Health Spending (health + spending)

Distribution by Scientific Domains

Selected Abstracts

Expenditure on the NHS in Perspective

Martin Chalkley
In the wake of the recently-announced increases in health spending, Martin Chalkley reviews the record of health spending in the UK both historically and comparatively. It is clear that prices paid by the NHS have increased more than prices in general, and once this is allowed for then it appears that real health spending today is only twice that of 50 years ago as compared with the fourfold increase suggested when using a general price deflator. Such differential inflation is obviously not a problem which is confined to the UK, and it does add considerably to problems in making proper comparisons between levels of health spending in different countries. In spite of these difficulties, it seems that compared with many other developed countries, health spending in the UK as a proportion of GDP is modest. So, looking ahead, there is some way to go before the UK attains the levels of spending achieved in many other countries. But understanding the reasons for relative price changes is vital if any proposed increases in spending is to be translated into increases in the quantity and quality of services provided. [source]

Health systems in East Asia: what can developing countries learn from Japan and the Asian Tigers?

Adam Wagstaff
Abstract The health systems of Japan and the Asian Tigers (Hong Kong, Korea, Singapore and Taiwan), and the recent reforms to them, provide many potentially valuable lessons to East Asia's developing countries. All five systems have managed to keep a check on health spending despite their different approaches to financing and delivery. These differences are reflected in the progressivity of health finance, but the precise degree of progressivity of individual sources and the extent to which households are vulnerable to catastrophic health payments depend on the design features of the system , the height of any ceilings on social insurance contributions, the fraction of health spending covered by the benefit package, the extent to which the poor face reduced copayments, whether there are caps on copayments, and so on. On the delivery side, too, Japan and the Tigers offer some interesting lessons. Singapore's experience with corporatizing public hospitals , rapid cost and price inflation, a race for the best technology, and so on , illustrates the difficulties of corporatization. Korea's experience with a narrow benefit package illustrates the danger of providers shifting demand from insured services with regulated prices to uninsured services with unregulated prices. Japan, in its approach to rate setting for insured services, has managed to combine careful cost control with fine-tuning of profit margins on different types of care. Experiences with DRGs in Korea and Taiwan point to cost-savings but also to possible knock-on effects on service volume and total health spending. Korea and Taiwan both offer important lessons for the separation of prescribing and dispensing, including the risks of compensation costs outweighing the cost savings caused by more ,rational' prescribing, and cost-savings never being realized because of other concessions to providers, such as allowing them to have onsite pharmacists. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Horizontal equity in utilisation of care and fairness of health financing: a comparison of micro-health insurance and user fees in Rwanda

Pia Schneider
Abstract This paper uses two methods to compare the impact of health care payments under insurance and user fees. Concentration indices for insured and uninsured groups are computed following the indirect standardisation method to evaluate horizontal inequity in utilisation of basic health care services. The minimum standard approach analyses the extent to which out-of-pocket health spending contributed to increased poverty. The analysis uses cross-sectional household survey data collected in Rwanda in 2000 in the context of the introduction of community-based health insurance. Results indicate that health spending had a small impact on the socio-economic situation of uninsured and insured households; however, this is at the expense of horizontal inequity in utilisation of care for user-fee paying individuals who reported significantly lower visit rates than the insured. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Does Deinstitutionalization Increase Suicide?

Jangho Yoon
Objectives. (1) To test whether public psychiatric bed reduction may increase suicide rates; (2) to investigate whether the supply of private hospital psychiatric beds,separately for not-for-profit and for-profit,can substitute for public bed reduction without increasing suicides; and (3) to examine whether the level of community mental health resources moderates the relationship between public bed reduction and suicide rates. Methods. We examined state-level variation in suicide rates in relation to psychiatric beds and community mental health spending in the United States for the years 1982,1998. We categorize psychiatric beds separately for public, not-for-profit, and for-profit hospitals. Principal Findings. Reduced public psychiatric bed supply was found to increase suicide rates. We found no evidence that not-for-profit or for-profit bed supply compensates for public bed reductions. However, greater community mental health spending buffers the adverse effect of public bed reductions on suicide. We estimate that in 2008, an additional decline in public psychiatric hospital beds would raise suicide rates for almost all states. Conclusions. Downsizing of public inpatient mental health services may increase suicide rates. Nevertheless, an increase in community mental health funding may be promising. [source]

Is Post-Communist Health Spending Unusual?

JŠnos Kornai
What factors determine a country's spending on health? And what factors determine the share of spending financed by the public sector? Taking these factors into account, is post-communist health spending unusual? For the OECD economies, we find that per capita health spending is strongly related to per capita income, with an elasticity of about 1.5. The elasticity for developing economies is close to one. Spending is also positively related to the elderly dependency rate, but the relationship is weaker than a static comparison of spending by the elderly and non-elderly would suggest. Even though health spending as a share of GDP in the post-communist countries of eastern and central Europe is below the OECD average, there is evidence of above normal health spending in most countries when we control for income and demographics. For Hungary, the ,excess' spending reached over three percentage points of GDP in 1994. For the OECD sample, four development indicators account for half the variation in the public sector share of total health spending. Political variables help explain the remainder. If the post-communist countries converge to the market economy pattern, the share of public financing will fall, yet still remain well above half. [source]

Employers' Benefits from Workers' Health Insurance

Ellen O'Brien
Most nonelderly americans receive their health insurance coverage through their workplace. Almost all large firms offer a health insurance plan, and even though they face greater barriers to providing coverage, so do the majority of very small firms. These employment-based plans cover two-thirds of nonelderly Americans and pay most of working families' expenses for health care and about one-quarter of national health spending. Despite employers' role in the health insurance market, however, very little attention has been paid to employers' motivations for providing health insurance to workers. Why do employers offer health insurance to workers? Is it because workers want it? Because their unions demand it? Or do employers offer health benefits to workers because their productivity and profitability depend on it? The standard economic theory of the availability of employer-provided health insurance focuses on worker demand (Cutler 1997; Pauly 1997; Summers 1989). Even though many employers believe that health insurance and health affect employees' productivity and firms' performance, health economists typically overlook and rarely measure firms' returns on health-related investments. Some research, however, suggests that firms may benefit economically by providing health insurance coverage for workers and their families. For example, health coverage may help employers recruit and retain high-quality workers. Health may contribute to productivity by reducing the costs of absenteeism and turnover and by increasing workers' productivity. This article reviews the evidence and proposes an agenda for future research. A better understanding of the benefits to employers of offering health coverage to workers may help clarify employers' behavior and help private employers and public officials make appropriate investments in health. [source]


David Glick
H51; H52; O12 ABSTRACT This study examines the effect of government health care and education programs on the poor in Chile from 2000 to 2006. Results are obtained from a country-wide provincial-level panel data set with information on poverty and indigence head-count ratios, measures on the severity of poverty as captured by the Foster,Greer,Thorbecke P2 statistic, per capita public expenditures on health and education, as well as other variables that are thought to influence well-being. We use fixed-effects techniques to correct for time-invariant province-specific characteristics that may affect program placement. Our analysis demonstrates that per capita public health and education expenditures significantly reduce the incidence of poverty and indigence in Chile. In particular, for a 10,000 pesos (about $23) increase in provincial per capita health spending, the poverty head-count ratio decreases by 0.48 percent. Per capita education expenditures are particularly important to reducing the severity of poverty. Our results indicate that for a 10,000 pesos increase in education spending, the severity of poverty declines by as much as 1.53 percent. Furthermore, we provide evidence that public spending in Chile is non-random. In particular, government education expenditures may be allocated in keeping with compensatory motives. [source]