Spending Categories Research Articles

10-Year Trends in Healthcare Spending among Patients with Schizophrenia in Alberta, Canada.

ObjectivesSchizophrenia is characterized by high levels of disability often resulting in increased healthcare utilization and spending. With expanding healthcare costs across all healthcare sectors, there is a need to understand how healthcare spending has changed over time. We conducted a population-based study using administrative health data from Alberta, Canada, to describe changes in medical complexity and direct healthcare spending among patients with schizophrenia over a 10-year period.MethodsA serial cross-sectional study from January 1, 2008, to December 31, 2017, was conducted to determine changes in demographic characteristics, medical complexity, and costs among all adults (18 years or older) with schizophrenia. Total healthcare spending and sector-specific costs attributable to hospitalizations, emergency department visits, practitioner billings, and prescriptions were calculated and compared over time.ResultsOver the 10-year period the contact prevalence of patients with schizophrenia increased from 0.6% (n = 16,183) to 1.0% (n = 33,176) within the province. There was a marked change in medical complexity with the number of patients living with 3 or more comorbidities increasing from 33.0% to 47.3%. Direct annual healthcare costs increased 2-fold from 321 to 639 million CAD (493 million USD) with a 7-fold increase in medication expenditures over the 10-year time frame. As of 2017, spending on pharmaceutical treatment surpassed hospitalizations as the leading spending category in this population.ConclusionsHealthcare spending among patients with schizophrenia continues to increase and may be partially attributable to growing rates of multimorbidity within this population. Although promising second-generation antipsychotic medications have entered the market, this has resulted in considerable changes in the distribution of healthcare spending over time. These findings will inform policy discussions around resource allocation and efforts to curb health spending while also improving care for patients with schizophrenia.

Crime, correction, education and welfare in the U.S. – What role does the government play?

As federal, state and local governments continue to allocate a significant share of their resources to law enforcement and correctional spending, concerns have risen that spending in education and welfare is declining. With fiscal pressure in the United States mounting, it is important to determine the effectiveness of public spending in deterring crime. This paper compares the effectiveness of the impact of government spending on welfare and education with that of law enforcement and correction on crime. Using panel data from 50 U.S. states over a time period of 1994–2014, results of linear regression with panel corrected standard errors as well as GMM estimation reveals that public welfare and education spending can potentially lower violent and property crime rates but law enforcement spending can only deter property crime. However, correctional spending can exacerbate both types of crimes. There is little to no evidence of the presence of crowding out of one category of spending by another. This results in the policy implication that more resources be allocated towards welfare and education programs.

Local fiscal multipliers of different government spending categories

This paper compares multipliers of different categories of US federal government spending, and in doing so provides a new insight as to why fiscal multipliers may differ across countries and time. We identify exogenous federal government spending shocks at the state level for defense and non-defense spending. Using a projection-based approach, we estimate the cumulative multiplier due to shocks in either of these spending categories. Our results indicate that defense spending yields lower multipliers than non-defense spending. Thus, focusing only on defense spending may result in underestimating the multiplier for government spending.

Healthcare utilization and costs among high-need and frail Mexican American Medicare beneficiaries.

ObjectivesTo examine Medicare health care spending and health services utilization among high-need population segments in older Mexican Americans, and to examine the association of frailty on health care spending and utilization.MethodsRetrospective cohort study of the innovative linkage of Medicare data with the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) were used. There were 863 participants, which contributed 1,629 person years of information. Frailty, cognition, and social risk factors were identified from the H-EPESE, and chronic conditions were identified from the Medicare file. The Cost and Use file was used to calculate four categories of Medicare spending on: hospital services, physician services, post-acute care services, and other services. Generalized estimating equations (GEE) with a log link gamma distribution and first order autoregressive, correlation matrix was used to estimate cost ratios (CR) of population segments, and GEE with a logit link binomial distribution was applied to estimate odds ratios (OR) of healthcare use.ResultsParticipants in the major complex chronic illness segment who were also pre-frail or frail had higher total costs and utilization compared to the healthy segment. The CR for total Medicare spending was 3.05 (95% CI, 2.48–3.75). Similarly, this group had higher odds of being classified in the high-cost category 5.86 (95% CI, 3.35–10.25), nursing home care utilization 11.32 (95% CI, 3.88–33.02), hospitalizations 4.12 (95% CI, 2.88–5.90) and emergency room admissions 4.24 (95% CI, 3.04–5.91).DiscussionOur findings highlight that frailty assessment is an important consideration when identifying high-need and high-cost patients.

