Share Of Health Care Expenditures Research Articles

External reference pricing for medicines in Ukraine: latest trends

Compared to the previous year, the share of healthcare expenditure in the state budget of Ukraine has decreased, which is associated with increased funding for the security and defense sector. In terms of gross domestic product, healthcare spending has reduced to 2.8 %, which corresponds to the figures for 2019. These circumstances indicate the importance of proper budget utilization, including effectively regulating medicine prices. One of the key elements of rational healthcare budget usage is the development and implementation of external reference pricing (ERP). A well-formulated and implemented ERP policy for pharmaceuticals contributes to improving patient access to essential medicines (EMs). The aim of this study is to analyze the current status of ERP implementation in Ukraine and provide recommendations for improving this policy. Materials and methods. During the research process, an analysis of the ERP’s current regulatory framework was conducted, and ERP implementation in Ukraine was assessed according to adherence to the 14 best practice principles of ERP proposed by Sullivan, Kanavos & Kalo in 2015. Results. In Ukraine, ERP has been introduced for medicines from the National Essential Medicine Lists (NEML) and the “Affordable Medicines” program. The Ministry of Health (MoH) of Ukraine has approved a Register of marginal wholesale prices for medicines purchased with state budget funds and subject to price regulation. Currently, the register includes 1239 medicinal products, of which 1233 are from NEML and 6 have undergone Health Technology Assessment (HTA). Approximately 58 % of medicines have a set price through ERP, 24 % are regulated by internal reference pricing (IRP), and nearly 18 % have declared prices. This indicates a lack of uniformity in approaches to price regulation for medicines and requires further improvements. According to the latest update of the Register of medicines for reimbursement under the state medical guarantees program, there are 486 medicines, including 72 insulins and 21 immunosuppressive medicines (184 medicines are provided with co-payment). Different approaches, including different reference countries and price calculation algorithms, are applied for the price regulation of medicines in NEML and the “Affordable Medicines” program. An assessment of the implementation of the ERP system in Ukraine based on the 14 best practice principles of ERP proposed by Sullivan, Kanavos & Kalo in 2015 showed that the current policy does not adhere to all principles. Conclusions. The analysis revealed different approaches to pricing for medicines NEML and the “Affordable Medicines” program, indicating the need for harmonizing pricing policies for different lists. The adoption of a unified positive list can contribute to improving pricing policies and efficient resource utilization. Collecting, disseminating, and exchanging data on drug prices is crucial to support transparency in pricing and its control. Regular monitoring of prices in the market will help ensure compliance with pricing policies and take appropriate measures in case of violations. The implementation of a unified pricing regulation policy for medicines in Ukraine is an important step towards European integration and compliance with international standards.

Influence of Non-financial Factors on Cost-efficiency of a General Hospital in Slovenia

Introduction: Hospitals account for the largest share of health care expenditures, which are mainly financed by public funds. In healthcare, it is of paramount importance that the management focus not on reducing costs at the expense of patient health, but on improving the value and thus the healthcare outcomes. In addition to the economic factors used to determine a hospital's cost efficiency, non-economic or soft factors should be considered. The aim of this study was to elucidate the influence of non-financial factors on a hospital's cost-efficiency.
 Method: An online survey was conducted among the staff of a typical Slovenian general hospital (N = 150).
 Results: Self-assessment of cost-efficiency was influenced by communication in the hospital, satisfaction and cooperation within the multidisciplinary team, willingness of employees to innovate, cooperation with external providers and evaluation of the quality of healthcare. Communication with the patient had the greatest impact, followed by communication with external providers and communication with the management.
 Conclusion: In order to reduce costs while maintaining or even improving the healthcare outcomes, communication with patients is extremely important.

Health Care Expenditures Among Individuals With Chronic Psychotic Disorders in Ontario: An Analysis Over Time.

