Provincial Health Expenditures Research Articles

Regional Health Accounts for Pakistan—Provincial and District Health Expenditures and the Degree of Districts Fiscal Autonomy on Health.

Since May 2009 the first National Health Accounts (NHA) for Pakistan have been finalised and published by Federal Bureau of Statistics (FBS) in cooperation with German Technical Cooperation (GTZ). This paper goes one step ahead the report and analyses in more detail the regional differences in health expenditure structures in Pakistan. The further analyses can be divided into four parts: health expenditures in provinces (Provincial Health Accounts, PHA),2 Punjab provincial and district governments health expenditures and its comparison with ADB figures, all districts of Pakistan and comparison between total district government and provincial government expenditure for each province; the latter calculation is applied as indication for the degree of fiscal autonomy of the districts in each province. Consequently we first analyse the provincial health expenditures by Financial Agents and compare them between the provinces which leads to very heterogeneous results (Section 2); the per capita health expenditures differ from 16 to 23 USD. Secondly, we compare NHA results on Punjab district government with available ADB results and present differences in methods as possible reasons for different results (Section 3). Third, we analyse district data of all district governments in all four Pakistani provinces on the level of detailed function codes in Section 4; the aim is to discover regional differences between districts of the same as well as of different provinces. Fourth, we analyse in Section 5 the degree of fiscal autonomy on health of the districts in each province; therefore we review the ordinance description and compare total district government with total provincial government expenditures per province. Finally we give recommendations for future rounds of NHA in Pakistan regarding formats and necessities of detailed health expenditure data collection to ensure evidence based decision-making not only on federal, but also on provincial and district level. JEL classification: H51, I1, O18, R1 Keywords: National Health Accounts, Health Expenditures, Regional Comparison, Regional Accounts, Fiscal Autonomy, Pakistan

Economic burden of chronic pain in Alberta, Canada.

Although chronic pain (CP) is common, little is known about its economic burden in Alberta, Canada. To estimate incremental (as compared to the general population or people without CP) societal (healthcare and lost productivity) costs of CP in Alberta. We applied the prevalence estimated from the Canadian Community Health Survey data to the population retrieved from the Statistics Canada to estimate the number of people with CP in Alberta in 2019. We analyzed the Alberta Health administrative databases to estimate the healthcare costs of person with CP. Finally, we multiplied the number of people with the cost per person. The prevalence of any CP was 20.1% and of activity-preventing CP was 14.5% among people aged > = 12 years. Incremental cost per person with CP per year was CA$2,217 for healthcare services (among people aged > = 12 years) and CA$8,412 for productivity losses (among people aged 18-64 years). Of the healthcare cost, prescription drugs accounted for the largest share (32.8%), followed by inpatient services (31.0%), outpatient services (13.1%), physician services (9.8%), other services (7.4%), and diagnostic imaging (5.8%). Provincially, total incremental cost of CP ranges from CA$1.2 to 1.7 billion for healthcare services (6% to 8% of total provincial health expenditure); and CA$3.4 to 4.7 billion for productivity losses. Considering costs for long-term care services, the total societal cost of CP in Alberta was CA$6.3 to 8.3 billion per year, reflecting 2.0% to 2.7% of Alberta's GDP. Interventions improving CP prevention and management to reduce this substantial economic burden are urgently needed.

Spatial Effect Analysis of Health Expenditure and Health Output in China From 2011 to 2018.

ObjectiveThe objective of this study is to study the spatial effects of health expenditure and health output in China.MethodsUsing the spatial panel data of 31 provinces in China from 2011 to 2018, the spatial weight matrix was introduced to analyze the spatial correlation, and the spatial Durbin model (SDM) was used to investigate the health output effect of health expenditure.ResultsExcluding the number of doctors per thousand, the provincial health expenditure, the number of beds per thousand population, and per capita education level had a positive impact on the regional health output. The health effect of China's health inputs showed a spatial spillover effect.ConclusionDue to the significant spatial effect, the health output of 31 provinces in China benefits not only from the local health inputs, but also from the health inputs of neighboring provinces.SuggestionsThis article puts forward some suggestions based on the conclusion: China should strengthen the health cooperation among neighboring provinces, promote the free flow of various health factors among provinces, make full use of the spillover and interdependence of health investment among provinces, and improve the medical policy environment in China.

Study of influential factors of provincial health expenditure -analysis of panel data after the 2009 healthcare reform in China

BackgroundTotal Healthcare Expenditure (THE) has increased substantially in all countries. Since the health system reform and health policy environment differ from each country, it is necessary to analyze the motivations of THE in a specific country.MethodsThe objective of this study was to analyze the influential factors of Provincial THE (PTHE) per capita in China by using spatiotemporal panel data across 31 provinces (including provinces, autonomous regions, and municipalities, all called provinces in here) from 2009 to 2016 at the provincial and annual level. Generalized Estimating Equation (GEE) was used to identify the influential factors of PTHE per capita.ResultsThe number of beds per 10,000 population explained most of the variation of PTHE per capita. The results also showed that health expenditure in China reacts more to mortality compared with the Gross Domestic Product (GDP) per capita. But mortality and Out-Of-Pocket Payments (OOP) as a percentage of THE were associated with PTHE per capita negatively. The rate of infectious diseases and THE as a percentage of GDP had no statistical significance. And the Proportion of the Population Aged 65 and Over (POP65) impact PTHE per capita positively. But the coefficient was small.ConclusionsIn response to these findings, we conclude that the impact of the increasing percentage of OOP in THE diminishes the PTHE. Furthermore, we find that both the “baseline” health level and health provision are positively correlated with PTHE, which outweighs the effect of GDP.

