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Health Expenditures (health + expenditure)
Selected AbstractsTHE POSITIVE FINANCIAL CONTRIBUTION OF HOME-BASED PRIMARY CARE PROGRAMS: GENERATING REVENUE OR REDUCING HEALTH EXPENDITURE?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2008Jeremy M. Jacobs MBBS No abstract is available for this article. [source] Economic Growth, Health and Poverty: An Exploratory Study for IndiaDEVELOPMENT POLICY REVIEW, Issue 2 2004Indrani Gupta This article analyses the possible links between economic growth, poverty and health, using panel data for the Indian states. The findings indicate that, though growth tends to reduce poverty, significant improvements in health status are also necessary for poverty to decrease. Also, economic growth and health status are positively correlated and have a two-way relationship, suggesting that better health enhances growth by improving productivity, and higher growth allows better human capital formation. Health expenditure is an important determinant of both higher growth and better health status, and is therefore a key tool available to policy-makers. Among other exogenous variables, literacy and industrialisation seem to improve both health outcomes and growth, and to reduce poverty. [source] Assessing household health expenditure with Box,Cox censoring modelsHEALTH ECONOMICS, Issue 9 2005Jean-Paul Chaze Abstract In order to assess the combined presence of zero expenditures and a heavily skewed distribution of positive expenditures, the Box,Cox transformation with location parameter is used to define a set of models generalising the standard Tobit, Heckman selection and double-hurdle models. Extended flexibility with respect to previous specifications is introduced, notably regarding negative transformation parameters, which may prove necessary for medical expenditures, and corner-solution outcomes. An illustration is provided by the analysis of household health expenditure in Switzerland. Copyright © 2005 John Wiley & Sons, Ltd. [source] Welfare reform and future challenges in the Republic of Korea: Beyond the developmental welfare state?INTERNATIONAL SOCIAL SECURITY REVIEW, Issue 4 2002ju Kwon Since the economic crisis of 1997,98, the Republic of Korea has carried out vigorous social policy initiatives including the reform of the National Pension Programme and National Health Insurance. This paper seeks to answer whether the country's welfare state has moved beyond welfare developmentalism, by examining the cases of those two programmes. By the reform, the coverage of the National Pension Programme was extended to the whole population; and its financial sustainability and accountability were enhanced. Regarding National Health Insurance, efficiency reform was carried out on the management structure, while reform regarding financing was put on hold. These reforms were in clear contrast to the welfare developmentalism that used to place overwhelming emphasis on economic considerations. Despite these reforms, however, the Republic of Korea's welfare state faces the issues of ineffectual implementation and lack of financial sustainability of social policy. The National Pension Programme has failed to cover the majority of irregular workers, whose numbers are on the increase, and National Health Insurance needs to find a way to meet increasing health expenditure. [source] A methodological framework of preparing economic evidence for selection of medicines in the Chinese settingJOURNAL OF EVIDENCE BASED MEDICINE, Issue 3 2010Xin Sun Medicines are becoming a major component of health expenditure in China. Selection of effective and cost-effective medicines represents an important effort to improve medicines use. A guideline on cost-effectiveness studies has been available in China. This guideline, however, fails to be a practical tool to prepare and critically appraise economic evidence. This article discusses, in the Chinese context, the approach to integrating economic component into the medicines selection, and elaborates the methods of producing economic evidence, including conducing economic reviews and primary economic studies. [source] Did globalisation affect health status?JOURNAL OF INTERNATIONAL DEVELOPMENT, Issue 8 2009A simulation exercise Abstract The last two decades of the 20th century recorded a slowdown in the pace of progress of life expectancy at birth in most developing and transitional regions. The paper explores the causes of such trend on the basis of existing mortality theories. The results obtained through an eclectic econometric model confirm the negative impact of the 1980,2000 trends in the main determinants of health, such as rising inequality and volatility, declining health expenditure, lower vaccination coverage, slowly improving female literacy and so on. Finally, the paper simulates the level of LEB that would have been achieved in 10 regions of the world if the above determinants of health had continued developing over 1980,2000 as they did over 1960,1980. The results indicate that in seven of