ACO Spending and Utilization Among Medicare Patients at the End of Life: an Observational Study.

End-of-life (EOL) costs constitute a substantial portion of healthcare spending in the USA and have been increasing. ACOs may offer an opportunity to improve quality and curtail EOL spending. To examine whether practices that became ACOs altered spending and utilization at the EOL. Retrospective analysis of Medicare claims. We assigned patients who died in 2012 and 2015 to an ACO or non-ACO practice. Practices that converted to ACOs in 2013 or 2014 were matched to non-ACOs in the same region. A total of 23,643 ACO patients were matched to 23,643 non-ACO patients. Using a difference-in-differences model, we examined changes in EOL spending and care utilization after ACO implementation. The introduction of ACOs did not significantly impact overall spending for patients in the last 6months of life (difference-in-difference (DID) = $192, 95%CI -$841 to $1125, P = 0.72). Changes in spending did not differ between ACO and non-ACO patients across spending categories (inpatient, outpatient, physician services, skilled nursing, home health, hospice). No differences were seen between ACO and non-ACO patients in rates of ED visits, inpatient admissions, ICU admission, mean healthy days at home, and mean hospice days at 180 and 30days prior to death. However, non-ACO patients had a significantly greater increase in hospice utilization compared to ACO patients at 180days (DID P-value = 0.02) and 30days (DID P-value = 0.01) prior to death. With the exception of hospice care utilization, spending and utilization were not different between ACOs and non-ACO patients at the EOL. Longer follow-up may be necessary to evaluate the impact of ACOs on EOL spending and care.

Fiscal Decentralization and the Composition of Local Government Expenditure: Evidence from South Korea

The implicit idea underlying theories of fiscal federalism is that fiscal decentralization can change the composition of government expenditure. That is, regardless of whether decentralization enables governments to more readily reflect citizen preferences regarding spending categories or fosters a race to the bottom with reduced taxation and public service levels, change in the composition of government expenditure may ensue. This study indirectly tests the impact of decentralization with respect to allocative efficiency by examining the relationship between fiscal decentralization and expenditure composition. Utilizing data from 224 local governments in South Korea over the period 2008–2018, the study finds that fiscal decentralization exerts downward pressure on welfare expenditure and that it tends to shift spending from the current to the capital account. Specifically, it finds that it is mainly revenue-side decentralization that affects the allocation of government expenditure.

The Impact Of The Structure Of Government Spending On Economic Growth In The Regions Of Russian Federation

The purpose of the article is to assess the impact of the structure of government spending on economic growth in the regions of Russia. The growth rate of the gross regional product (GRP) in real terms is used as an indicator of economic growth. For econometric modeling, the group average method is used. Although in general the issue of the impact of certain categories of public spending remains debatable, empirical results show that government spending on health care and sports are the long-term drivers of economic growth in the regions. Meanwhile, for regions with GRP per capita lower than average, spending on education and the media has a noticeable and positive effect. On the basis of the results obtained, practical recommendations for improving the regional policy are formulated.

КОРЕЛЯЦІЙНИЙ АНАЛІЗ СТІЙКОСТІ СОЦІАЛЬНО ОРІЄНТОВАНИХ ВИДАТКІВ ЗВЕДЕНОГО БЮДЖЕТУ УКРАЇНИ В УМОВАХ БЮДЖЕТНОЇ ДЕЦЕНТРАЛІЗАЦІЇ