Provincial health expenditure and cardiovascular disease mortality, a panel data study of Canadian provinces.

Health expenditures on cardiovascular disease (CVD) account for a large proportion of health care expenditures of all the diseases in Canada, and hence there is a need to examine the responsiveness of CVD outcomes to health expenditures. The objective of this study was to examine the relationship between health care expenditures and CVD mortality, as a health care outcome at the provincial level in Canada. A 10-year (2000-2009) panel dataset was constructed from multiple data sources for the purposes of this study. The dataset composed of age standardized CVD mortalities, health care expenditures, and covariates for the 10 Canadian provinces. We employed a fixed effects model based on the results of the Hausman test, with CVD mortalities as the dependent variable and health care expenditure and other covariates, as explanatory variables. Health care expenditures were significantly (0.05) and negatively associated with CVD mortality, with a 1% increase in health care expenditures associated with a decrease of 6.31 per 1000000 people in CVD mortality. In the Canadian context, increases in spending on health care were associated with improvements in CVD outcomes for the time period under investigation.

Utilisation and costs of nursing agencies in the South African public health sector, 2005–2010

Background Globally, insufficient information exists on the costs of nursing agencies, which are temporary employment service providers that supply nurses to health establishments and/or private individuals. Objective The aim of the study was to determine the utilisation and direct costs of nursing agencies in the South African public health sector. Design A survey of all nine provincial health departments was conducted to determine utilisation and management of nursing agencies. The costs of nursing agencies were assumed to be equivalent to expenditure. Provincial health expenditure was obtained for five financial years (2005/6–2009/10) from the national Basic Accounting System database, and analysed using Microsoft Excel. Each of the 166,466 expenditure line items was coded. The total personnel and nursing agency expenditure was calculated for each financial year and for each province. Nursing agency expenditure as a percentage of the total personnel expenditure was then calculated. The nursing agency expenditure for South Africa is the total of all provincial expenditure. The 2009/10 annual government salary scales for different categories of nurses were used to calculate the number of permanent nurses who could have been employed in lieu of agency expenditure. All expenditure is expressed in South African rands (R; US$1 ∼ R7, 2010 prices). Results Only five provinces reported utilisation of nursing agencies, but all provinces showed agency expenditure. In the 2009/10 financial year, R1.49 billion (US$212.64 million) was spent on nursing agencies in the public health sector. In the same year, agency expenditure ranged from a low of R36.45 million (US$5.20 million) in Mpumalanga Province (mixed urban-rural) to a high of R356.43 million (US$50.92 million) in the Eastern Cape Province (mixed urban-rural). Agency expenditure as a percentage of personnel expenditure ranged from 0.96% in KwaZulu-Natal Province (mixed urban-rural) to 11.96% in the Northern Cape Province (rural). In that financial year, a total of 5369 registered nurses could have been employed in lieu of nursing agency expenditure. Conclusions The study findings should inform workforce planning in South Africa. There is a need for uniform policies and improved management of commercial nursing agencies in the public health sector.

The determinants of Canadian provincial health expenditures: evidence from a dynamic panel

This article seeks to reveal the magnitude of the income elasticity of health expenditure and the impact of non income determinants of health expenditure across Canada. For this purpose, panel data on gross domestic product, the relative price of health care, the share of publicly funded health expenditure, the share of senior population and the life expectancy at birth have been used to investigate the determinants of Canadian provincial health expenditures over a 28 year period. Dynamic models of health expenditure are analysed via Generalized Instrumental Variables (GIV) and Generalized Method of Moments (GMM). Results indicate that the long run income elasticity of health expenditure is substantially lower than one. Thus, health care is far from being a luxury in Canada.

The Canadian Joint Replacement Registry—what have we learned?

The Canadian Joint Replacement Registry (CJRR) was launched in 2000 through the collaborative efforts of the Canadian Orthopedic Association and the Canadian Institutes for Health Information. Participation is voluntary, and data collected by participating surgeons in the operating room is linked to hospital stay information from administrative databases to compile yearly reports. In the fiscal year 2006–2007, there were 62,196 hospitalizations for hip and knee replacements in Canada, excluding Quebec. This represents a 10-year increase of 101% and a 1-year increase of 6%. Compared to men, Canadian women have higher age-adjusted rates per 105 for both TKA (148 vs. 110) and THA (86 vs. 76). There also exist substantial inter-provincial variations in both age-adjusted rates of arthroplasty and implant utilization that cannot be explained entirely on the basis of differing patient demographics. The reasons for these variations are unclear, but probably represent such factors as differences in provincial health expenditure, efforts to reduce waiting lists, and surgeon preference. The main challenge currently facing the CJRR is to increase procedure capture to > 90%. This is being pursued through a combination of efforts including simplification of the consent process, streamlining of the data collection form, and the production of customized reports with information that has direct clinical relevance for surgeons and administrators. As the CJRR continues to mature, we are optimistic that it will provide clinically important information on the wide range of factors that affect arthroplasty outcome.