such regions (including China and India) in 2000 LEB would have been higher than actually observed. In this regard, the paper raises some doubts about the way globalisation has taken place and the way public policy oriented it. Copyright © 2009 John Wiley & Sons, Ltd. [source] Catastrophic payments for health care among households in urban Tamil Nadu, IndiaJOURNAL OF INTERNATIONAL DEVELOPMENT, Issue 2 2009Salem Deenadayalan Vaishnavi Abstract Urban residents in India face important health problems due to unhygienic conditions, excessive crowding and lack of proper sanitation. The private sector has started occupying the centre stage of the health system and households are burdened with increasing levels of health expenditure. This paper aims to study out-of-pocket expenditure (OOPE) and the extent of catastrophic payments for health care among households in a highly urbanised state, Tamil Nadu. The study used data on morbidity and health care for the year 2004 collected by the National Sample Survey Organization, India. Care was sought for 84 per cent of illness episodes in urban areas, and the majority used private sector providers (67 per cent for inpatients and 78 per cent for outpatients). Mean OOPE for inpatients and outpatients was higher for households with higher income. The average cost burden per visit was higher among those who sought care from private providers for inpatient services (29 per cent of household consumption expenditure) and outpatient services (20% of household consumption expenditure) compared with the burden associated with public health service use (3,4 per cent of consumption expenditure). About 60 per cent of households which used private health services faced catastrophic payments at the 10 per cent threshold level. To avoid catastrophic expenditure, greater use of the public sector which is providing services at an affordable cost is needed. Improving access to public health services, better gate-keeping systems, stronger controls on drug prices and increasing the quality of services are required to reduce the incidence of catastrophic expenditure both on inpatients and outpatients. Greater use of risk pooling mechanisms would encourage the poor to seek health care and also to protect households from all socio-economic groups from catastrophic expenditure. Copyright © 2009 John Wiley & Sons, Ltd. [source] Cost of renal replacement therapy in TurkeyNEPHROLOGY, Issue 1 2004EKREM EREK SUMMARY: Background and Results: By the end 2000, 22 224 patients were on renal replacement therapy (RRT) in Turkey. We investigated the cost of RRT in three medical faculties and one private dialysis centre. Yearly expenses were US$22 759 for haemodialysis (HD), US$22 350 for continuous ambulatory peritoneal dialysis (CAPD), and US$23 393 and US$10 028, respectively, for the first and second years of transplantation (Tx). In the first year, renal Tx was significantly more expensive than CAPD. However, after the first year of renal transplantation, Tx became significantly more economical than both CAPD and HD. The sum of all yearly RRT expenses for the country was US$488 958 709, which corresponds to nearly 5.5% of Turkey's total health expenditure. Conclusion: Measures such as early construction of vascular access, promoting home dialysis and the reuse of the dialysers, strict control of the use of some expensive drugs like erythropoietin and active vitamin D, and also increasing the number of transplantations, especially if pre-emptive transplantation is possible, should be taken into account in order to reduce these expenses. [source] Generational Accounting in the UKTHE ECONOMIC JOURNAL, Issue 467 2000Roberto Cardarelli This paper presents the first set of generational accounts for the United Kingdom. We find that under our baseline scenario, in which pensions are price indexed and health expenditure grows modestly, the imbalance in UK generational policy is small when compared with other leading industrial countries like the United States, Japan, and Germany. However, under an alternative policy scenario, where all social benefits are wage-indexed and health care spending is increased, there is a larger fiscal bill left for future generations to pay. In this case, achieving generational balance would require much stronger medicine. [source] A HISTORICAL PERSPECTIVE ON MENTAL HEALTH SERVICES IN AUSTRALIA: 1883,84 TO 2003,04AUSTRALIAN ECONOMIC HISTORY REVIEW, Issue 2 2009Article first published online: 22 JUN 200, Darrel Phillip Doessel Australia; deinstitutionalisation; mental health expenditure; mental health policy; public psychiatric hospitals This paper describes changes in the number of residents and admissions to public psychiatric hospitals in Australia, and in the state of Queensland in particular, from 1883 to 2003. It identifies when the deinstitutionalisation of dedicated psychiatric institutions began in Queensland and finds that the policy described as ,opening the back door' (discharging residents) began around 1952,53, while the policy of ,closing the front door' (reducing