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PubMed1987

Aggregate health care expenditures and national income. Is health care a luxury good?

It is well known that a strong relationship exists between national expenditures on health care and national income. This has been used to suggest that health care is a luxury good, and that factors such as the type of health care delivery system in a country are of little importance in determining expenditure levels. This paper argues that these implications rely upon the application of microeconomic analysis to macroeconomic data, and that this is not appropriate. As well as raising questions about the inferences drawn from previous studies, new empirical evidence is presented which casts some doubts on previous findings. International comparisons are based on Purchasing Power Parity rather than exchange rate conversions, underlining the importance of prices as well as quantities in the relationship, and leading to the conclusion that the aggregate data show health care to be, if anything, a necessity rather than a luxury good.

Australia↗
PubMed2005

A cross-national perspective on cost of illness: a comparison of studies from The Netherlands, Australia, Canada, Germany, United Kingdom, and Sweden.

All Western health systems are in search of efficiency. Cost of illness (COI) studies can contribute to the efficiency debate by elucidating the relation between health expenditure and health status and population demography. Since the purpose of COI data being summarized in the OECD Health Data publications is to facilitate cross-national comparisons, it is important to assess the comparability. We compared COI data from six countries at macrolevel of total health expenditure and disaggregated the data from four countries to sectors such as hospitals, drugs, health professionals, and residential care. Although the distribution of health expenditure over major diseases showed similar patterns in all countries, overall comparability was bad. We conclude that the current scope of COI studies is bound to national levels because health care systems dominate the magnitude and distribution of health expenditure. Cross-national comparisons may be possible if data and methods are standardized, and COI estimates are made for a common comparable package.

Cost of Illness↗
PubMed1990

[The present status and trends in health care expenditures throughout the world and in Czechoslovakia].

Expenditure on health services on a world-wide scale have an ever increasing trend. The trends in advanced countries where nowadays the expenditure on health services is cca 10% of the national gross product is to restrict a further rise and to make maximum use of available resources. In Czechoslovakia the position is different, as expenditure on health services is roughly half as compared with advanced countries. Provisions thus will be specific and funds from other sources than the stage budget will be increased and there will be efforts to achieve a maximum effectiveness as regards the use of available resources. At the same time it will be, however, necessary to make an effort to increase the total volume of financial resources for the health services. The importance of these efforts ensues from the present health status of the population.

Czechoslovakia↗
PubMed1999

Adding up provincial expenditures on health care for Manitobans: a POPULIS project. Population Health Information System.

OBJECTIVES: Using the POPULIS framework, this project estimated health care expenditures across the entire population of Manitoba for inpatient and outpatient hospital utilization, physician visits, mental health inpatient, and nursing home utilization. RESEARCH DESIGN: This estimated expenditure information was then used to compare per capita expenditures relative to premature mortality rates across the various areas of Manitoba. RESULTS: Considerable variation in health care expenditures was found, with those areas having high premature mortality rates also having higher health care expenditures.

Adolescent↗
PubMed1991

[Do we need predictions for health care expenditures?].

The unfavourable health status of our population is generally known, its improvement being one of the basic prerequisites for the further development of our society. To a certain extent improvement may be promoted by high standard health services. The standard of these services depends, in addition to effective use of available financial means, on the increase of the total volume of financial resources for the health services. For a qualified decision on the actual volume of financial resources it will be necessary to have a well elaborated prognosis of expenditure on health services which among others will justify the financial demands of the branch. The prognosis of expenditure on health services will be a socio-economic prognosis which may be started in the near future, if suitable conditions will be created.

Czechoslovakia↗
PubMed1978

Expenditures for health care of children and youth in the United States.

This paper describes the expenditures for health care in the United States in fiscal year 1975. Proportionately, health expenditures for children and youth are lower than for other age groups. The average per capita expenditure for children and youth was $212.00. For children and youth public health care expenditures represented 24 per cent of the total; from public funds, Medicaid and the Department of Defense were the largest two programs; from the public sector, the federal government provided two thirds of the total health expenditures. For children and youth, two thirds of all health expenditures were for hospital care and physicians' services.