Chronic psychotic disorders are severe and disabling mental disorders associated with poor psychiatric and medical outcomes, and among the most costly mental disorders to treat. Understanding trends in aggregate health care expenditures over time, and respective drivers, can provide relevant insights for decision makers, namely around appropriate allocation of scarce resources within the health care sector. Using administrative health care times series data from Ontario, this analysis examined trends in aggregate public health care expenditures and activity from 2012 to 2019 among all individuals with a diagnosis of a chronic psychotic disorder. Total aggregate health care expenditures for individuals with a chronic psychotic disorder in Ontario increased at a moderate rate over this time period, in line with the growth of the number of people diagnosed, and thus not likely driven by unit costs or resource use. Psychiatric hospitalizations made up the largest share of health care expenditures (~30%). Nonetheless, among all health services, expenditures of acute medical hospitalizations, outpatient prescription drugs and home care saw the largest growth over time. Mean/per capita health care expenditures were greater for females, and increased with age as well as with the presence of comorbidities/chronic conditions. In particular, mean/per capita health care expenditures increased steadily with the number of comorbidities and were highest for individuals with 5 or more comorbidities and those with congestive heart failure, highlighting the ever-increasing importance of addressing physical health conditions among this patient population. These findings will have important implications for decision makers, namely around the appropriate allocation of health care resources for patients with chronic psychotic disorders. Future research should continue to monitor health care expenditures for individuals with chronic psychotic disorders as well as extend this analysis beyond 2019 to understand how the COVID-19 pandemic, and resulting lockdowns, has impacted aggregate health care expenditures and outcomes for patients living with chronic psychotic disorders.

ANALYSIS OF PATTERNS OF THE FINANCIAL SUPPORT OF THE HEALTH CARE SYSTEM IN UKRAINE UNDER DECENTRALIZATION REFORM AND THE COVID-19 PANDEMIC

In Ukraine, the coronavirus disease (COVID-19) pandemic partially overlapped in time with such critically important transformational processes as the second stage of the financial decentralization reform and the integration stage of the health care system reform. In this regard, the study of the main peculiarities of the change in the model of financial support of the health care system in Ukraine in these conditions, as well as the determination of which of these processes had the greatest impact on the volatility of the health care public expenditures, becomes relevant. The research involves the implementation of two stages - bibliometric analysis and statistical analysis. According to the results of the bibliometric analysis of Scopus publications concerning financial support of the health care system and COVID-19, six contextual clusters of scientific research were identified, focused on determining the impact of health care expenditures on the effectiveness of anti-coronavirus measures, age, gender, social and medical prerequisites and consequences of the spread of the COVID-19, relationship between the cost of medical services and outpatient treatment, socioeconomic, financial-economic and institutional prerequisites for ensuring the quality of the health care system and its resistance to shocks caused by the pandemic, key determinants, tools and measures to combat the spread of COVID-19. As part of the second block of bibliometric analysis, aimed at identifying the relationship between health care expenditures and decentralization reforms, five contextual clusters are identified, which are focused on the study of approaches and models to optimize health care expenditures taking into account socio-demographic factors and decentralization reform priorities, fiscal, economic and ecological determinants and factors of public health, age and geographical prerequisites that determine the peculiarities of the formation of the health care financing system, the influence of micro-financial and managerial prerequisites for financial assurance of the quality of the health care system I, effectiveness of insurance medicine. According to the results of the statistical analysis, it is established that during the period of active implementation of the financial decentralization reform (2015-2018), the share of health care expenditures in the State Budget of Ukraine was relatively stable and fluctuated within 2%, while in 2019 the share of this group of expenditures has been increased to the level of almost 3.6%. At the same time, there was a reduction in health care expenditures in the expenditures of local budgets of Ukraine: during 2015-2019, their share gradually decreased by 3-5% annually, and in 2020-2021, the reduction amounted to almost 33% and 45% to the level the previous year respectively. The specific weight of this group of expenditures in the Consolidated Budget of Ukraine is relatively stable (9–11.1%). In general, according to the results of the analysis, it can be noted that the reform of financial decentralization did not lead to a significant transformation of the structure of spending powers, while the medical reform and the COVID-19 pandemic caused a redistribution of the expenditure burden in the field of health care from the local to the state budget, although the specific weight of these expenses in the structure of the Consolidated Budget of Ukraine did not increase significantly even during the pandemic period.

