Expenditure Trends Research Articles

The Effects of Cost Containment and Price Policies on Pharmaceutical Expenditure in South Korea.

Policy-makers have proposed and implemented various cost-containment policies for drug prices and quantities to regulate rising pharmaceutical spending. Our study focused on a major change in pricing policy and several incentive schemes for curbing pharmaceutical expenditure growth during the 2010s in Korea. We constructed the longitudinal dataset from 2008-2017 for 12 904 clinics to track the prescriber behavior before and after the implemented policies. Applying an interrupted time series model, we analyzed changes in trends in overall monthly drug expenditure and antibiotic drug expenditure per prescription for outpatient claims diagnosed with three major diseases before and after the policies' implementation. Significant price reductions and incentives for more efficient drug prescriptions resulted in an immediate decrease in monthly drug expenditures in clinics. However, we found attenuated effects over the long run. The top-spending clinics showed the highest rate of increase in drug costs. Future policy interventions can maximize their effects by targeting high-spending providers.

Trends of Antibiotic Use and Expenditure After an Intensified Antimicrobial Stewardship Policy at a 2,200-Bed Teaching Hospital in China.

Objective: This study aimed to evaluate the effects of intensified Chinese special rectification activity on clinical antibiotic use (CSRA) policy on a tertiary-care teaching hospital.Methods: A 48-month longitudinal dataset involving inpatients, outpatients, and emergency patients were collected. Study period included pre-intervention stage (adopting soft measures like systemic training) and post-intervention stage (applying antibiotic control system to intensify CSRA policy). Antibiotic use was evaluated by antibiotic use rate (AUR) or antibiotic use density (AUD). Economic indicator was evaluated by antibiotic cost in prescription or antibiotic expenditure in hospitalization. Data was analyzed by interrupted time series (ITS) analysis.Results: The medical quality indicators remained stable or improved during the study period. AUR of inpatients (AURI) declined 0.553% per month (P = 0.025) before the intervention and declined 0.354% per month (P = 0.471) after the intensified CSRA policy was implemented. AUD, expressed as defined daily doses per 100 patients per day (DDDs/100PD), decreased by 1.102 DDDs/100PD per month (P = 0.021) before and decreased by 0.597 DDDs/100PD per month (P = 0.323) thereafter. The ratio of antibiotic expenditure to medication expenditure (AE/ME) decreased by 0.510% per month (P = 0.000) before and fell by 0.096% (P = 0.000) per month thereafter. AE per patient decreased by 25.309 yuan per month (P = 0.002) before and decreased by 7.987 yuan per month (P = 0.053) thereafter. AUR of outpatient (AURO) decreased by 0.065% per month before (P = 0.550) and decreased by 0.066% per month (P = 0.994) thereafter. The ratio of antibiotic cost to prescription cost in outpatient (ACO/PCO) decreased by 0.182% per month (P = 0.506) before and decreased by 0.216% per month (P = 0.906) thereafter. AUR of emergency patient (AURE) decreased by 0.400% per month (P = 0.044) before and decreased by 0.092% per month (P = 0.164) thereafter. The ratio of antibiotic cost to prescription cost in emergency patient (ACE/PCE) decreased by 0.616% per month (P < 0.001) before and decreased by 0.151% per month (P < 0.001) thereafter.Conclusions: Implementation of CSRA policy was associated with declining antibiotic use and antibiotic expenditure in inpatients, outpatients, and emergency patients. However, it is also important to note that the declining trend of antibiotic consumption slowed due to the limited capacity for decline in the later stages of CSRA intervention.

