Share Of Health Expenditure Research Articles

The Effects of Health Expenditure on Health Outcomes Based on the Classification of Public Health Expenditure: A Panel Data Approach

Background: Health expenditure is among the factors affecting the improvement of a society’s health status. Hence, recognizing the effects of public and private health expenditure on health status is vital for making the required decisions. Objectives: This study aimed to compare the effects of different levels of health expenditure on life expectancy, infant mortality rate, and under-five mortality rate as health indicators. Methods: The current study is an analytical research, which was conducted based on a cross-sectional and annual time series data. In this study the effects of private and public health expenditure on health indicators from 2000 to 2015 were investigated. The selected countries had the middle or high-income level and were classified into three groups based on the public health expenditure rate and k-mean method. The required data were collected from the World Bank site and for estimating the model, panel data regression models were used. Results: Public health expenditure had a significant effect on health indicators in all groups, thus, an increase in public health expenditure led to increasing life expectancy and decrease infant and under-five mortality rate in all groups. Also, the group with the highest share of health expenditure had a greater impact on life expectancy and infant mortality, however, in regards to the under-five mortality rate, it was contrary. The effect of private health expenditure was different and in most cases it had no significant effect. Conclusions: The findings of this study indicated that public health expenditure is more effective than the private health expenditure and it also improved health status by creating positive external effects. Therefore, the governments must provide enough required financial resources for improving health status.

Gender difference in quarterly out of pocket expenditure on Diabetes care in Thoothukudi – a cross-sectional study.

Background: Diabetes Mellitus is a long term disease which require higher medical expenditure. If inadequately treated or undiagnosed, it leads to multiple chronic complications, which again increase the expenditure multi-fold. Gender has got implications in diabetes care due to sex differences as well as that of social inequities entrenched within gender. This study is done to compare quarterly Out of Pocket expenditure (OOPE) on diabetes care with gender as a covariate. Methods : Quarterly OOPE is defined as any expenditure incurred by households as a payment to health practitioners and suppliers of pharmaceuticals, therapeutic appliances and other goods and services during the last three months due to diabetes. A cross sectional study was done in Thoothukudi Corporation among 180 diabetic patients using a semi structured questionnaire. Results: Among the study participants, 49.2%were males and 50.8% were females. The median quarterly OOPE for males was Rs.2387 with an interquartile range of Rs.2742 and that of females was Rs.1249.42 with an interquartile range of Rs.2836 which was statistically significant(p value -.0.01). The proportion of family monthly income spent on diabetes care was also significantly lower for women(2.6%) compared to men (4.48%). Conclusion: The quarterly OOP expenditure was significantly lower among women compared to men. In a country like India, where larger share of health expenditure is contributed through OOPE, this finding is revealing that gender equity in diabetes care is nowhere near its reach.

Transition of Hospital Acute-Centric to Long Term Care in An Ageing Population in Hong Kong - Is it an issue of service gap?

Health expenditure at around 5.7% GDP is low for a developed society like Hong Kong, which is unique in having a dual track of public and private services in its health care system. Such phenomenon has been steady over the last three decades, apparently not affected at all by a major change in the Government in 1997. The public and private sections have equal share of the total health dollars consistently over the years, despite the increase of Government’s annual spending from 11% to 17% since 1990, implying a similar trend in the private sector, which is funded predominantly by out of the pocket expenses with some insurance contribution. However, Hong Kong has the longest life expectancy in the world. This has resulted in the increase in the demand for health and long-term care, casting doubt on whether the traditional model of financing and delivery of care will be sustainable. The Government has pledged that that no one is denied adequate medical treatment due to lack of means, a stance in existence for decades and being reflected by the steady state of public and private share of health expenditure. Apart from two major re-structuring of the governance system, there has been little change in the service provision organisations. The system is often criticized for being heavily hospital based and acute-centric, particularly in the public services. Primary care is taken up predominantly by the private sector, mostly in clinical services, not focusing on prevention. It is apparent that there is a significant service gap, that needs to be examined and addressed systematically before a practical solution can be formulated. A more holistic, humanistic and better integrated system of care, with innovative care patterns, shall be the way forward.