Adolescent↗
PubMed1990

Health care expenditure patterns for adolescents.

Health care expenditure patterns are described using a sample of 2,767 adolescents aged 10 to 18 years from the National Medical Care Utilization and Expenditure Survey. Average total per capita health care expenditures were $525. Average out-of-pocket expenses were $151 in 1988 dollars. The burden of out-of-pocket expenses was distributed unevenly among the families of adolescents. The 10% of adolescents with the highest expenses accounted for 65% of all out-of-pocket expenses. The presence of health insurance coverage greatly reduced the risk of incurring burdensome out-of-pocket expenses. Health policy interventions to improve health insurance coverage of adolescents are discussed.

Adolescent↗
PubMed2000

Past and present attempts to control health service expenditure and its effects on National Health dentistry.

OBJECTIVE: To examine the methods used by policy makers to try to reduce or limit expenditure within the National Health Service. METHOD: A chronological examination of cost related health care policy and its wider impact on society. Comparison of past developments in the NHS with new methods of health care organisation in the United Kingdom (UK). The experiences of two dental Total Purchasing Pilots are used to describe where the dental profession now stands in relation to current NHS developments. RESULTS: The introduction of Primary Care Groups (PCGs) constitutes part of a continued effort by health care policy makers to control expenditure on health services. In the PCG system, as in Total Purchasing (TP), a group of primary care practitioners control a finite budget. These groups therefore must decide which health care services should be available to the population they represent. Inevitably such systems result in the rationing of health care, but the decisions are instigated by primary health care professionals rather than by government edict. CONCLUSION: Unless GDPs are allowed, willing and able, to participate in and influence the newly emerging Primary Care Groups and Trusts, dental services may once again be pushed to the fringe of NHS care provision. Without adequate representation, the value of dental care may not be recognised and PCGs may decide to make use of traditional dental resources, to fund other services.

Cost Control↗
PubMed2003

Impact of separating drug prescribing and dispensing on provider behaviour: Taiwan's experience.

In many Asian countries, physicians both prescribe and dispense drugs. This practice is hypothesized to have caused high drug expenditure and widespread prescription of antibiotics in Asia. Recently, Taiwan implemented the separation policy on an experimental basis. This paper's objective is to empirically evaluate the impact of Taiwan's reform to separate drug prescribing and dispensing on drug expenditure and total health expenditure. The research design consists of a pre/post comparison of the experimental with the control sites (difference-in-difference). Separation policy was implemented in Kaohsung and Taipei in March 1997, and expanded to Chia-yi and Taichung in March 1998. Changes in drug prescription behaviour before and after implementation in these two pairs of experimental cities were compared to Hsin-chu and Tainan (control), where separation policy was not implemented during the study period. To reduce resistance, providers in experimental sites were allowed to hire on-site pharmacists and dispense drugs through them if they chose to do so. Our study sample consists of all outpatient visits to clinics in the study sites between December 1996 and June 1998, with a total of 55.23 million claim records. The drug prescription rate, drug expenditure and total health expenditure per visit were the main outcome measures. We found that the probability of prescription and drug expenditure per visit were, respectively, 17-34% and 12-36% less among visits to clinics without on-site pharmacists, compared with the control sites. However, no difference in total health expenditure was found between these two types of visits. Hence, the separation policy could be effective in reducing drug expenditure and affecting prescription behaviour, but is less certain as a policy for reducing total health expenditure. We also found that the policy has practically no effect on clinics that have on-site pharmacists.

Drug Costs↗
PubMed1990

Health care expenditures for the elderly: a current and future dilemma.