The decentralization reform implemented in Ukraine since 2014, besides the administrative division and territorial governance transformation, has a considerable fiscal aspect. The 2015 amendments to The Budget Code of Ukraine have established direct bilateral relations between the budgets of central government and territorial communities, most often in their turn reconstituted as an amalgamation of diverse settlements. Equalization of disparities in territorial development, as well as spending optimization, were the primary concerns in the reform process, which resulted in establishment of specific budget transfer mechanisms, including the targeted subventions for education and public health (Art. 97 of the BCU), as well as horizontal equalization of taxability, constituted by the two-way transfers to or from particular communities depending on their dedicated tax income (Art. 98 of the BCU). The present escalation of military aggression towards Ukraine has introduced further territorial discontinuities into the fiscal system, ranging from physical destruction of communities to disproportionate fiscal burdens upon the refugee-welcoming regions. Furthermore, against the war-induced background of one of the deepest economic crises of the Ukrainian independence history, the resilience of socially oriented spending against macroeconomic shocks gains acute relevance. In this context, quarterly consolidated budget spending data provided by the National Bank of Ukraine, which includes total spending on both central governmental and community levels since 2011, despite the obvious limitations, overcome some obstacles to a preliminary efficiency assessment of the reform due to their abstraction from both the interbudgetary transfer mechanisms and the territorial structure. We employed a simple correlation analysis, using Fisher’s z-transformation, of the consolidated budget and GDP data, aimed at establishment of statistical significance of correlation breaks between the real GDP and a number of functional spending categories. The significance is established at the 95% confidence level for educational and social security spending series, which, together with the recent spending observations, testifies for a positive impact having occurred since 2015 upon the resilience of consolidated spending. While the effects may be explained on the macroeconomic level by the mentioned transfer mechanisms in place, this aggregated analysis needs further supportive evidence from the communities’ level.

Geographic Variation in Medicare Fee-for-Service Health Care Expenditures Before and After the Passage of the Affordable Care Act

Geographic variation in Medicare spending is often used as a measure of wasteful spending. A 2013 Institute of Medicine report found that postacute care was a key contributor of geographic variation from 2007 to 2009. However, payment reforms and antifraud efforts implemented after the passage of the Affordable Care Act (ACA) may have reduced geographic variation in spending, especially postacute care spending. To investigate how geographic variation in Medicare fee-for-service per-beneficiary spending changed from 2007 to 2018 before and after passage of the ACA. This cross-sectional study included all fee-for-service Medicare enrollees 65 years or older from January 1, 2007, to December 31, 2018. The fee-for-service Medicare Geographic Variation Public Use File was used to group hospital referral regions (HRRs) in each year into deciles (10 equal groups) based on per-beneficiary total spending. The difference between the per-beneficiary monthly spending in each decile and the national mean, as well as the ratio of per-beneficiary total spending in the top deciles to that of the bottom decile, were reported. Data analysis occurred from July 22, 2019, to October 21, 2021. Per-beneficiary spending on hospital inpatient, hospital outpatient, physician, and postacute care (and type of postacute care). There were 27.2 million fee-for-service beneficiaries in 2007 (58.0% women) and 28.3 million beneficiaries in 2018 (55.9% women). Per-beneficiary Medicare spending was $9691 in 2007 and $9847 in 2018 (using inflation-adjusted 2018 dollars). Geographic variation in Medicare spending was stable from 2007 to 2011 and then declined steadily from 2012 to 2018. The ratio of per-beneficiary total Medicare spending in the HRRs in the top decile to the bottom decile was 1.68 in 2007 ($415 monthly difference in spending) but only 1.56 ($361 monthly difference in spending) in 2018 (estimated change, -0.12 [95% CI, -0.21 to -0.02]; P = .01). Focusing on specific spending categories, the only statistically significant reductions in geographic variation were found for home health; the ratio of home health spending among HRRs in the top to bottom deciles of total Medicare spending fell from 5.14 in 2007 to 3.45 in 2018 (change, -1.69 [95% CI, -3.30 to -0.09]; P = .04). Geographic variation in total per-beneficiary Medicare spending fell from 2007 to 2018, with home health spending being a key factor associated with geographic variation. The ACA's value-based payment programs and enhanced integrity efforts in home health provide a possible explanation for the decrease.

Trends in Health Care Use and Spending for Young Children With Neurologic Impairment.