The causality of road traffic fatalities with its determinants in upper middle income countries: A continent-wide comparison

This study aims to compare the causality and elasticity of road traffic fatalities (RTF) with their determinants for upper middle income countries from three continents by using annual data from 1994 to 2016. Vector Error Correction Model revealed the long run causality of RTF (Asia, Europe, America), GDP (Asia), rainfall (Europe), and population density (Europe, America). Two-way short-run causality was established in three panels of UMICs between RTF and rainfall (Asia), RTF and GDP (Europe, America), and RTF and population density (America). Short-run uni-directional causal association was also observed from RTF to GDP (Asia), RTF to rainfall (Europe, America), RTF to population density (Asia, Europe), and health expenditures to RTF (Europe). A significant fall in RTF was observed due to 1% rise in the share of health expenditures in GDP in UMICs from Asia (0.267%), Europe (0.064%), and America (0.549%). The significant rise in RTF was0.180%, 0.241%, and 0.702%due to 1%increase in per capita GDP in Asia, Europe, and America. The road safety is reduced due to rainfall because the rise in RTF was 0.082%and 0.260%for 1% rise in the rainfall in Asia and America, respectively. The impact of population density was beneficial for the road safety because the decrease in RTF was 0.246%, 0.234%, and 0.977% for 1% rise in the population density in Asia, Europe, and America. The governments should make strict policies for traffic laws implementation. The government should allocate more budget for health sector expenditures. The governments should include traffic education as part of syllabus from primary to higher studies. Government should create awareness about the loss due to road crashes.

R&D-driven medical progress, health care costs, and the future of human longevity

We set up a life-cycle model of gerontologically founded human aging with overlapping generations to make quantitative inferences about the future development of morbidity, life expectancy, and the health expenditure share in GDP, conditional on the extent of future access to health care. Importantly, we take into account the endogeneity of medical technology to health good demand. For the baseline policy scenario of health care access, the calibrated model predicts substantial future increases in health and life expectancy, associated with rising shares of health expenditure in GDP. Fixing the expenditure share at the 2020 level severely reduces potential gains in health, longevity and welfare; for example, reducing the gains in life-expectancy at age 65 by about 4 years in the year 2050. Perhaps surprisingly, young individuals (i.e. those who would save the most health care contributions) would suffer the greatest losses in terms of life expectancy and welfare. These results reflect reduced incentives for medical R&D.

The welfare implications of public healthcare financing: a macro-micro simulation analysis of Uganda.

Studies on global health and development suggest that there is a strong correlation between the burden of disease and a country's level of income. Poorer countries tend to suffer more deaths from preventable causes such as communicable, maternal, perinatal and nutritional conditions, compared with high-income countries. In low-income countries, the government health expenditure share in the general government budget is low and out-of-pocket payments for healthcare relatively high. They also rely heavily on external resources for health funding, yet sustainability of external resource flows is not guaranteed. This article explores increasing public healthcare funding from domestic resources mobilization, and evaluates the impact of measures to achieve this on sectoral growth and poverty reduction rates in Uganda using a dynamic computable general equilibrium model. This article shows that increasing the government health budget share, facilitates expanded healthcare services, improved population health, higher sectoral growth and reduced poverty. The agricultural sector is predicted to post the highest growth when compared with services and industry sectors under both domestic taxation and aid funding scenarios, while national poverty is predicted to decline from 31 to 12% of the population by 2020. This article demonstrates that the most effective measure is to frontload investment in healthcare and generate additional domestic funding for health from a household tax earmarked for health.

Is the sustainable development goal target for financial risk protection in health realistic?

BackgroundSetting Millennium Development Goals and Sustainable Development Goals for health has largely focused on defining specific targets of mortality and morbidity reduction over given time periods. Yet, less attention has...

Income from International Commodity Price Windfalls and HIV Infections in sub-Saharan Africa

This paper examines effects of exogenous income from international commodity price windfalls on HIV infections in a panel of sub-Saharan African countries during the period 1985–2007. The main finding is that an increase in income leads to a significant rise in HIV infections in autocratic countries while there is no significant effect in democracies. Further analysis suggests that increasing urbanisation and decreasing public health expenditure share in GDP in autocracies are the dominant channels behind such distinct comparison. After controlling for urbanisation and public health expenditure share, the effect of income on HIV infection rates shrinks drastically and is statistically insignificant.