Financing health care for the elderly is becoming a familiar topic in the popular press. Considering that those aged 65 yr and older constitute 12% of the population and consume about 30% of all health care expenditures, health care financing for the elderly makes a timely and interesting topic. In this paper the financing issue is addressed. With the elderly, on average, becoming more affluent, the issue of self-financing must be explored. This of course does not mean the elimination of Medicare but possibly development of a different/alternative approach. As part of our analysis, the potential political pressure from the younger generation is considered.

Aged↗
PubMed2006

The impact of cost sharing of prescription drug expenditures on health care utilization by the elderly: own- and cross-price elasticities.

PURPOSE: To estimate healthcare demand elasticity and evaluate the impact of deductible/co-payment policy changes for prescription drugs on the use of drugs and physician visits among seniors with rheumatoid arthritis (RA) in British Columbia (BC), Canada. METHODS: According to the BC drug insurance program, prior to 2002, seniors co-paid the dispensing fee of each prescription to an annual maximum of CAN$ 200 (plan A). Starting in 2002, this plan was split into plan A and plan A1 (Premium Assistance) such that the co-payment amount equaled a maximum of CAN$ 25 and CAN$ 10 per prescription to an annual maximum of CAN$ 275 and CAN$ 200, respectively. Because of the endogeneity of the beneficiary price in the presence of a non-linear price schedule resulting from the cost-sharing policy, we implemented the method of instrumental variables to estimate price elasticities. The instrument was based on the price an individual would face under the new cost-sharing policy if their consumption remained at the pre-policy level. RESULTS: A total of 8017 patients were included. The estimated own-price elasticity of demand for prescription drugs and the cross-price elasticity of demand for physician visits were found to be negative and positive, respectively. The implications of our findings were that when cost sharing for prescription drugs increased, the demand for prescription drugs decreased and the demand for physician visits increased. CONCLUSIONS: In a predominantly publicly funded health care system, the selective introduction of market driven cost containment concepts such as patient cost-sharing might have the unintended impact of increasing overall health utilization for seniors with RA.

Aged↗
PubMed1989

Health care expenditure and other data.

This international compendium from the Organization for Economic Cooperation and Development Secretariat contains available data for the 24 Member countries for 1960 through 1987. The Federal Republic of Germany is listed as Germany. Tables are presented for expenditure on health, health care pricing trends, social protection and public participation, utilization of medical services and available personnel resources, selected variations in common medical care practice, selected health status indicators, and demographic and general economic background data. There may be some inconsistencies between the data presented in the articles in this issue and those in this data compendium. The articles were based on earlier versions of the Health Data File. As a result, revisions to the data in a number of countries, including Canada, France, Germany, and Italy, are not reflected in the articles. However, the changes are relatively minor and do not affect the results presented in the articles in any substantive way.

Canada↗
PubMed1996

Health care expenditure and life expectancy in Australia: how well do we perform?

The Australian health care system consists of mixed public and private financing underpinned by Medicare, a universal government-run insurance scheme paid through taxation (and levy) on income. Australia has improved its ranking for life expectancy (at birth) since 1960, and in 1990 ranked ninth and seventh of 24 countries for females and males respectively; this is ahead of the United States and United Kingdom, and approximately equal to Canada. Australian hospital bed supply and utilisation are average, after deletion of day-only cases. The proportion of gross domestic product (GDP) spent on health, in relation to GDP per capita (adjusted for purchasing power), in Australia in 1990 was average, and the prices for health care from 1975 to 1990 did not increase when adjusted for inflation. Although 68 per cent of health expenditure emanates from public sources in Australia, this is lower than in the majority of European countries and Canada. Some countries are doing poorly (such as the United States, with lower than average life expectancy and higher than predicted health expenditure) and some countries are doing well (with higher than average life expectancy and lower than predicted health expenditure; for example, Japan). Australia has higher than average life expectancy and only slightly higher than predicted health expenditure per capita. Although the Australian system could be improved, there are no indications that radical changes are required. The relatively high life expectancy in Australia can be attributed to favourable social and economic conditions, successful public health programs, and the availability of universal quality health care.

Australia↗