Trends in healthcare resource use and expenditure before and after ischaemic stroke. A population-based study

IntroductionDespite improved survival rates, stroke represents an increasing healthcare and socioeconomic burden. We describe the main characteristics of patients with ischaemic stroke and resource use and associated expenditure one year before and 3 years after stroke, using a population-based dataset. MethodsThe information technology systems of the Catalan Health Service were used to identify patients with ischaemic strokes occurring between January 2012 and December 2016. For each patient, information from one year before the stroke and up to 3 years thereafter was linked across databases. We describe annual and monthly resource use and healthcare expenditure per patient. ResultsWe identified 36 044 patients with ischaemic stroke (mean age, 74.7 ± 13.3 years). The survival rate at 3 years was 63%. Average expenditure per patient was €3230 the year before stroke, €11 060 for year 1 after stroke, €4104 for year 2, and €3878 for year 3. The greatest determinants of cost in year 1 were hospitalisation (including initial hospitalisation), representing 45% of the difference in expenditure compared to the previous year, and convalescence and rehabilitation services, representing 33% of this difference. After year one, the increase in expenditure was mainly determined by additional hospital admissions and drug treatment. ConclusionAfter ischaemic stroke, healthcare expenditure increases primarily because of initial hospitalisation. After year one, the expenditure decreases but remains above baseline values. Information from population-based datasets is useful for improving the planning of stroke services.

1396Trends in household food expenditure patterns by ethnic and income group in New Zealand

Abstract Background Dietary factors are one of the most important risk factors for health loss worldwide, however there is very limited information on dietary trends in New Zealand (NZ) and whether inequities in dietary patterns are changing. Methods We employed a validated economic dataset, the Household Economic Survey (HES), which was designed to provide information on impacts of policy-making in NZ. Three HES waves in 2006/07, 2009/10 and 2012/13 (n = 9030) were used to examine the trends in household expenditure for key food groups by income-level and ethnicity. Results Overall, food expenditure per capita increased by 1% annually. In absolute terms, low-income households spent around half that of high-income households on food, but with no relative differences out of the total food expenditure or income. Māori households (Indigenous population) tended to spend less money compared to the other households, both in absolute and relative terms (ie, on healthy food including fruit and vegetables, and nuts and seeds, but with relatively more expenditure on processed meats). Similar food expenditure patterns by income-level and ethnicity persisted over time. Conclusions HES data were useful for understanding trends in food expenditure patterns, in the absence of nutrition survey data, but limitations remain. Assuming food consumption is highly correlated to expenditure, diet inequities do not seem to have improved during this recent time period. Key messages Public policies that aim to support healthy diets for all might need to involve changes to the food environment and involve government support for culturally appropriate Māori-led interventions.

Change of Consumption Behaviours in the Pandemic of COVID-19: Examining Residents' Consumption Expenditure and Driving Determinants.

This study investigated changes of individuals’ consumption behaviours during the COVID-19 pandemic and explored the driving determinants in consumption expenditure in Zhejiang China. Based on the 454 samples of survey data, which were collected in 2020 and 2021, it showed a reduction trend in consumption expenditure during the pandemic. Compared to the consumptions before the pandemic, money spent on housing, food, and beverage did not change too much. However, expenditures on wearing, recreation, and education reduced. Age, family size, and household income were significant to the expenditure changes. Online shopping became an important alternative way for residents during the pandemic and the trend is expected to continue even after the pandemic. Based on the findings, suggestions are summarized as two points. First, the young and single residents are the main group for recovering the consumption for wearing, recreation, education, and public transport. Meanwhile, to improve the satisfactions in online shopping, regulations should be issued by the government in improving the quality of goods and service.

Spending trends on neuropsychiatric drugs in Minas Gerais, Brazil: is the offer of anti-parkinson drugs increasing?

Neuropsychiatric drugs are used for a wide variety of neurological and psychiatric conditions. This article aims to analyze the trend and determinants of public expenditure of these medicines in Minas Gerais, from 2010 to 2017. Data from the Integrated Materials and Services Administration System (SIAD) database were used to estimate volumes of acquisition and expenditure. A breakdown analysis was performed, and the list of purchased drugs was reviewed, and the Drug Utilization technique (DU90%) applied concerning anti-Parkinson drugs. Annual expenditure dropped by 36%, from R$ 111.7 million in 2010 to R$ 40.9 million in 2017, and the determinant factors were the falling prices and volume, associated with changes in the drug mix, which favored the acquisition, on average, of more expensive products. Higher levels of expenditure for anti-Parkinson drugs stand out, however, with a significant change in the list purchased. This study contributed to a better understanding of public spending on neuropsychiatric drugs. A reduced volume can increase the risk of shortages. Regarding anti-Parkinson drugs, there is no evidence to suggest an increased supply to the population.

