had several positive incentives for health care actors in the Economics category. The Enforcement category had a stronger legal component in Sweden compared to Japan. The Swedish policies were mainly directed towards prescribing and dispensing whereas the Japanese addressed several stakeholders to promote use of generic drugs. The countries were similar with respect to the Education category. Within the Enforcement component the Swedish policies were legally enforced whereas the Japanese to large extent were recommendations.

Affordability of Healthcare in the Eight North Eastern States of India

The government dominates the healthcare sector in the eight North Eastern States of India and hence the average expenditure on treatment is much lower as compared to the all-India average where private sector dominates. However, as a proportion of total expenditure, a substantial portion goes into non-medical expenses, thus offsetting the advantage of lower cost of medical care. Expenditure on medicines accounted for the largest share of expenditure item in medical treatment, which can be contained through public procurement by the government through tendering process. Loans from banks at minimum cost/interest rate could be made available for expenditure on non-medical expenses. There is need to improve public (government) healthcare sector terms of quantity, quality and reach especially in the rural areas by providing adequate infrastructure (including road connectivity, accommodation, etc), manpower and facilities. This calls for huge public expenditure.

The effect of age and sex on cost of inpatient facility encounters among patients with multiple sclerosis

Objective:To explore the effect of age and sex on cost of all-cause and multiple sclerosis (MS)-related inpatient facility encounters.Methods:Adult patients with an initial MS diagnosis were identified from a national managed-care database (IMS LifeLink Health Plans Database). The analysis included newly diagnosed MS patients with 12 months insurance eligibility before and after their first MS diagnosis. Inpatient facility encounters (stays) were analyzed for all-cause and MS-related events (ICD-9-CM = 340.XX), other demyelinating CNS disease (ICD-9-CM = 341.XX), rehabilitation (ICD-9-CM = V57.89), and a group of symptom-related diagnoses. Costs and length of stay were evaluated using a general linear model controlling for age and sex.Results:A total of 57,236 patients met study criteria; 74.3% were female. Mean age for females was 45.5 years and for males it was 47.5 years. In total, 17.0% had an all-cause inpatient stay in the 360-day post index, and 3.2% had an in patient stay with a MS relapse-related diagnosis as primary discharge diagnosis. Additional MS-related diagnoses that led to inpatient stays included other demyelinating CNS disease (0.3%), symptom-related diagnoses (1.0%), and rehabilitation (1.1%). All-cause inpatient cost was higher for males vs females across all age groups; however, cost for females increased at a greater rate as age increased (p = 0.0007). Symptom-related inpatient cost was flat for males, was lower for females than males at an average age of 30, and was greater for females than males at an average age of 60 (p = 0.0199). Cost for MS inpatient stays ($11,931), other demyelinating CNS-related stays ($14,931), and rehabilitation ($23,643) did not differ by age and sex. The average cost for any MS-related relapse inpatient stay was $13,761 and varied with increasing age (p < 0.0001).Conclusion:Burden of illness for relapse among MS patients is substantial. Costs vary by age and sex depending on the discharge diagnosis. Inclusion of symptom-related and rehabilitation inpatient stays may account for an under-recognized proportion of total expenditures.

Ffects of the Demographic Changes on Private Consumption: An Almost Ideal Demand System Analysis for Austria

Abstract: The following paper analyzes potential effects of the demographic changes on private consumption. An extended Almost Ideal Demand System is used to simulate changes in the consumption of goods and services due to the ageing of the population in Austria – on national as well as regional level. Therefore, age-specific income elasticity and price elasticity are estimated. The estimated model is used to simulate the consumption structure in 2030 for four scenarios: Firstly, only the ageing process of the population is considered. Secondly, the ageing as well as changes in household structure are taken into account. Scenario three and four furthermore consider potential changes in income distribution due to the ageing as well as price changes and its effects on the consumption structure of the ageing society. The results reveal direct positive effects of the ageing of the population on the consumption shares of food and non-alcoholic beverages, housing, water and fuel, health, as well as miscellaneous goods and services, while the consumption category transport looses the highest proportion in total consumption. But it can also be seen that these results do not hold anymore as soon as potential changes in income distribution – as indirect effect of the ageing – are considered.

Evaluating health care delivery reform initiatives in the face of "cost disease".

The authors analyzed historical claims data from 2007 to 2011 from the Vermont All-Payer Claims database for all individuals covered by commercial insurance and Medicaid to determine per capita inpatient expenditures, cost per discharge, and cost per inpatient day. The authors further evaluated the proportion of all health care expenditure allocated to mental health, maternity care, surgical services, and medical services. Although utilization of inpatient services declined during the study period, cost per discharge and cost per inpatient day increased in a compensatory manner. Although the utilization of inpatient services by the Medicaid population decreased by 8%, cost per discharge increased by 84%. Among the commercially insured, discharges per 1000 members were essentially unchanged during the study period and inpatient cost per discharge increased by a relatively modest 32%. The relative utilization of mental health, maternity care, surgical services, and medical services was unchanged during the study period. The significant increase in the cost of inpatient services increased the proportion of total expenditure on surgical services from 21% in 2007 to 33% in 2011. The authors conclude that although health care providers are increasingly being assessed on their ability to control health care costs while achieving better outcomes, there are many cost drivers that are outside of their control. Efforts to assess initiatives, such as patient-centered medical homes, should be focused on utilization trends and outcomes rather than cost or, at a minimum, reflect cost drivers that physicians and other providers cannot influence.