Does expanding primary healthcare improve hospital efficiency? Evidence from a panel analysis of avoidable hospitalisations in 5506 municipalities in Brazil, 2000–2014

BackgroundHospitals account for the major share of health expenditure. Primary healthcare may improve efficiency at the hospital level by reducing avoidable admissions. We examined whether rapid expansion of primary healthcare...

Does Context Matter? Literacy Disparities in Self-rated Health Using Evidence from 17 Developed Countries.

The study examines whether adult literacy skills predict self-rated health status beyond educational credentials in 17 developed countries using a cross-national survey, the Programme for the International Assessment of Adult Competencies (PIAAC). The study uses linear regression models with country-level fixed effects to predict self-rated health to account the unobserved country-level heterogeneity. A total of 73,806 respondents aged 25 to 65 were included in the analysis. Although adult literacy is positively associated with better self-rated health in general, the strength of the relationship varies across nations. The literacy-related health inequalities are less severe in countries with the higher public share of health expenditures that may better address the needs of individuals with limited cognitive abilities. Curriculum standardization also contributes to reducing the literacy gradients in health by decreasing variations in skills obtained in school across individuals with different social origins. Overall, this study reveals that promoting equity in adult literacy skills is an important way to improve a population's health. Country-level differences in the strength of the relationship between literacy and self-rated health are systematically related to between-country differences in health financing and educational systems.

Impoverishing effects of catastrophic health expenditures in Malawi

BackgroundOut of pocket (OOP) health spending can potentially expose households to risk of incurring large medical bills, and this may impact on their welfare. This work investigates the effect of catastrophic OOP on the incidence and depth of poverty in Malawi.MethodsThe paper is based on data that was collected from 12,271 households that were interviewed during the third Malawi integrated household survey (IHS-3). The paper considered a household to have incurred a catastrophic health expenditure if the share of health expenditure in the household’s non-food expenditure was greater than a given threshold ranging between 10 and 40%.ResultsAs we increase the threshold from 10 to 40%, we found that OOP drives between 9.37 and 0.73% of households into catastrophic health expenditure. The extent by which households exceed a given threshold (mean overshoot) drops from 1.01% of expenditure to 0.08%, as the threshold increased. When OOP is accounted for in poverty estimation, additional 0.93% of the population is considered poor and the poverty gap rises by almost 2.54%. Our analysis suggests that people in rural areas and middle income households are at higher risk of facing catastrophic health expenditure.ConclusionWe conclude that catastrophic health expenditure increases the incidence and depth of poverty in Malawi. This calls for the introduction of social insurance system to minimize the incidence of catastrophic health expenditure especially to the rural and middle income population.

Trends in annual drug expenditure - a 16 year perspective of a public healthcare maintenance organization.

BackgroundModern drug therapy accounts for a major share of health expenditure and challenges public provider resources. The objective of our study was to compare drug expenditure trends for ten major drug classes over 16 years at Maccabi Healthcare Services (MHS), the 2nd largest healthcare organization in Israel.MethodsA retrospective analysis of drug expenditure per HMO beneficiary between the years 1998–2014. Trends in annual mean drug expenditures per MHS member were compared among 10 major drug classes.ResultsAverage annual drug expenditure per beneficiary increased during the study period from 429.56 to 474.32 in 2014 (10.4 %). Ten drug classes accounted for 58.0 % and 77.8 % of total drug cost in 1998 and 2014, respectively. The overall distribution of drug expenditure among drug classes differed significantly between 1998 and 2014 (p < 0.001), mainly due to the increase in expenditure for cancer drugs, from 6.8 % of total drug cost to 30.3 %. In contrast, expenditures for cardiovascular drugs decreased during the same period from 16.0 to 2.7 %. Moreover, the median annual increase in net drug costs per HMO member during 1998–2014 was largest for cancer drugs (NIS 6.18/year; IQR, 1.70–9.92/year), about two-fold that of immunosuppressants, the second fastest growing drug class (NIS 2.81; IQR, 0.58–7.43/year).ConclusionsThe continuous rise in anti-cancer drug expenditure puts a substantial burden on the medication budgets of public health organizations. Coordinated measures involving policy makers, physicians, and pharmaceutical companies will be required for efficient cost containment.