Factors Influencing the Purchase of Individual Health Insurance Policy in Urban India with Special Reference to Visakhapatnam City

Post insurance reforms of India witnessed new insurance products in the health sector which were not available before the reforms. The share of health care expenditure to GDP is very low in India compared to other developing nations. Due to the exponential increase in the health care segment, the demand for health insurance product increased. As the demand for health care services is increasing in India it becomes important to study the factors which induce the demand for health insurance. Due to the absence of proper health care system in India, private health care system emerges very strongly and cost per head in health care is increasing very fast. It has become very difficult for lower-middle and middle-class people to afford the cost of health care. This has improved the awareness level of having health insurance to protect them from any unforeseen health cost in near future. I assume and propose that rising cost of health insurance would help people to understand the importance of unforeseen risk in case of health cost and induce to purchase health insurance products. As the cost of health seems to be rising so far In India people are becoming more conscious of health insurance purchase. The change in lifestyle encourages people to take treatment at high-end hospitals. This factor and the rising inflation are making individuals purchase health insurance. The outcome of this study would help the insurers and financial policy makers formulate proper strategies to increase the penetration of health insurance.

SYSTEM OF FINANCING HEALTH CARE IN THE EUROPEAN UNION COUNTRIES AS AN EXPERIENCE FOR UKRAINE

Purpose. The purpose of the article is to analyse the state of the system of financing health care in the European Union countries and Ukraine, to identify and compare their efficiency. To achieve this purpose, the following tasks were set: to analyse the current state of the system of financing health care in the European Union using up-to-date statistics on health care expenditures; to analyse the state of the system of financing health care in Ukraine for the last five years based on statistical data on expenditures of the Consolidated Budget of Ukraine; to consider what needs the health care sector directs expenditures to; to identify the problems that were prompted medical reform in Ukraine; to identify and compare the efficiency of financing the health care system of the European Union countries and Ukraine. Methodology. During the preparation of the article, the author used the method of analysis and synthesis to review statistical data that provided an opportunity to analyse the current state of the system of financing health care in the European Union countries and Ukraine; the method of comparison was used to determine the efficiency of the models of the system of financing health care in the countries of the European Union, in order to further form useful advice for use in Ukraine during the period of medical reform; generalization method was used to summarize the results of the study. Results. Analysing the state of the system of financing health care among the European Union countries in 2019, it was found that the largest amount of health care expenditures was in Germany (the system of financing was based on the Bismarck model), and the smallest was in Latvia (the system of financing was based on the Beveridge model). Analysis of the dynamics of health care expenditures in Ukraine showed that over the past five years, the volume of expenditures has increased 2.33 times. In terms of the funds of the Consolidated Budget of Ukraine, the largest percentage (85-91%) falls on the expenditures of the general fund. In relation to the total expenditures of the Consolidated Budget of Ukraine, the share of health care expenditures in 2020 has amounted to 11.02%, which is 1.99% higher than in 2016. Despite the growing trend, the amount of budget expenditures is not enough for all the needs of the health sector. To identify the efficiency of the models of the systems of financing health care operating in the European Union countries and Ukraine, a comparison of the average life expectancy among the people of these countries was made. In the countries of Northern and Western Europe, there was the highest rate in the range of 81.1-83.1 years for both men and women; the lowest rate was observed in Ukraine (73 years). Ukraine is currently undergoing health care reform, which should change the Soviet model to one that will be closer to the English, which shows its efficiency on the example of European countries in the post-Soviet space. Practical implications. The results of the study can be used to form practical suggestions in preparation for the next stage of health care reform in Ukraine.