admissions) began in 1962,63. Deinstitutionalisation in Queensland thus began earlier than most contemporary writers suggest. [source] The role of permanent and transitory shocks in explaining international health expendituresHEALTH ECONOMICS, Issue 10 2008Paresh Kumar Narayan Abstract While there is a growing literature that examines the issue of cointegration (co-movement over the long run) among health expenditures, there are no studies that examine the issue of common cycles (co-movement over the short run) among health expenditures. We undertake a multivariate variance decomposition analysis of per capita health expenditures of the USA, the UK, Japan, Canada, and Switzerland based on a common-trend,common-cycle restriction framework, to examine the relative importance of permanent and transitory innovations in explaining variations in per capita health expenditures in each of the five countries. Our main finding is that transitory shocks are more important in explaining per capita health expenditures in the UK, Japan, and Switzerland, while permanent shocks dominate variations in per capita health expenditures in the USA and Canada over short horizons. Copyright © 2007 John Wiley & Sons, Ltd. [source] Healthy, wealthy and insured?HEALTH ECONOMICS, Issue 3 2008The role of self-assessed health in the demand for private health insurance Abstract Both adverse selection and moral hazard models predict a positive relationship between risk and insurance; yet the most common finding in empirical studies of insurance is that of a negative correlation. In this paper, we investigate the relationship between ex ante risk and private health insurance using Australian data. The institutional features of the Australian system make the effects of asymmetric information more readily identifiable than in most other countries. We find a strong positive association between self-assessed health and private health cover. By applying the Lokshin and Ravallion (J. Econ. Behav. Organ 2005; 56:141,172) technique we identify the factors responsible for this result and recover the conventional negative relationship predicted by adverse selection when using more objective indicators of health. Our results also provide support for the hypothesis that self-assessed health captures individual traits not necessarily related to risk of health expenditures, in particular, attitudes towards risk. Specifically, we find that those persons who engage in risk-taking behaviours are simultaneously less likely to be in good health and less likely to buy insurance. Copyright © 2007 John Wiley & Sons, Ltd. [source] Do health expenditures ,catch-up'?HEALTH ECONOMICS, Issue 10 2007Evidence from OECD countries Abstract In this paper, we examine the ,catch-up' hypothesis, that is, whether or not per capita health expenditures of the UK, Canada, Japan, Switzerland, and Spain converge to the per capita health expenditures of the USA over the period 1960,2000. We propose a framework to examine convergence of health expenditures and use recent developments in unit root testing, namely the Lagrange multiplier univariate and panel approaches that allow for at most two structural breaks. Our main finding is that while univariate and panel tests that do not incorporate structural breaks fail to find evidence of convergence, univariate and panel LM tests that allow for structural breaks find strong evidence of convergence of per capita health expenditures of the UK, Canada, Japan, Switzerland, and Spain to that of the USA. Copyright © 2007 John Wiley & Sons, Ltd. [source] Health care reform in BelgiumHEALTH ECONOMICS, Issue S1 2005Erik Schokkaert Abstract Curbing the growth of public sector health expenditures has been the proclaimed government objective in Belgium since the 1980s. However, the respect for freedom of choice for patients and for therapeutic freedom for providers has blocked the introduction of microeconomic incentives and quality control. Therefore , with some exceptions, particularly in the hospital sector , policy has consisted mainly of tariff and supply restrictions and increases in co-payments. These measures have not been successful in curbing the growth of expenditures. Moreover, there remains a large variation in medical practices. While the structure of health financing is relatively progressive from an international perspective, socioeconomic and regional inequalities in health persist. The most important challenge is the restructuring of the basic decision-making processes; i.e. a simplification of the bureaucratic procedures and a re-examination of the role of regional authorities and sickness funds. Copyright © 2002 John Wiley & Sons, Ltd. [source] Comparing alternative models: log vs Cox proportional hazard?HEALTH ECONOMICS, Issue 8 2004Anirban Basu Abstract Health economists often use log models (based on OLS or generalized linear models) to deal with skewed outcomes such as those found in health expenditures and inpatient length of stay. Some recent studies have employed Cox proportional hazard regression as a less parametric