Comovements in Military Spending: Evidence from a Dynamic Factor Model with Time-Varying Stochastic Volatility

ABSTRACT This study examines the trend and comovements of military expenditures across 70 countries from 1967 to 2018. While previous research recognizes the degree of cross-correlations using principal components analysis, we adopt a dynamic factor model with time-varying stochastic volatility to examine the trend and comovements in military spending. Specifically, the dynamic factor model allows us to partition the trend of military spending into global, regional, and country-specific components. We find significant evidence of the global factor that explains a considerable portion of the variation in military spending across countries. Moreover, our findings reveal a significant time variation in the importance of the global factor. We also show the presence of regional and country-specific factors in the military spending of countries, but the importance of the regional factor is less than that of the global and country-specific factors. Additionally, we find that countries under consideration are becoming less exposed to global influences with respect to their decisions in military spending over time.

Iranian households expenditure pattern between 2013 and 2018 with emphasis on health care expenditure trends after Iran’s health transformation plan (IHTP)

Iranian households expenditure pattern between 2013 and 2018 with emphasis on health care expenditure trends after Iran’s health transformation plan (IHTP)

Food and Non-food Expenditure Trends Among the Poor and Needy in Kelantan, Malaysia

This article attempts to analyze the food and non-food expenditure among the poor and needy zakat recipients in Kelantan, Malaysia, which holds the lowest quartile of poor population. This study is motivated by the lack of concern in providing the perfect amount of food and non-food items in zakat distributions as a poverty alleviation program for these groups. The difference between food and non-food expenditure that does not reflect the true expenditure among the poor and needy can make poverty alleviation (zakat distribution) ineffective. The Kelantan state was selected because of their achievement of being among the highest zakat fund collectors and distributors (fourth in Malaysia and the highest among the government zakat agencies) (MAIK, 2014). Conversely, the state of Kelantan also has among the highest number of poor and needy in Malaysia (EPU, 2014). A sample of 505 households from the 2014 Household Expenditure Survey (HES) among the poor and needy zakat recipients in Kelantan is used in this study. Descriptive statistics is used to profile the pattern of household expenditure on food and non-food items, expenditure patterns of food and non-food items across poverty status and an estimation of the effects of household characteristics on food and non-food expenditures. Household characteristics include age, region (rural/urban), gender, size, and household head?s marital status. The findings show that the expenditure pattern among the poor and needy is different based on food and non-food items? shares. The result of this study indicates that not all poor and needy in Kelantan spend most of their expenditure on food items. Thus, applying the same higher food items on each poor and needy household would overstate the food expenditure and devalue the cost of non-food items. Therefore, it will create a flawed poverty line which will further create a flawed poverty assessment.

Energy expenditure trends in patients following roux-en-y gastric bypass surgery

Searchable abstracts of presentations at key conferences in obesity ISSN 2632-9808 (online)

Change in health spending after implementation of a health transformation plan in Iran: an interrupted time series analysis

BackgroundHealth transformation plan (HTP) implemented in Iran since 2014 to improve accessibility and financial protection of patients. This study aimed to assess the impact of HTP on health spending in Iran.MethodsThis was a quasi-experimental design using Interrupted Time Series. All registered impatient records in Iran health insurance organization (IHIO) for the population of Mazandaran province (1,628,919 population in 2011), north of Iran from March 2010 to February 2019 were included. Data for three depended variables: hospitalization rate, average inpatient cost and inpatient expenditure per capita was extracted in 96 monthly observations. Segmented regression analysis was done in R version 3.6.1.ResultsHospitalization rate in 2010 was 6.6 in 1000 people and its level change was 0/799 immediately after HTP (P < 001). Post-reform level and trend changes for monthly average inpatient cost of registered admissions in IHIO were also significant (P < 001). IHIO inpatient expenditure per capita for 1,628,919 population in Mazandaran province was 24,436 Rials in 2011 and increased significantly immediately following HTP as 34,459 Rials (P < 001).ConclusionsThree important components of health spending including hospitalization rate, average inpatient cost and inpatient expenditure per capita were increased dramatically after HTP. Cost containment strategies and strengthening the preventive care initiatives is required to control the escalating trends of inpatient expenditure in Iran.