Государственные расходы на здравоохранение и экономический рост в России: региональный аспект

The aim of this paper was to investigate the influence of an increase in government healthcare expenditures on regional economic growth in Russia. Studies have shown that an increase in healthcare expenditures stimulate an increase in GDP through several channels. Firstly, it improves the quality of labor force, which can lead to an increase in labor productivity. Secondly, an increase in productivity and size of labor force lead to consumption expansion and then to firms’ income growth, so there is a multiplication effect. Including the assumption that the relationship between healthcare expenditure and economic growth may be non-linear we formed the hypothesis of the existence of the average optimal share of healthcare expenditure in GRP that maximizes average regional economic growth rate. In this research it was suggested that an increase in healthcare expenditures besides the direct effect on economic growth of a particular region also affects economic growth of neighboring regions. The possible explanation of this is the positive impact of healthcare services received in the neighboring regions on nearby territories, joint national healthcare projects, and distribution of scientific knowledge. Using the spatial Durbin model focusing on regional data of 2005–2017, it was shown that the average optimal share of healthcare expenditures equals to 5,9% of GRP with an inclusion of spatial effects and 7,6% without them, outlining the importance of including interconnection variables between Russian regions into the model. The regional statistics analysis showed the failure to reach the recommended share by most Russian regions, which can be viewed as a possibility for economic growth stimulation in case of the increase in governmental spending on healthcare in the future

National Health Care Expenditures Associated With Disability.

In 2003, national disability-associated health care expenditures (DAHE) were $398 billion. Updated estimates will improve our understanding of current DAHE. The objective of this study was to estimate national DAHE for the US adult population and analyze spending by insurance and service categories and to assess changes in spending over the past decade. Data from the 2013-2015 Medical Expenditure Panel Survey were used to estimate DAHE for noninstitutionalized adults. These estimates were reconciled with National Health Expenditure Accounts (NHEA) data and adjusted to 2017 medical prices. Expenditures for institutionalized adults were added from NHEA data. National DAHE in total, by insurance and service categories, and percentage of total expenditures associated with disability. DAHE in 2015 were $868 billion (at 2017 prices), representing 36% of total national health care spending (up from 27% in 2003). DAHE per person with disability increased from $13,395 in 2003 to $17,431 in 2015, whereas nondisability per-person spending remained constant (about $6700). Public insurers paid 69% of DAHE. Medicare paid the largest portion ($324.7 billion), and Medicaid DAHE were $277.2 billion. More than half (54%) of all Medicare expenditures and 72% of all Medicaid expenditures were associated with disability. The share of health care expenditures associated with disability has increased substantially over the past decade. The high proportion of DAHE paid by public insurers reinforces the importance of public programs designed to improve health care for people with disabilities and emphasizes the need for evaluating programs and health services available to this vulnerable population.

Exploring the Backyard of nCOVID: Determinants of death toll in pandemics

Heterogeneity in number of deaths in different countries during the ongoing nCOVID crisis challenged us to look for determinants of pandemic death toll across the world. Using the past two decades data of pandemic deaths in the world, this study considered if engagement in international trade, health care expenditure and population density have any impact on the pandemic death toll. Using linear regression model controlled for types of disease, we not only found trade significantly impacting death toll, but also surprisingly found positive correlation between share of healthcare expenditure in GDP and fatalities in pandemics. Our findings suggest that policy intervention is required for mitigating health impacts of trade and ‘tweaking’ the health expenditure towards pandemic prevention.