Gender gap matters in maternal mortality in low and lower-middle-income countries: A study of the global Gender Gap Index

ABSTRACTReducing maternal mortality has been a crucial part of the global development agenda. According to modernisation theory, the effect of gender equality on maternal health may differ depending on a country’s economic development status. We explored the correlation between the Global Gender Gap Index (GGI) provided by the World Economic Forum and the maternal mortality ratio (MMR) obtained from the World Development Indicators database of the World Bank. The relationships between each score in the GGI, including its four sub-indices (measuring gender gaps in economic participation, educational attainment, health and survival, and political empowerment), and the MMR were analysed. When the countries were stratified by gross national income per capita, the low and lower-middle-income countries had lower scores in the GGI, and lower scores in the economic participation, educational attainment, and political empowerment sub-indices than the high-income group. Among the four sub-indices, the educational attainment sub-index showed a significant inverse correlation with the MMR in low and lower-middle-income countries when controlling for the proportion of skilled birth attendance and public share of health expenditure. This finding suggests that strategic efforts to reduce the gender gap in educational attainment could lead to improvements in maternal health in low and lower-middle-income countries.

Decentralized Governance, Expenditure Composition, and Preferences for Public Goods

The literature on decentralization has long asserted that decentralized governance increases public sector allocative efficiency. We offer an indirect test of this hypothesis by examining how decentralized governance affects revealed preferences for public goods. Specifically, we examine the relationship between expenditure decentralization and the functional composition of public expenditures. We hypothesize that higher levels of expenditure decentralization induce agents to demand increased production of publicly provided private goods. We test this hypothesis using an unbalanced panel data set of forty-two developed and developing countries over twenty-two years. Using system Generalized Methods of Moments and Quasi-Maximum Likelihood estimators, we find that expenditure decentralization positively, significantly, and robustly influences the share of education expenditures in consolidated government budgets. We also find evidence to suggest that expenditure decentralization positively influences the share of health expenditures in consolidated government budgets. Decentralized governance appears to alter the composition of public expenditures toward publicly provided private goods.

Health spending autonomy and infant mortality rates: A matter of local administrative capacity?

Brazil opted for decentralization in the provision of health services at the time of the 1988 Constitution´s promulgation. The municipalities became entirely responsible for primary healthcare provision, sharing financing responsibilities with the central government. The aim of this paper is to evaluate the impact of health spending autonomy on infant mortality rates, using Brazilian local data from 2000 to 2007. As a measure of spending autonomy we used the share (%) of overall health expenditures financed by municipalities’ own resources. The larger the share of health expenditures which is not financed by the central government (grants), the greater the autonomy, because local governments can decide how and on what to spend these resources, and most of intergovernmental transfers to the health sector are allocated to predefined specific purposes. The fixed effects estimates, through the use of an instrumental variables approach, show that, on average, greater spending autonomy is not associated with lower infant mortality rates. However, given that local governments and populations are different in many aspects, it is reasonable to expect a heterogeneous response to decentralization. Galiani et al. (2008), for instance, assess the hypothesis that decentralization of high schools in Argentina may have increased the difference in educational outcomes. Could the same have happened to the quality of health in Brazilian municipalities? In well-managed municipalities and in which individuals participate actively and can support their preferences, fiscal autonomy ought to improve the delivery of public services. Using a measure of efficiency in the delivery of health services to split the municipalities in two groups, we got significant results for the more efficient municipalities, implying an increase in inequality. This measure corresponds to efficiency scores estimated using data envelopment analysis (DEA). We also test for heterogeneous impacts of the Family Health Program (PSF), the most important Brazilian basic health care policy, which main expansion occurred until 2007. It is a federal Program that each municipality runs independently. Again, we find evidence of a heterogeneous response, since PSF only reduces infant mortality rates in efficient municipalities. We then confirm Galiani’s (2008) hypothesis that decentralization may help only the best to do even better.

Socialized medicine and mortality.