Low-value medical care in the pandemic—is this what the doctor ordered?

Low-value medical care in the pandemic—is this what the doctor ordered?

Determinants of Growth in Prescription Drug Spending Using 2010-2019 Health Insurance Claims Data.

Background: Despite policies to manage prescription drug spending and ensure accessibility, prescription drug spending has continued to increase in South Korea. Using nationwide claims data, this study analyzed trends in total pharmaceutical expenditures and pharmaceutical expenditures by drug classification. Methods: We conducted a retrospective population-based study using the Korean National Health Insurance claims database from January 2010 through December 2019. Pharmaceuticals were categorized as new drugs, continued drugs, and abandoned drugs. Prescription drug spending was calculated using the components of price and quantity for individual products in successive two-year periods, to obviate the need to consider changes over time. Results: Total pharmaceutical expenditures increased by 54.2% from 2010 to 2019 (from USD 11.3 billion to USD 17.4 billion). The average annual growth rate was 4.9% overall (the 4% rate for continued drugs was decomposed into −3.5% for the price of drugs, 8.0% for the quantity of drugs, and −0.5% for mixed effects, a measure of changes in drug treatment patterns). The trends were generally consistent. Particularly sharp increases in expenditures were found for groups L (antineoplastic and immunomodulating agents), C (cardiovascular system drugs), and A (alimentary tract and metabolism drugs). Conclusions: Since increased prescription drug spending was primarily driven by an increase in the quantity of drugs used, consumer-focused policies to reduce drug use are necessary.

Thực trạng kết quả hoạt động tài chính tại bệnh viện đa khoa tỉnh lào cai giai đoạn 2015 – 2019

Objective: The study was conducted to understand the financial autonomy situation at the Lao Cai General Hospital for the period 2015-2019. Methods: Cross-sectional descriptive study design using retrospective quantitative research methodology of secondary data from financial statements of Lao Cai General Hospital in the 5 years 2015-2019. Results: The hospital's total revenue tended to increase (in 2019, it increased by 97,445 million VND compared to 2015), of which, non-business revenues accounted for more than 80% of the total revenue each year. Revenue from hospital fees and health insurance accounts for a high proportion in the total non-business revenues of the hospital, accounting for about 66-79%. Total hospital spending tends to decrease from 2015 to 2018 (down 3%) and increase in 2019. Professional spending is at the top of the recurrent expenditure structure, accounting for about 38-40%. The personal payment group accounts for 25-29% of the total recurrent expenditure in the hospital and tends to increase each year. The hospital's revenue and expenditure difference tends to increase with the total difference of VND 15,322 million, VND 18,875 million, VND 10,578 million, VND 16,950 million and VND 16,950 million respectively for the years 2015-2019. In general, the total revenue and expenditure realized were in excess of the estimate. Conclusion: In the period 2015 - 2019, total hospital revenues tend to increase, total hospital expenditures tend to decrease, leading to an increasing trend in hospital revenues and expenditures over the years. The appropriation of funds is in accordance with the current regulations, so the salary reform fund accounts for a large proportion and tends to increase sharply, making the bonus fund, the welfare fund, the salary fund increase and decrease. gradually. Keywords: Financial revenue and expenditure activities, Lao Cai Province General Hospital

Examination of orthodontic expenditures and trends in the United States from 1996 to 2016: disparities across demographics and insurance payers