alternative to OLS and GLM models, even when there was no need to correct for censoring. This study examines how well the alternative estimators behave econometrically in terms of bias when the data are skewed to the right. Specifically we provide evidence on the performance of the Cox model under a variety of data generating mechanisms and compare it to the estimators studied recently in Manning and Mullahy (2001). No single alternative is best under all of the conditions examined here. However, the gamma regression model with a log link seems to be more robust to alternative data generating mechanisms than either OLS on ln(y) or Cox proportional hazards regression. We find that the proportional hazard assumption is an essential requirement to obtain consistent estimate of the E(y,x) using the Cox model. Copyright © 2004 John Wiley & Sons, Ltd. [source] Time to include time to death?HEALTH ECONOMICS, Issue 4 2004The future of health care expenditure predictions Abstract Government projections of future health care expenditures , a great concern given the aging baby-boom generation , are based on econometric regressions that control explicitly for age but do not control for end-of-life expenditures. Because expenditures increase dramatically on average at the end of life, predictions of future cost distributions based on regressions that omit time to death as an explanatory variable will be biased upward (or, more explicitly, the coefficients on age will be biased upward) if technology or other social factors continue to prolong life. Although health care expenditure predictions for a current sample will not be biased, predictions for future cohorts with greater longevity will be biased upwards, and the magnitude of the bias will increase as the expected longevity increases. We explore the empirical implications of incorporating time to death in longitudinal models of health expenditures for the purpose of predicting future expenditures. Predictions from a simple model that excludes time to death and uses current life tables are 9% higher than from an expanded model controlling for time to death. The bias increases to 15% when using projected life tables for 2020. The predicted differences between the models are sufficient to justify reassessment of the value of inclusion of time to death in models for predicting health care expenditures. Copyright © 2003 John Wiley & Sons, Ltd. [source] Health status and heterogeneity of cost-sharing responsiveness: how do sick people respond to cost-sharing?HEALTH ECONOMICS, Issue 4 2003Dahlia K. Remler Abstract This paper examines whether the responsiveness of health care utilization to cost-sharing varies by health status and the implications of such heterogeneity. First, we show theoretically that if health care utilization of those in poor health is less responsive to cost sharing, this, combined with the skewness of health expenditures in health status, leads to overestimates of the effect of cost sharing. This bias is exacerbated when elasticities are generalized to populations with greater expenditure skewness. Second, we show empirically that cost-sharing responsiveness does differ by health status using data from the Medicare Current Beneficiary Survey. Medicare beneficiaries are stratified into health status groups based on activity of daily living (ADL) impairments and self-reported health status. Separately, for each of the health status groups, we estimate the effect of Medigap insurance on Part B utilization using a two-part expenditure model. We find that the change in expenditures associated with Medigap is smaller for those in poorer health. For example, when stratified using ADLs, Medigap insurance increases expenditures for ,healthy' groups by 36.4%, while the increase for the ,sick' group is 12.7%. Results are qualitatively the same for different forms of supplemental insurance and different methods of health status stratification. We develop a test to demonstrate that adjusting our results for selection bias would result in estimates of greater heterogeneity. Our results imply that a lowerbound estimate of the bias from neglecting heterogeneity is about 2,7%. Copyright © 2002 John Wiley & Sons, Ltd. [source] Health Care Markets, the Safety Net, and Utilization of Care among the UninsuredHEALTH SERVICES RESEARCH, Issue 1p1 2007Carole Roan Gresenz Objective. To quantify the relationship between utilization of care among the uninsured and the structure of the local health care market and safety net. Data Sources/Study Setting. Nationally representative data from the 1996 to 2000 waves of the Medical Expenditure Panel Survey (MEPS) linked to data from multiple secondary sources. Study Design. We separately analyze outpatient care utilization and whether an individual incurred any medical expenditure among uninsured adults living in urban and rural areas. Safety net measures include distances between each individual and the nearest safety net providers as well as a measure of capacity based on local government and hospital health expenditures. Other covariates