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PubMed2005

[Private expenditure in health by state in Mexico].

OBJECTIVE: Present information on the magnitude and composition of private health expenditure (PHE) in Mexico. MATERIAL AND METHODS: Total PHE by state was calculated using the System of National Health Accounts and National Performance Assessment Survey 2002-2003 by means of elasticities and growth relative contributions. RESULTS: 58% of the total PHE was private and 90% of this was out-of-pocket expenditure. Most of the latter is expenditure in ambulatory care and drugs. 60% of the PHE was concentrated in only six states. PHE was lower than public expenditure in six states. CONCLUSIONS: The magnitude of out-of-pocket expenditure in health is worrying, since it is the most unfair, inefficient and regressive way of financing health care. Health authorities should look for alternative ways to finance health care, like the Popular Health Insurance.

Ambulatory Care↗
PubMed2006

The utility of extended longitudinal profiles in predicting future health care expenditures.

BACKGROUND: Health care spending is highly concentrated. Prediction models that accurately identify the characteristics of individuals most likely to incur high levels of health expenditures in a subsequent year are important analytical and statistical tools. OBJECTIVES: This study examined the capacity of alternative models to predict the likelihood of incurring high levels of medical expenditures in a subsequent year. This effort also evaluated the utility of an additional year of longitudinal information. SUBJECTS: A nationally representative sample from the Medical Expenditure Panel Survey (MEPS). METHODS: The MEPS longitudinal data are used to examine the persistence of high expenditures during a 2-year period. With the unique linkage of the MEPS to the National Health Interview Survey, the utility of an additional year of data also was examined. Resultant models were evaluated in terms of sensitivity, specificity, and predictive capacity. RESULTS: Only modest marginal gains in discrimination capacity were realized from the use of extended longitudinal profiles from the National Health Interview Survey, relative to information on prior year characteristics. CONCLUSIONS: Our results highlight the continuing concentration of health care expenditures during the period 1996 to 2002 and reveal some attenuation in magnitude in the tail of this distribution over time. Further, our results provide evidence of the utility of probabilistic models as prediction tools to identify individuals likely to incur high levels of expenditures in future years. Predictive capacity does not suffer when restricted to a single year of prior information.

Adolescent↗
PubMedDate not supplied

The equity principle in the allocation of health care expenditure on primary health care services in Portugal: the human capital approach.

This article examines the equity principle as it could be applied to the financing of primary health care resources in Portugal. Three resource allocation criteria are considered: namely, the demand/utilization criterion; the health situation criterion; and, the coverage by health services criterion. With data based on health service expenditure, district by district, for 1983, the article shows that quite different results would emerge from the selection of one criterion rather than another. In particular, a policy of positive discrimination would reallocate resources towards the north rather than the south of Portugal, though differences would emerge between districts and between specific activities provided within the framework of primary health care. The results are presented and conclusions drawn.

Health Expenditures↗
PubMed2007

A multilevel analysis on the determinants of regional health care expenditure: a note.

Health care in most countries is a rather "local good" for which the fiscal decentralization theory applies and heterogeneity is the result. In order to address the issue of multijurisdictional health care in estimating income elasticity, we constructed a unique sample using data for 110 regions in eight Organisation for Economic Co-operation and Development (OECD) countries in 1997. We estimated this sample data with a multilevel hierarchical model. In doing this, we tried to identify two sources of random variation: within- and between-country variation. The basic purpose was to find out whether the different relationships between health care spending and the explanatory variables are country specific. We concluded that to take into account the degree of fiscal decentralization within countries in estimating income elasticity of health expenditure proves to be important. Two plausible reasons lie behind this: (a) where there is decentralization to the regions, policies aimed at emulating diversity tend to increase national health care expenditure and (b) without fiscal decentralization, central monitoring of finance tends to reduce regional diversity and therefore decrease national health expenditure. The results of our estimation do seem to validate both these points.

Age Factors↗
PubMed2006

Catastrophic household expenditure for health care in a low-income society: a study from Nouna District, Burkina Faso.

OBJECTIVE: To quantify the extent of catastrophic household health care expenditure and determine the factors responsible for it in Nouna District, Burkina Faso. METHODS: We used the Nouna Health District Household Survey to collect data on 800 households during 2000-01 for our analysis. The determinants of household catastrophic expenditure were identified by multivariate logistic regression method. FINDINGS: Even at very low levels of health care utilization and modest amount of health expenditure, 6-15% of total households in Nouna District incurred catastrophic health expenditure. The key determinants of catastrophic health expenditure were economic status, household health care utilization especially for modern medical care, illness episodes in an adult household member and presence of a member with chronic illness. CONCLUSION: We conclude that the poorest members of the community incurred catastrophic health expenses. Setting only one threshold/cut-off value to determine catastrophic health expenses may result in inaccurate estimation leading to misinterpretation of important factors. Our findings have important policy implications and can be used to ensure better access to health services and a higher degree of financial protection for low-income groups against the economic impact of illness.