MARKET SEGMENTATION IN HEALTHCARE

The share of healthcare expenditure in the first income decile in their income is higher in comparison with other deciles, however, their expenditure is the lowest. The main purpose of the research is to show the availability of healthcare in different income groups of households. Literature sources indicate that some specific household social classes face problems with access to healthcare because of low income. Firstly, public healthcare expenditure is evaluated. The low share of research and development expenditure in healthcare is alarming. Investigation continues in the accessibility of healthcare and medicines in households. The paper reveals segments of endangered low-income households with insufficient healthcare that decrease their living standard. The main data source for conducted analyses of household situations is primary data from Household Budget Survey and primary data from EU-Statistics on Income and Living Conditions survey in four years 2007, 2010, 2014 and 2016 in the Czech Republic. The paper presents the results of an analysis of households which showed that first low-income decile has the lowest healthcare payments in absolute expression but the relative number of healthcare expenditure confirms that low-income households spend the most of their income on healthcare in the comparison with other households. The first income decile is mainly composed of old-age pensioners and unemployed consumers. The structure of household healthcare expenditure according to expenditure categories shows that all consumers pay the most for non-prescription drugs followed by prescription drugs, orthopaedic and therapeutic aids, ambulatory dental care and ambulatory medical care. The research confirms that specific groups of households cannot afford appropriate healthcare. The constructed Health Poverty Index expresses that low-income households would need their income to be higher by at least 4.36 % to be able to afford average healthcare expenditure and appropriate healthcare.

Cancer Drugs Provide Positive Value In Nine Countries, But The United States Lags In Health Gains Per Dollar Spent.

Cancer drugs account for a growing share of health care expenditure, raising questions about how much value is gained from their use. We used a proprietary international data set to examine real-world cancer drug consumption and expenditure in the period 2004-14 in Australia, Canada, France, Germany, Italy, Japan, Sweden, the United Kingdom, and the United States and to explore the value obtained. Even after adjusting for population and epidemiological factors, we found that the United States spent more than the other countries on cancer drugs, yet it often had lower utilization. All nine countries-most notably France and Japan-witnessed an improvement in neoplasm-related years of potential life lost, which suggests that although the costs of drugs have risen, their therapeutic benefits have increased as well. Net economic value derived from cancer drug expenditures appears to have remained positive, with base-case analyses indicating that the United States obtained an estimated $32.6billion in net positive return from cancer drug care in 2014. However, the United States lags behind other countries in health gains obtained per dollar spent on cancer drugs, which suggests an opportunity to improve value in the oncology drug market.

Health care spending and utilization by race/ethnicity under the Affordable Care Act's dependent coverage expansion.

We estimated the effect of the ACA expansion of dependents' coverage on health care expenditures and utilization for young adults by race/ethnicity. We used difference-in-difference models to estimate the impact of the ACA expansion on health care expenditures, out-of-pocket payments (OOP) as a share of total health care expenditure, and utilization among young adults aged 19 to 26 years by race/ethnicity (White, African American, Latino, and other racial/ethnic groups), with adults aged 27 to 30 years as the control group. In 2011 and 2012, White and African American young adults aged 19 to 26 years had significantly lower total health care spending compared with the 27 to 30 years cohort. OOP, as a share of health care expenditure, remained the same after the ACA expansion for all race/ethnicity groups. Changes in utilization following the ACA expansion among all racial/ethnic groups for those aged 19 to 26 years were not significant. Our study showed that the impact of the ACA expansion on health care expenditures differed by race/ethnicity.

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.

The Affordable Care Act's payment reforms and the future of hospitals.

Hospitals have remained consistent in their share of health care expenditures despite dramatic changes in the payment and financing of care, including the passage of the Patient Protection and Affo...

Economics, Ethics and Thanatology: Lessons from the Ancients

The normative presuppositions motivating rational choice decision-making based on optimizing objectives amount to a thin account of ethical economic behavior. Ancient thought offers insights that can provide a firmer basis both for personal, individual choice as well as for public policy. After a brief review of Epicurean and Stoic ethical principles, a comparison is made of modern economic and Hellenistic conceptions of rationality and rational behavior. These competing conceptions are then applied to an examination of a contemporary public policy problem, namely health care, particularly as this applies to “end-of-life” issues. The argument concludes that decision-making based on a eudaimonic conception of the good has the potential to provide us with a more efficient health care system as well as one that more satisfactorily addresses the needs of the chronically ill and dying patients who account for a highly disproportionate share of health care expenditures.