include the managed care presence in the local health care market, the percentage of individuals who are uninsured in the area, and local primary care physician supply. We simulate utilization using standardized predictions. Principal Findings. Distances between the rural uninsured and safety net providers are significantly associated with utilization. In urban areas, we find that the percentage of individuals in the area who are uninsured, the pervasiveness and competitiveness of managed care, the primary care physician supply, and safety net capacity have a significant relationship with health care utilization. Conclusions. Facilitating transport to safety net providers and increasing the number of such providers are likely to increase utilization of care among the rural uninsured. Our findings for urban areas suggest that the uninsured living in areas where managed care presence is substantial, and especially where managed care competition is limited, could be a target for policies to improve the ability of the uninsured to obtain care. Policies oriented toward enhancing funding for the safety net and increasing the capacity of safety net providers are likely to be important to ensuring the urban uninsured are able to obtain health care. [source] Predictors of Health Resource Use by Disabled Older Female Medicare Beneficiaries Living in the CommunityJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2003Michael Weiner MD OBJECTIVES: To identify specific clinical factors that could best predict resource use by disabled older women. DESIGN: Cross-sectional. SETTING: Urban community in Baltimore, Maryland. PARTICIPANTS: One thousand two community-dwelling, moderately to severely disabled, female Medicare beneficiaries aged 65 and older, from the Women's Health and Aging Study I (WHAS). MEASUREMENTS: WHAS data were merged with participants' 1992,1994 Medicare claims data for the year after baseline evaluation, reflecting inpatient, outpatient, home-based, and skilled-nursing services. The independent contributions of factors hypothesized to predict health expenditures were assessed, using chi-square and regression analyses, with the logarithm of Medicare expenditures as the primary outcome. RESULTS: Demographic factors were not associated with Medicare expenditures. Factors associated with expenditures in bivariate analyses included heart disease (1.4x), chronic obstructive pulmonary disease (1.3x), diabetes mellitus (1.1x), smoking, comorbidity, and severity of disability, as well as low creatinine clearance, serum albumin, caloric expenditure, or skinfold thickness. Heart disease, diabetes mellitus, and low skinfold thickness remained significant after adjustment for other factors. CONCLUSION: Heart disease, diabetes mellitus, and low skinfold thickness are important independent predictors of 1-year Medicare expenditures by disabled older women. Many other variables that reflect disease, disability, nutrition, or personal habits have less predictive ability. Most demographic factors are not predictors of expenditures in this population. Focusing on the best predictors may facilitate more-effective risk adjustment and creation of related health policies. [source] The Burden of Disease and the Cost of Illness Attributable to Alcohol Drinking,Results of a National StudyALCOHOLISM, Issue 8 2010Helena Cortez-Pinto Background and Aims:, The World Health Organization estimated that 3.2% of the burden of disease around the world is attributable to the consumption of alcohol. The aim of this study is to estimate the burden of disease attributable to alcohol consumption in Portugal. Methods:, Burden and costs of diseases attributable to alcohol drinking were estimated based on demographic and health statistics available for 2005, using the Disability-Adjusted Life Years (DALY) lost generated by death or disability. Results:, In Portugal, 3.8% of deaths are attributable to alcohol (4,059 of 107,839). After measuring the DALY generated by mortality data, the proportion of disease attributable to alcohol was 5.0%, with men having 5.6% of deaths and 6.2% of disease burden, while female figures were, respectively, 1.8 and 2.4%. Considering the sum of death and disability DALYs, liver diseases represented the main source of the burden attributable to alcohol with 31.5% of total DALYs, followed by traffic accidents (28.2%) and several types of cancer (19.2%). As for the cost of illness incurred by the health system, our results indicate that ,95.1 millions are attributable to alcohol-related disease admissions (liver diseases, cancer, traffic accidents, and external causes) while the ambulatory costs of alcohol-related diseases were estimated in ,95.9 million, totaling ,191.0 million direct costs, representing 0.13% of Gross Domestic Product and 1.25% of total national health expenditures. An alternative analysis was carried out using higher consumption levels so as to replicate aggregate alcohol consumption statistics. In this case, DALYs lost increased by 11.7% and health costs by 23%. Conclusion:, Our results