Comparing Types of Local Public Health Agencies in North Carolina

Some states are considering restructuring local public health agencies (LPHAs) in hopes of achieving long-term efficiencies. North Carolina's experience operating different types of LPHAs, such as county health departments, district health departments, public health authorities, and consolidated human services agencies, can provide valuable information to policy makers in other states who are examining how best to organize their local public health system. To identify stakeholders' perceptions of the benefits and challenges associated with different types of LPHAs in North Carolina and to compare LPHA types on selected financial, workforce, and service delivery measures. Focus groups and key informant interviews were conducted to identify stakeholders' perceptions of different LPHA types. To compare LPHA types on finance, workforce, and service delivery measures, descriptive statistical analyses were performed on publicly available quantitative data. North Carolina. Current and former state and local public health practitioners, county commissioners, county managers, assistant managers, state legislators, and others. In addition to identifying stakeholders' perceptions of LPHA types, proportion of total expenditures by funding source, expenditures per capita by funding source, full-time equivalents per 1000 population, and percentage of 127 tracked services offered were calculated. Stakeholders reported benefits and challenges of all LPHA types. LPHA types differ with regard to source of funding, with county health departments and consolidated human services agencies receiving a greater percentage of their funding from county appropriations than districts and authorities, which receive a comparatively larger percentage from other revenues. Types of LPHAs are not entirely distinct from one another, and LPHAs of the same type can vary greatly from one another. However, stakeholders noted differences between LPHA types-particularly with regard to district health departments-that were corroborated by an examination of expenditures per capita and full-time equivalents per 1000 population.

Low microbial respiration of leucine at ambient oceanic concentration in the mixed layer of the central Atlantic Ocean

Bacterioplankton are the primary consumers of dissolved organic matter in the ocean, thus the quantification of bacterioplankton production (BP) is essential to our understanding of carbon cycling in the largest ecosystems on Earth. We compared BP, measured as the rate of 14C‐leucine or 3H‐leucine uptake at close to saturating concentration (20 nmol L−1), with ambient uptake measured from dilution bioassays. We hypothesized that saturation with leucine would lead to its respiration as a carbon source, thereby not truly representing ambient BP. Seawater was collected from the photic zone throughout the Atlantic Ocean. Respiration as a proportion of total consumption (uptake + respiration) of close to ambient (0.4 nmol L−1) and close to saturating (20 nmol L−1) 14C‐leucine concentrations were compared. Saturating 3H‐leucine additions overestimated ambient leucine uptake at low rates (200% ± 100% ambient) and underestimated uptake at high rates (90% + 20% ambient). The proportion of total leucine uptake that was respired was threefold higher for 20 nmol L−1 14C‐leucine additions than 0.4 nmol L−1 14C‐leucine additions (15% ± 8% and 5% ± 4%, respectively). Consequently, microbial efficiency of leucine assimilation—an indicator of bacterioplankton growth efficiency—was significantly higher and more stable at close to ambient 14C‐leucine additions than at saturating concentrations (95% ± 4% and 85% ± 8%, respectively). Thus, saturation of oligotrophic open Atlantic Ocean bacterioplankton with leucine, or other molecules indicative of microbial metabolism, leads to the measurement of a response to a nutrient addition, rather than an ambient measurement.

Has Vietnam Health care funds for the poor policy favored the elderly poor?

BackgroundThe elderly population is increasing in Vietnam. Access to health services for the elderly is often limited, especially for those in rural areas. User fees at public health care facilities and out-of-pocket payments for health care services are major barriers to access. With the aim of helping the poor access public health care services and reduce health care expenditures (HCE), the Health Care Funds for the Poor policy (HCFP) was implemented in 2002. The aim of this study is to investigate the impacts of this policy on elderly households.MethodsElderly households were defined as households which have at least one person aged 60 years or older. The impacts of HCFP on elderly household HCE as a percentage of total expenditure and health care utilization were assessed by a double-difference propensity score matching method using panel data of 3,957 elderly households in 2001, 2003, 2005 and 2007, of which 509 were classifies as “treated” (i.e. covered by the policy). Variables included in a logistic regression for estimating the propensity scores to match the treated with the control households, were household and household-head characteristics.ResultsIn the first time period (2001–2003) there were no significant differences between treated and controls. This can be explained by the delay in implementing the policy by the local governments. In the second (2001–2005) and third period (2001–2007) the utilizations of Communal Health Stations (CHS) and go-to-pharmacies were significant. The treated were using CHS and pharmacies more between 2001 and 2007 while control households decreased their use.ConclusionThe main findings suggest HCFP met some goals but not all in the group of households having at least one elderly member. Utilization of CHS and pharmacies increased while the change in HCE as a proportion of total expenditures was not significant. To some extent, private health care and self-treatment are replaced by more utilization of CHS, indicating the poor elderly are better off. However, further efforts are needed to help them access higher levels of public health care (e.g. district health centers and provincial/central hospitals) and to reduce their HCE.