Children with neurologic impairment (NI) are a growing subset of children who frequently use health care. We examined health care use and spending trends across services for children with NI during their first 5 years of life. This was a retrospective study of 13 947 children with NI in the multistate IBM Medicaid MarketScan Database (2009-2017). We established birth cohorts of children with NI and analyzed claims from birth to 5 years. NI, identified by using International Classification of Diseases, 9th Revision, diagnosis codes, was defined as ≥1 neurologic diagnosis that was associated with functional and/or intellectual impairment. We measured annual health care use and per-member-per-year spending by inpatient, emergency department (ED), and outpatient services. Population trends in use and spending were assessed with logistic and linear regression, respectively. During their first versus fifth year, 66.8% vs 5.8% of children with NI used inpatient services, and 67.8% vs 44.4% used ED services. Annual use in both categories decreased over 0-5 years (inpatient odds ratio: 0.35, 95% confidence interval: 0.34 to 0.36; ED odds ratio: 0.78, 95% confidence interval: 0.77 to 0.79). The use of outpatient services (primary care, specialty care, home health) decreased gradually. Per-member-per-year spending on inpatient services remained the largest spending category: $83 352 (90.2% of annual spending) in the first year and $1944 (25.5%) in the fifth year. For children with early-onset NI from 0-5 years, use and spending on inpatient services decreased dramatically; ED and outpatient service use decreased more gradually. These findings may help systems, clinicians, and families optimize care by anticipating and adjusting for shifting use of health care services.

R&D Spending in the Energy Sector and Achieving the Goal of Climate Neutrality

Research and development (R&D) spending in the energy sector, which is aimed at exploring ways to reduce greenhouse gas emissions, among other things, plays a vital role in achieving the goal of climate neutrality. The purpose of this paper is to assess the environmental performance of R&D spending in the energy sector of selected EU member states from 2011–2017/2019, and to compare the results. Taxonomic research with the zero unitarization method was used, which enabled a synthetic assessment of EU countries according to the environmental performance of the total spending in the energy sector and an analysis of the changes in performance for six categories of spending in this area. The assessment of changes in the environmental performance of individual categories of R&D spending over time using the applied method was an added value compared with the assessment methods previously used in this area. The study found that there were significant differences in the level of environmental efficiency of R&D expenditures in the energy sector between countries, changes in environmental efficiency in most of the countries studied were not satisfactory, the most environmentally efficient expenditures were on renewable energy, other power and storage, hydro and fuel cell technologies, and the least on fossil fuels and nuclear energy. The results reflected both the member states’ progress towards climate neutrality and the discussion on the environmental performance of the means and directions of actions aimed at this.

What drives variations in public health and social services expenditures? the association between political fragmentation and local expenditure patterns.

The US spends two times more than the OECD average in health expenditure but has a much smaller portion of public health spending to total health expenditure than other OECD countries. While it has been suggested that public health and social services spending is crucial to promoting health outcomes, less is known about what drives variations in public health expenditure across regions. This study aims to examine whether political fragmentation inlocal governance is associated with variations in public health and social services expenditures. Using the US Census of Governments, we constructed a panel dataset of political fragmentation and local government spending patterns (1997-2012) for 792 US counties (population > 60,882, top 25%) and employed Least Squares Dummy Variable (LSDV) and Generalized Estimating Equations (GEE) models. We found that per capita public health spending tended to be smaller in areas where the degree of political fragmentation was higher (Coef: - 0.034; p < 0.01), particularly when general-purpose governments were more fragmented (Coef: - 0.087; p < 0.001). The proportion of public health spending alsodecreased when local governments were more fragmented (Coef: - 0.012; p < 0.001). Social services expenditures and their proportions to total government expenditure fell with an increase in the degree of political fragmentation. Our findings suggest that fragmented governance settings, in which localities are more likely to face competition with others, may lead to a reduction in public spending essential for population health and that political fragmentation can also have a deterrent effect on broader categories of health-related social services spending.

Effects of High-Deductible Health Plans on Enrollees With Mental Health Conditions With and Without Substance Use Disorders.