Over the last century life expectancy has increased substantially and so has the share of health care expenditures financed by governments. In cross-country comparisons, the US, which has the lowest government health expenditure share, often has the poorest health outcomes. Is there a plausible connection between health outcomes and government financing of health care? This paper addresses this question with panel data from 20 developed countries from 1950 to 2010. I review the history of government involvement in health care financing over this period. Then I use panel regression methods to examine whether a variety of mortality based outcome measures are correlated with the extent of government involvement. The answers are robustly negative.

Health Financing in Progressive India- A Comparative Analysis of Priorities

Objective : a. To estimate the budget priorities for health, b. To estimate the increase in public health expenditure required to achieve the declared health goals. Materials and Method : This study is an analytical study based on budget estimates placed in public domain. The study estimates the health expenditure across various components of the national rural health mission in comparison with the total health expenditure. The study also compares the expenditures of other sectors like Defense and compares it with health expenditure. Result : a . General government health expenditure (GGHE) has been roughly 2 % of the general government expenditure (GGE), out of which National Rural Health Mission (NRHM) expenditure takes a share of about 50%. This is about 0.9% to 1.1% of the GGE. b. The expenditure on defense is 7 to 10 times more than that made on health and 14-20 times that of NRHM annually. This is with respect to General Government Expenditure. Conclusion : Increase of 0.2% of GDP per annum on healthcare, to help government reach the goal of 1% of GDP increases in its contribution, would mean an increase in the share of health expenditure by nearly 1% from the present estimation of 2.29% in 2011-12 to 3.07% in 2012-2013. The expenditure of NRHM would increase from 1.13 % of GGE to 1.62% of GGE. Percentage GDP for the allocation could be the policy road map, however, share in expenditure budget could be a more cognitive approach in determining the operational guidelines to achieve policy objectives.

Health care cost disease as a threat to Iranian aging society.

Because of the rapid aging rate, the share of health expenditure in gross domestic product rises irreversibly and increases concern among politicians and the general public. The aim of this study was to examine the accuracy of the Baumol's model of unbalanced growth in Iran over the period 1981-2010. This theoretical-analytical study was conducted in 2012 to investigate the various determinants of ongoing rise in the health expenditures. To this end, an Error Correction Model was derived from the long run cointegrating equation to inquire the veracity of Baumol's theory. Estimating the short run and long run equations by using time series data shows that the rate of increase in health expenditure is aligned with the difference between wage increases in and growth of productivity in the health sector. Besides, results show that both the per capita income and the inflation rate of health care had significant effects on raising the share of health sector in domestic economy. According to rapid population aging and existence of Baumol's cost disease in Iranian health sector, we predict much more rise in health expenditure in a few decades.

Income and Health Spending: Evidence from Oil Price Shocks

Abstract Health expenditures as a share of GDP in the United States have more than tripled over the past half-century. A common conjecture is that this is a consequence of rising income. We investigate this hypothesis by instrumenting for local area income with time series variation in oil prices interacted with local oil reserves. This strategy enables us to capture both partial equilibrium and local general equilibrium effects of income on health expenditures. Our central income elasticity estimate is 0.7, with 1.1 as the upper end of the 95% confidence interval, which suggests that rising income is unlikely to be a major driver of the rising health expenditure share of GDP.

Estimating health expenditure shares from household surveys

To quantify the effects of household expenditure survey characteristics on the estimated share of a household's expenditure devoted to health. A search was conducted for all country surveys reporting data on health expenditure and total household expenditure. Data on total expenditure and health expenditure were extracted from the surveys to generate the health expenditure share (i.e. fraction of the household expenditure devoted to health). To do this the authors relied on survey microdata or survey reports to calculate the health expenditure share for the particular instrument involved. Health expenditure share was modelled as a function of the survey's recall period, the number of health expenditure items, the number of total expenditure items, the data collection method and the placement of the health module within the survey. Data exists across space and time, so fixed effects for territory and year were included as well. The model was estimated by means of ordinary least squares regression with clustered standard errors. A one-unit increase in the number of health expenditure questions was accompanied by a 1% increase in the estimated health expenditure share. A one-unit increase in the number of non-health expenditure questions resulted in a 0.2% decrease in the estimated share. Increasing the recall period by one month was accompanied by a 6% decrease in the health expenditure share. The characteristics of a survey instrument examined in the study affect the estimate of the health expenditure share. Those characteristics need to be accounted for when comparing results across surveys within a territory and, ultimately, across territories.