BackgroundOrthodontics prevent and treat facial, dental, and occlusal anomalies. Untreated orthodontic problems can lead to significant dental public health issues, making it important to understand expenditures for orthodontic treatment. This study examined orthodontic expenditures and trends in the United States over 2 decades.MethodsThis study used data collected by the Medical Expenditure Panel Survey to examine orthodontic expenditures in the United States from 1996 to 2016. Descriptive statistics for orthodontic expenditures were computed and graphed across various groups. Trends in orthodontic expenditures were adjusted to the 2016 United States dollar to account for inflation and deflation over time. Sampling weights were applied in estimating per capita and total expenditures to account for non-responses in population groups.ResultsTotal orthodontic expenditures in the United States almost doubled from $11.5 billion in 1996 to $19.9 billion in 2016 with the average orthodontic expenditure per person increasing from $42.69 in 1996 to $61.52 in 2016. Black individuals had the lowest per capita orthodontic visit expenditure at $30.35. Out-of-pocket expenses represented the highest total expenditure and although the amount of out-of-pocket expenses increased over the years, they decreased as a percentage of total expenditures. Public insurance increased the most over the study period but still accounted for the smallest percentage of expenditures. Over the course of the study, several annual decreases were interspersed with years of increased spendingConclusionWhile government insurance expenditure increased over the study period, out of pocket expenditures remained the largest contributor. Annual decreases in expenditure associated with economic downturns and result from the reliance on out-of-pocket payments for orthodontic care. Differences in spending among groups suggest disparities in orthodontic care among the US population.

Trend in Tyrosine Kinase Inhibitor Utilization, Price, and Out-of-Pocket Costs in Patients With Chronic Myelogenous Leukemia.

Treatment of chronic myelogenous leukemia (CML) with tyrosine kinase inhibitors (TKIs) has improved survival but is associated with significant financial burden. We measured the annual trend in TKI utilization, Medicare gross payment, and patient out-of-pocket (OOP) expenditure from 2007 to 2016. We used SEER linked to Medicare part-D claims data to identify prevalent CML cases from 2007 to 2016. TKI utilization was measured as the proportion of cases with at least one TKI fill in each year. Average TKI gross payment and median per-member per-month OOP expenditure were calculated from claims data and plotted annually from 2007 to 2016. Year-to-year percent change in gross payment and OOP expenditure was compared with inflation indices. The cohort included 3,189 CML cases with at least one TKI claim. The proportion of prevalent patients with a TKI fill in a year increased from 17.9% in 2007 to 52.8% in 2015. The average annual gross payment per 30-day supply of a TKI increased by an average of 12.8% throughout the period from $9,000 to $10,000 US dollars in 2016. There was no increasing trend in median OOP expenditure per 30-day supply, which varied between $450 and $600 US dollars. Rising TKI use and TKI drug prices place considerable financial pressure on Medicare part-D insurers. Although there was no increasing trend in OOP expenditure, it may be burdensome for Medicare patients who are likely retired on a fixed income. Our findings support legislation that mitigates increasing drug prices to protect the Medicare system and its beneficiaries.

Incremental health care utilization and expenditures for sleep disorders in the United States.