Open Access Pricing Models would Reduce Journal Expenditure at Most Colleges and Universities

Open Access Pricing Models would Reduce Journal Expenditure at Most Colleges and Universities

Health Care for Children and Youth in the United States: 2002 Report on Trends in Access, Utilization, Quality, and Expenditures

To examine changes in insurance coverage, health care utilization, perceived quality of care, and expenditures for children and youth in the United States using data from 1987-2001. Three national health care databases serve as the sources of data for this report. The Medical Expenditure Panel Survey (1996-2001) provides data on insurance coverage, utilization, expenditures, and perceived quality of care. The National Medical Expenditure Survey (1987) provides additional data on utilization and expenditures. The Nationwide Inpatient Sample (1995-2000) from the Healthcare Cost and Utilization Project provides information on hospitalizations. The percent of children uninsured for an entire year declined from 10.4% in 1996 to 7.7% in 1999. Most changes in children's health care occurred between 1987 and the late 1990s. Overall utilization of hospital-based services has declined significantly since 1987, especially for inpatient hospitalization. Several of the observed changes from 1987 varied significantly by type of health insurance coverage, poverty status, and geographic region. Quality of care data indicate some improvement between 2000 and 2001, which varies by insurance coverage. Overall, mean length of stay of hospitalizations did not change significantly from 1995 to 2000, but changes in the prevalence of hospitalizations and the length of stay associated with age-specific diagnoses were evident during this time period. Health care for children and youth has changed significantly since 1987, with most of the changes occurring between 1987 and 1996. Insurance coverage has improved, the site of care has shifted toward ambulatory sites, hospital utilization has declined, and expenditures on children as a proportion of total expenditures have decreased. Variation in these changes is evident by insurance status, poverty, and region.

Decentralization in Zambia: resource allocation and district performance.

Zambia implemented an ambitious process of health sector decentralization in the mid 1990s. This article presents an assessment of the degree of decentralization, called 'decision space', that was allowed to districts in Zambia, and an analysis of data on districts available at the national level to assess allocation choices made by local authorities and some indicators of the performance of the health systems under decentralization. The Zambian officials in health districts had a moderate range of choice over expenditures, user fees, contracting, targeting and governance. Their choices were quite limited over salaries and allowances and they did not have control over additional major sources of revenue, like local taxes. The study found that the formula for allocation of government funding which was based on population size and hospital beds resulted in relatively equal per capita expenditures among districts. Decentralization allowed the districts to make decisions on internal allocation of resources and on user fee levels and expenditures. General guidelines for the allocation of resources established a maximum and minimum percentage to be allocated to district offices, hospitals, health centres and communities. Districts tended to exceed the maximum for district offices, but the large urban districts and those without public district hospitals were not even reaching the minimum for hospital allocations. Wealthier and urban districts were more successful in raising revenue through user fees, although the proportion of total expenditures that came from user fees was low. An analysis of available indicators of performance, such as the utilization of health services, immunization coverage and family planning activities, found little variation during the period 1995-98 except for a decline in immunization coverage, which may have also been affected by changes in donor funding. These findings suggest that decentralization may not have had either a positive or negative impact on services.

Extração de Alimento por Cosmoclopius nigroannulatus Stål (Hemiptera: Reduviidae) de Ninfas de Spartocera dentiventris (Berg) (Hemiptera: Coreidae)

Avaliou-se a extração de alimento por Cosmoclopius nigroannulatus Stål, de ninfas de primeiro ínstar de Spartocera dentiventris (Berg). O experimento foi conduzido em laboratório, utilizando-se 10 adultos de cada sexo de C. nigroannulatus, recém-emergidos, em cada quantidade de ninfas de (5,1, 14,7, 29,8, 36,6 e 44,8 mg oferecidas aos machos e 5,5, 14,7, 31,1, 37,4 e 48,5 mg oferecidas às fêmeas). A cada 24h, por cinco dias, registrava-se o peso dos adultos, a quantidade total de ninfas consumidas, o peso das ninfas remanescentes, tempo gasto em ingerir o alimento, estimando-se a quantidade e o percentual de alimento extraído de cada ninfa, a quantidade extraída por minuto, as sobras e a taxa de consumo relativa. Em ambos os sexos, houve um aumento no consumo total de ninfas ingeridas, no ganho de peso, nas sobras de alimento e na taxa de consumo, com o aumento da quantidade de ninfas oferecidas e uma diminuição na taxa de consumo total, na quantidade e no percentual de alimento extraído e na quantidade extraída por minuto. O consumo total e a quantidade de alimento extraído por presa estabilizaram-se a cerca de 29,8 g e 31,1 mg, respectivamente para os machos e para as fêmeas, não sendo evidenciada correlação do tempo de ingestão com o número de ninfas. As fêmeas consumiram e ganharam mais peso que os machos, ingerindo o alimento mais rapidamente. Os resultados sugerem que o comportamento alimentar do predador está diretamente relacionado com a quantidade de presas disponíveis.