High-deductible health plans (HDHPs) are increasingly common in the U.S. health insurance market and are intended to reduce the use of low-value services, but evidence suggests that HDHP enrollees also reduce the use of high-value services. This study examined the effects of HDHPs on enrollees with mental health conditions, a population with high levels of unmet treatment need, often because of financial barriers. Enrollees with a co-occurring substance use disorder have greater treatment needs and unique barriers to care, perhaps changing their response to an HDHP. Commercial health insurance claims data in a difference-in-differences design was used to evaluate the effect of an employer's offer of an HDHP on 6,627,128 enrollee-years among enrollees with mental health conditions, stratified by having a co-occurring substance use disorder or not. Among enrollees without a co-occurring substance use disorder, an HDHP offer was associated with a 4.8% (95% confidence interval [CI]=2.4%-7.2%) reduction in overall spending on mental health care, despite an 11.3% (95% CI=1.0%-21.6%) increase in spending on mental health-related emergency department visits. Among enrollees with a co-occurring substance use disorder, no significant changes attributable to an HDHP offer were found in most categories of spending on combined mental health and substance use disorder care, apart from a 4.5% (95% CI=1.9%-7.2%) reduction in spending on psychotropic medications. HDHPs may reduce use of necessary care among enrollees with mental health conditions, which could exacerbate undertreatment in this population and result in adverse health outcomes.

Private and public consumption: substitutes or complements?

Abstract This article investigates the degree to which government consumption expenditures substitute or complement private consumption, one of the most important (and most overlooked) determinants of the fiscal multiplier. Using panel datasets from a large number of heterogeneous economies over 1970–2016, we find that private and government consumption are best described as complementary both in the aggregate and for nine different categories of government spending we consider. The degree of complementarity, however, differs substantially across government spending categories, being the highest for education, recreation, and housing in the Organisation for Economic Co-Operation and Development (OECD); and for Public Order and Recreation in the non-OECD. Our estimates imply that fiscal multiplier values in those spending categories are substantially higher than in categories that are less (or not at all) complementary with private consumption.

A Run for Their Money: Examining Changes in Runners’ Event-Related Expenditures

Abstract: This study examines spending changes between the first and second year of participation in a mass participation sport event. Previous research has been inconclusive about anticipated spending changes from year one to year two, which may be attributed to the prominence of cross-sectional research designs. This study utilized a within-person, year-to-year design with a seven-year sample from a US running event ( n = 247) to track spending from participants. Using a within-subject ANCOVA, expenditures across eight categories were analyzed as individuals progressed from first-time to repeat participant. Results show no significant differences across any of the spending categories. From the same time frame, a sample of one-off participants was generated ( n = 6,257) to compare with the repeat participants, and significant differences emerged. These findings provide event organizers and community officials with information regarding the spending behavior of customers in their first and second years, allowing for a more tailored marketing approach.

Measuring Attitudes toward Public Spending Using a Multivariate Tax Summary Experiment

AbstractIt is difficult to measure public views on trade‐offs between spending priorities because public understanding of existing government spending is limited and the budgetary problem is complicated. We present a new measurement strategy using a continuous treatment, multivariate choice experiment. The experiment proposes deficit‐neutral bundles of changes in spending and taxation, allowing us to investigate attitudes toward modifications to the existing budget. We then use a structural choice model to estimate public preferences over spending categories and the taxation level, on average and as a function of respondent attributes. In our application, we find that the UK public favors paying more in tax to finance large spending increases across major budget categories, that spending preferences are multidimensional, and that younger people prefer lower levels of taxation and spending than older people.

How Does a Reduction in Mandated Medicaid Spending Affect Local Fiscal Behaviors? Evidence from New York State

In 2005, New York (NY) state capped the growth of county-level Medicaid spending, which abruptly decreased counties’ Medicaid outlay in both relative and absolute terms. This study exploits this discontinuity in county Medicaid outlay to estimate the impact of the relief mandate policy on county budgets and property tax levies. It bridges a gap in the public finance literature by addressing local government responses to a sudden decrease in the outlay of a large mandatory spending category. We find a compositional change but no income effect on non-Medicaid spending. However, the policy reduced the effective property tax rate significantly by 6.6 to 8.1 percent on average among affected NY counties after the enactment of the policy relative to control counties. This study advances our understanding of local fiscal responses to an intergovernmental fiscal policy that changes how state and local governments share the costs of a large public social insurance program.