Does morbidity matter? Perceived health status in explaining the share of healthcare expenditures

We argue that the demand for healthcare services can be better explained by individual need based variables rather than by macro variables such as the Gross Domestic Product (GDP) per capita and the share of public healthcare expenditures. This study introduces a self-rated health variable called morbidity that describes individual needs for health care – healthy individuals need less health care than sick ones – and that is measured through personal interviews conducted by the Organization for Economic Co-operation and Development (OECD). In addition, stationary properties of the series are considered in order to understand the effect of shocks to expenditure behaviour on health care. Stationary test results show that we should not only use differenced values for the model variables but also incorporate time-specific effects into the model. Using the appropriate specification and accounting for the time effect, we find evidence supporting the hypothesis that the share of healthcare expenditure in GDP rises with the increased need for health care. The need for health care is also found to be more important than per capita GDP when explaining the change in the share of healthcare expenditures for the examined countries.

Health-Care Financing Reforms in Central and Eastern Europe: Common Problems and Possible Approaches

Mihaljek focuses on health care financing issues in Central and Eastern Europe from the public finance and macroeconomic perspectives, given that there are defective financial incentives to health-care providers and an unsustainable structure of health-care financing. There are several similarities among the countries in question: their health care systems are ineffective, the current manner of financing the sector will become increasingly unsustainable, and reform options need to be examined immediately to prevent the systems’ financial collapse. Whereas most recent health care financing reforms have focused on cost containment, resulting in a shift of a growing portion of health care costs onto households and in uncoordinated efforts among sectors, Mihaljek recommends financing a larger share of health care expenditure out of general tax revenues. Replacement of flat fees with fee-for-service payments based on a points system, accompanied by suitable monitoring and auditing of the bills submitted by primary care providers and a reform of the system of co-payments, would be desirable to keep costs from escalating. Finally, Mihaljek stresses the importance of the authorities’ ability to manage the political economy aspects for the success of health care reform.

An exploration for China's reform of public hospitals

A description of the positioning of public hospitals in China, and an exploration of such issues as their compensation mechanism, management system, and operation mechanism. The authors hold that it is imperative to maintain a reasonable balance of the government, society and individuals in their share of healthcare expenditure, prioritize funding recipients, and encourage medical cost payment based on disease diagnosis groupings; to precisely distinguish the ownership, operation right, decision right, and supervision right of public hospitals, for building an effective incentive and supervision mechanism; to further consolidate the president responsibility system and target responsibility system, build a flexible talent use system and distribution mechanism, build a better quality control mechanism, a strict expenditure and cost control mechanism, and a scientific talent development mechanism as well. Key words: Public hospital; Reform; Exploration

What drives health care expenditure?—Baumol's model of ‘unbalanced growth’ revisited

The share of health care expenditure in GDP rises rapidly in virtually all OECD countries, causing increasing concern among politicians and the general public. Yet, economists have to date failed to reach an agreement on what the main determinants of this development are. This paper revisits Baumol's [Baumol, W.J., 1967. Macroeconomics of unbalanced growth: the anatomy of urban crisis. American Economic Review 57 (3), 415–426] model of ‘unbalanced growth’, showing that the latter offers a ready explanation for the observed inexorable rise in health care expenditure. The main implication of Baumol's model in this context is that health care expenditure is driven by wage increases in excess of productivity growth. This hypothesis is tested empirically using data from a panel of 19 OECD countries. Our tests yield robust evidence in favor of Baumol's theory.

What Drives Health Care Expenditure? Baumol's Model of 'Unbalanced Growth' Revisited

The share of health care expenditure in GDP rises rapidly in virtually all OECD countries, causing increasing concern among politicians and the general public. Yet, economists have to date failed to reach an agreement on what the main determinants of this development are. This paper revisits Baumol's (1967) model of 'unbalanced growth', showing that the latter offers a ready explanation for the observed inexorable rise in health care expenditure. The main implication of Baumol's model in this context is that health care expenditure is driven by wage increases in excess of productivity growth. This hypothesis is tested empirically using data from a panel of 19 OECD countries. Our tests yield robust evidence in favor of Baumol's theory.