Burkina Faso↗
PubMed2005

Use of diagnosis-based risk adjustment models to predict individual health care expenditure under the National Health Insurance system in Taiwan.

BACKGROUND AND PURPOSE: Diagnostic information has been extensively studied and employed in the prediction of risk adjusted capitation payments in some countries. Nevertheless, few studies have been dedicated to the development of diagnosis-based risk adjusters in Taiwan. The purposes of this study were to develop outpatient diagnosis-based risk adjusters for a model of Taiwan's National Health Insurance (NHI) system and to evaluate the predictability of the risk adjustment models generated utilizing these adjusters. METHODS: Using a 2% random sample of 371,620 NHI enrollees, 5 risk adjustment models--i.e., demographic, inpatient diagnostic information outpatient diagnostic information, full diagnostic information, and prior utilization models--were evaluated with respect to predictive R2 and predictive ratios. While inpatient diagnosis-based risk adjusters were borrowed from previous research, outpatient diagnosis-based risk adjusters, referred to as Taiwan Ambulatory Spending Groups (TASGs), were developed based on 1996 claims data. RESULTS: The values of predictive R2 for the 5 risk adjustment models showed that the inclusion of outpatient diagnostic information considerably improved the predictability of the risk adjustment models for Taiwan's NHI system. Moreover, the predictive ratios revealed that the full diagnostic information model would reimburse different risk subgroups more fairly than the demographic, inpatient diagnostic information, and outpatient diagnostic information models and also outperform the prior utilization model with respect to disease risk groups. CONCLUSIONS: The risk adjustment model including the TASG risk adjusters can significantly improve predictability and can be employed to assess the NHI's current and proposed reform measures.

Capitation Fee↗
PubMed1997

A four-year comparison of physical health benefit expenditures of mental and physical health claimants.

The pattern of covered physical health benefit expenditures before and after initiation of mental health treatment for a cohort of individuals with mild to moderate mental health problems was examined in this study. The results indicated the mental health treatment group (MHTG) began to have higher total covered benefits expenditures about one year prior to starting mental health treatment. Statistically significant differences between the MHTG and comparison groups (groups with no mental health treatments during the study period and matched on age and gender) began at the quarter just before treatment and continued through the seventh quarter after treatment initiation. The higher pattern of total health benefit expenditures of the MHTG declined gradually for two years before it returned to pretreatment levels. The study suggests the need for a better understanding of the types of physical health benefits expenditures preceding and following mental health treatment. It further indicates that the integration of physical and mental health benefits case management may have potential for reducing overall health benefit costs.

Adult↗
PubMed2006

The development of a Local Index of Need (LIN) and its use to explain variations in social services expenditure on mental health care in England.

Wide variations in deprivation exist across England and it is likely that these variations translate into differences in the need for mental health care. Social Services Departments in England account for a substantial proportion of mental health expenditure. It is important that the distribution of expenditure reflects mental health needs. This paper's aims are to (1) describe the development of a new indicator of mental health needs, (2) use the index to explain variations in social services expenditure on mental health, and (3) compare the index with other established measures of need. A principal components analysis of sociodemographic variables considered to be indicators of need was used to produce four distinct factors for 148 Local Authority areas in England. A weighted sum of these factors was used to produce a single index. (Weights were the proportion of variance explained by each factor.) The index was used in a regression model to explain variations in spending on mental health care and was compared with (1) a model containing the four individual factors, (2) the current method of allocating resources, (3) the index used to allocate resources to primary care trusts, (4) the Mental Illness Needs Index (MINI), (5) four indices of deprivation produced by the Office of the Deputy Prime Minister, and (6) the average of the above four indices. The new index could explain 54% of variation, compared with 56% using the current method. The four-factor model could explain 66%, whilst the other models could explain between 37% and 20%. This new index has the advantage that it is not based on previous levels of utilisation or expenditure and yet still explains a comparable amount of variation as the current method. However, a disaggregated model containing individual factors may be preferable.

Adolescent↗
PubMed1999

Improving service quality: experience from the Tanzania Family Health Project.

OBJECTIVE: To improve the quality and uptake of reproductive health service in rural communities in Tanzania. DESIGN: Descriptive study of operational research. SETTING: One and a half million people living in urban and rural communities in the Mbeya Region of Tanzania. METHOD: Design and implementation of a range of service quality improvement measures. INTERVENTIONS: Management systems strengthening; clinical skills training; orientation of health staff to service quality; introduction of quality assurance systems; improvement to supervision systems; community involvement in monitoring health service delivery. OUTCOME MEASURES: Health service utilization rates; client perceptions of health service quality; situation analysis of health service provision. RESULTS: Uptake of reproductive health services increased; improved client perceptions of service quality; improved health infrastructure; increased community participation in health service management. CONCLUSIONS: Health service quality in sub-Saharan Africa can be improved substantially through a process of identifying and addressing the constraints which militate against effective service provision. The cost of such improvement is modest compared with current health expenditure. Health planners and managers involved in sectoral reform programmes should give due attention to quality assurance mechanisms in addition to structural elements of the reform process.