To determine the incremental increases in health care utilization and expenditures associated with sleep disorders. Adults with a diagnosis of a sleep disorder (International Classification of Diseases, 10th Revision, code G47.x) within the medical conditions file of the 2018 Medical Expenditure Panel Survey medical conditions file were identified. This dataset was then linked to the consolidated expenditures file and comparisons in health care utilization and expenditures were made between those with and without sleep disorders. Multivariate analyses, adjusted for demographics and comorbidities, were conducted for these comparisons. Overall, 5.6% ± 0.2% of the study population had been diagnosed with a sleep disorder, representing approximately 13.6 ± 0.6 million adults in the United States. Those with sleep disorders were more likely to be non-Hispanic, White, and female, with a higher proportion with public insurance and higher Charlson Comorbidity Scores. Adults with sleep disorders were found to have increased utilization of office visits (16.3 ± 0.8 vs 8.7 ± 0.3, P < .001), emergency room visits (0.52 ± 0.03 vs 0.37 ± 0.02, P < .001), and prescriptions (39.7 ± 1.2 vs 21.9 ± 0.4, P < .001) vs those without sleep disorders. The additional incremental health care expenses for those with sleep disorders were increased in all examined measures: total health care expense ($6,975 ± $800, P < .001), total office-based expenditures ($1,694 ± $277, P < .001), total prescription expenditures ($2,574 ± $364, P < .001), and total self-expenditures for prescriptions ($195 ± $32, P < .001). Sleep disorders are associated with significantly higher rates of health care utilization and expenditures. By using the conservative prevalence estimate found in this study, the overall incremental health care costs of sleep disorders in the United States represents approximately $94.9 billion. Huyett P, Bhattacharyya N. Incremental health care utilization and expenditures for sleep disorders in the United States. J Clin Sleep Med. 2021;17(10):1981-1986.

Trends in Health Care Utilization and Expenditures in the United States Across 5 Decades: 1977-2017.

Health care expenditures in the United States are high and rising, with significant increases over the decades. The delivery, organization, and financing of the health care system has evolved over time due to technological innovation, policy changes, patient preferences, altering payment mechanisms, shifting demographics, and other factors. The objective of this study was to examine trends over time in health care utilization and expenditures in the United States. This analysis employs descriptive statistics to examine 5 decades of health care utilization and expenditure data from the Agency for Healthcare Research and Quality (AHRQ) for 1977-2017. Measures include utilization and expenditures (not charges) for inpatient, emergency department, outpatient physician, outpatient nonphysician, office-based physician, dental, and out-of-pocket retail prescription drugs. We demonstrate that while health care expenditures have increased significantly overall and by type of care, utilization trends are less pronounced. The population of the United States grew 53% between 1977 and 2017, while annual total expenditures on health care increased by 208%. Amidst attention to out-of-pocket exposure for unexpected medical care bills, out-of-pocket payments for care have declined from 32% in 1977 to 12% in 2017 but increased in amount. This article provides the first extended snapshot of the dynamics of health care utilization and expenditures in the United States. Aspects of health care are much different today than in previous decades, yet the inpatient setting still dominates the expenditures.

Timor‐Leste economic survey: The end of petroleum income

AbstractAs Timor‐Leste nears the end of its petroleum‐exporting era, the transition to a sustainable economy has become even more challenging due to partisan political competition, disastrous flooding and the pandemic. This article describes the current economic context, and deteriorating trends. After a brief discussion of the political situation and the impacts of COVID‐19, it explores expenditure and income trends in recent state budgets, with a particular focus on dependency on oil and gas revenues and their investments, which pay for 80% of state spending and may run out within a decade. It then assesses in detail revenue prospects from current and future oil and gas activities, including Greater Sunrise and the planned Tasi Mane petroleum infrastructure project. The analysis shows that it is highly likely that resource revenue will continue to decline. Diversification is not an option; it is the only way forward.

THE EFFECTS OF OUTCOME FROM HEALTH CARE EXPENDITURE IN INDIA: A TIME-SERIES ANALYSIS

The effects of outcome from Health Care Expenditure in India: A Time-Series Analysis is the objective of this article with reveals that the level of health expenditure on various schemes and indicates is a little bit low. It can be suggested that some relevant measures need to be taken towards the improvement of the role of government for providing proper schemes related to the health sector and increments budgetary allocation at both national and states governments’ level. Moreover in India, many more problems arise in government hospital scheduled at poor physical or health care facilities in medical supplies, ineffective leadership and faculty with staff problems. Regarding health care facilities in a private hospital, it is not there rather many modern facilities with proper staff working regularly are available. In view of the above, the present article analyses the trend and pattern of health care expenditure in India. This article carries some statistical methodologies for the analysis like regression and some statistical tests. KEY WORDS: Health care Sector, Public &amp; Private Healthcare Expenditure, Regression, Budgetary allocation.