Economic Contribution Analysis of National Estuarine Research Reserves

Increased attention to the value of protected natural areas has led to the proliferation of ecosystem service valuations for coastal habitats. However, these studies do not provide a full representation of the economic value of these habitats. Protected coastal environments, such as the National Estuarine Research Reserve System (NERRS), add jobs and revenue to their local communities. Institutions such as NERRS provide economic contributions that extend beyond their operational spending and jobs they provide. Spending by reserves and their partners ripples throughout the economy. We performed an economic contribution analysis at four pilot sites using input-output modeling through IMPLAN. Sites contributed millions in revenue and tens to hundreds of jobs in their respective regions. Each of the four sites had a different category of spending that was the largest contributor of revenue and jobs, which is likely due to the community context and location of the reserves. Understanding these contributions is helpful in validating funding for NERRS. Communicating these contributions along with ecosystem service values may increase support from community members who otherwise do not use or rely on NERRS as much as traditional reserve supporters.

A Decade of Nutrition and Health Disparities Research at NIH, 2010–2019

ObjectivesNutrition health disparities include the differences in incidence, prevalence, morbidity, and mortality of diet-related diseases and conditions that disproportionally affect disadvantaged groups (e.g., race, ethnicity, socioeconomic status, disability, rural, immigration status). These disparities arise from the complex interaction of individual, interpersonal, community, and societal factors within the biological, behavioral, and environmental domains. The purpose of this study is to describe the scope of nutrition health disparities research supported by the National Institutes of Health (NIH) over the past decade to identify research gaps and opportunities relevant to NIH’s mission. MethodsData were extracted from an internal reporting system from 2010 to 2019 using the Research, Condition, and Disease Categorization (RCDC) spending categories for “Nutrition” and “Health Disparities.” ResultsOver the past decade, the number of NIH supported nutrition and health disparities research studies have generally increased, with 860 grants funded in 2010 and 937 grants in 2019, while total nutrition and health disparities funding remained relatively stable. The top 5 Institutes/Centers that funded nutrition and health disparities research included the National Institute of Diabetes and Digestive and Kidney Diseases, National Heart Lung and Blood Institute, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Cancer Institute, and National Institute on Minority Health and Health Disparities. ConclusionsConsistent with the mission of the top funding ICs, the top research areas were obesity, diabetes, digestive diseases, cancer, heart disease, clinical research, prevention, and behavioral and social sciences. Cross-cutting topics relevant to all NIH ICs included special populations areas such as pediatric and minority health followed by aging and women’s health. Consistent with the Strategic Plan for NIH Nutrition Research, it is critical to advance health equity through the application of precision nutrition approaches that acknowledge the influence of biologic, behavioral, psychosocial, environmental, and social factors on nutrition health disparities, and to develop effective targeted interventions to address these disparities. Funding SourcesNone.

أنماط ومحـددات الإستهلاک المصــرى من اللحـــوم والأسمـــاک

The study showed that the population, imports of red meat, and retail prices of red meat are the most important factors affecting the amount of red meat consumed during the study period. But the production of white meat, the population and the retail price of white meat are the most important factors affecting the amount of white meat consumed. As for the most important factors affecting the amount of fish consumed, they were represented in fish imports, national income, retail prices of fish and retail prices of white meat. The study also found that the meat group ranks first among the food groups, with a spending rate of about 27.4% and 28.19% of the total spending on food and drink in both rural and urban areas, respectively. While fish ranked sixth with a spending rate of about 6.37% and 6.88% in both rural and urban areas, respectively for the year 2017/2018. It also showed that the annual per capita spending on both meat and fish varies according to the spending categories of the family, and the annual per capita spending on meat in urban areas has increased by 13.65%, 39.64% from its counterpart in rural in each of the second spending category (50 thousand - less than 100 thousand pounds) and the third category (100 thousand pounds or more), respectively, and an increase in the annual per capita spending on fish in urban areas by 6.1%, 23.29% and 84.17% over its counter-part in the rural in the three spending categories, respectively. The spending flexibility in urban areas compared to the countryside on the two groups of meat and fish also increased, as the spending elasticity of the meat group reached about 0.492 and 0.677 in both rural and urban areas, respectively, while the spending elasticity for fish reached about 0.369 and 0.645 in both rural and urban areas, respectively.