Family Practice↗
PubMed2007

Prioritizing health problems in women in developing countries: comparing the financial burden of reproductive tract infections, anaemia and depressive disorders in a community survey in India.

OBJECTIVES: To compare the health care and opportunity costs of three common health problems [depressive disorders, reproductive tract infections (RTIs) and anaemia] affecting women and their associated risks of catastrophic health expenditure (defined a priori as out-of-pocket expenditure on health care exceeding 10% of the total monthly household income). METHODS: Cross-sectional survey of 2494 women who consented to participate, from a randomly selected sample of 3000 women aged 18-50, living in the catchment area of a primary health centre in Goa, India. Depressive disorders were diagnosed with the Revised Clinical Interview Schedule; anaemia on the basis of a fingerprick sample of blood using the Haemocue system; and RTI using PCR, culture and microscopy with vaginal or urine specimens. Economic consequences were measured using the Costs of Illness Schedule and the WHO Disability Assessment Schedule. Health provision costs were calculated using previously derived unit costs for services for the main types of health care provider. RESULTS: Catastrophic health expenditure, defined a priori as >10% of total household income spent out of pocket on health in the previous month, was reported by 138 women (5.5%; CI: 4.7-6.5%); they were more likely to report economic difficulties, such as having gone hungry in the past 3 months because of lack of money (OR 1.99, CI 1.1-3.6, P = 0.02). Only depressive disorder was associated with significantly higher health care costs, lost time costs and risk of catastrophic health expenditure (OR 2.66, CI 1.6-4.4, P < 0.001, after adjustment for possible sociodemographic confounders and other physical health problems). There was a linear association between the psychological morbidity score (arranged into quintile groups) and the risk of catastrophic health expenditure (adjusted). CONCLUSIONS: If economic arguments were considered a key driver for global health policy, then depressive disorder should be considered a major health priority for women in developing countries.

Adolescent↗
PubMed1987

Family out-of-pocket expenditures for health care: United States, 1980.

Information on out-of-pocket health care expenditures for families in 1980 is presented in this report. The data discussed here were gathered through the national household sample of the National Medical Care Utilization and Expenditure Survey (NMCUES). Information for the year 1980 was collected on health problems, health care received, expenditures for care, health insurance, and related topics from approximately 6,800 families in the U.S. civilian, noninstitutionalized population. All individuals who are in institutions or in the military are excluded from this analysis as are all families with military heads of family, even if they have civilian members. For this report, a family was initially defined as: two or more persons living together who were related either by blood, marriage, adoption, or a formal foster care relationship; or as a single person living outside such relationships. Because these data were collected throughout an entire year, the important concept of "longitudinal family" was developed. This concept was necessary to deal with the fact that the composition of a family could change over time, and that families could come into existence and go out of existence over time. As the data are based on this dynamic concept of families, all measures of health care expenditures are calculated in terms of annual rates. Family data are important for understanding the health care system because decisions to seek and use health care are usually family decisions, health care is usually paid for out of family resources, and family distributions for health-related variables differ from the distributions found for individuals.

Adult↗
PubMed2003

Health care expenditures and ageing: an international comparison.

This study examines national health expenditure trends for Japan, Canada, Australia, and England and Wales (combined) to assess the impact of changing demographics and changing age-specific per capita expenditure on national health expenditure. Age-specific expenditure data were obtained from each country's department of health. We calculated changes in age-specific per capita expenditure, population demographics and the share of expenditures used by the different age groups over time. We then determined the extent to which isolated changes in population growth, demographic shifts and changes in age-specific per capita expenditure could predict observed increases in health expenditure. For Japan, Canada and Australia per capita health expenditure increased fastest among those aged 65 and over, at up to twice the increase of those aged 45-64. In England and Wales, on the other hand, those aged 65 and over experienced one-third of the cost increase of those aged 45-64. Hence, the proportion of national health expenditures used by the population aged 65 and over decreased from 40% to 35% in England and Wales, while increasing in the other countries by up to 10 percentage points. Demographic shifts and population growth predicted only 18% of the observed increases in health care expenditures in England and Wales, compared to 68%, 44% and 34% for Japan, Canada and Australia respectively. These differential changes in costs for older age groups over time invite future research into the driving forces behind these costs.

Adolescent↗