confirm that alcohol is an important health risk factor in Portugal and a heavy economic burden for the health system, with hepatic diseases ranking first as a source of burden of disease attributable to alcohol. [source] Population Ageing and Social Expenditure in New ZealandTHE AUSTRALIAN ECONOMIC REVIEW, Issue 1 2005John Creedy As the population ages there will be potentially significant implications for a wide range of economic variables, including in particular the fiscal costs of social expenditures. Long-term fiscal planning requires estimates of the possible future path of public spending. This article presents projections for 14 categories of social spending. These projections are based on detailed demographic estimates covering fertility, migration and mortality. Distributional parameters are incorporated for all of the major variables, and are used to build up probabilistic projections for social expenditure as a share of gross domestic product using simulation. Attention is focused on health expenditures which are disaggregated into seven broad classes. In addition, we explore the impacts of alternative hypotheses about future health costs. While it can be predicted with some confidence that overall social expenditures will rise, the results suggest that long-term planning would be enriched by recognising the distributions around point estimates of projected social costs. [source] COSTLY AGEING OR COSTLY DEATHS?AUSTRALIAN ECONOMIC PAPERS, Issue 1 2006UNDERSTANDING HEALTH CARE EXPENDITURE USING AUSTRALIAN MEDICARE PAYMENTS DATA In health economics and health care planning, the observation that age cohorts are generally positively correlated with per capita health expenditures is often cited as evidence that population ageing is the main driver of health care costs. Several recent studies, however, challenge this view. Zweifel et al. (1999) and Felder et al. (2000), for example, find that individuals incur the highest health care costs around the time before their death. Thus, they argue, it is proximity to death rather than ageing that is driving health care costs. This paper examines the issue by estimating a two-equation exact aggregation demand model using Australian Medicare payments data over an eight-year period (1994,2001). The results suggest that once proximity to death is accounted for, population ageing has either a negligible or even negative effect on health care demand. [source] Tax credits, insurance, and the use of medical careCANADIAN JOURNAL OF ECONOMICS, Issue 2 2005Michael Smart Little is known about the effects of such tax measures on individual behaviour, in contrast to the extensive research on the tax exemption for employer-provided health insurance. In this paper, we exploit variation in the after-tax cost of health expenditures under the tax law to estimate the tax price elasticity of demand for prescription drugs, health insurance, and other eligible expenditures. We find evidence of moderate to large tax price elasticities, compared with traditional point-of-service price elasticity estimates , despite the apparent differences in the way tax subsidies are experienced by consumers. In contrast, we find no evidence the tax subsidy affects demand for health insurance on the intensive margin, which we show is consistent with the theory of optimal self-insurance. We discuss the implications of our results for recent proposals to reform public and private health insurance systems. JEL classification: I1, H2 Crédits d'impôt, assurance et l'utilisation des soins médicaux., Les systèmes d'impôt sur le revenu des particuliers au Canada, aux Etats-Unis et ailleurs permettent des déductions ou crédits d'impôt pour les dépenses directes en soins de santé assumées par les particuliers ou pour les primes d'assurance privée. On connaît mal les effets de ces mesures fiscales sur le comportement des personnes par comparaison avec les résultats extensifs de la recherche sur les effets des exemptions fiscales pour l'assurance santé fournie par les employeurs. Dans ce texte, on utilise la variation dans le fardeau des dépenses pour la santé après impôt selon les diverses juridictions pour évaluer l'élasticité de la demande de médicaments d'ordonnance, de l'assurance santé, et d'autres dépenses éligibles en réponse à des différences de prix fiscaux. On découvre que l'ordre de grandeur des élasticité se situe entre modérée et grande quand on les compare aux évaluations des élasticités traditionnelles de la demande aux points de service par rapport aux prix , et ce malgré les différences apparentes dans les expériences de ces subventions fiscales pour les consommateurs. D'autre part, on ne trouve pas de support pour l'hypothèse que les subventions fiscales affectent la demande d'assurance santéà la marge intensive , ce qui concorde bien avec ce que nous enseigne la théorie de l'auto-assurance optimale. On discute les implications de ces résultats pour certaines réformes récentes proposées aux systèmes d'assurance santé privés et publics. 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