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The health care spending share of gross domestic product (GDP) remained steady between 1993 and 1999 as moderate-to-strong economic growth coincided with a rapid shift to managed care. This shift, along with decelerating growth in Medicare spending, appears to have generated a mostly one-time saving that lowered aggregate health expenditure growth.
In the last fifteen years Mexico suffered several economic crisis which have negatively affected public expenditure in social welfare and, as a consequence, public expenditure in health. This paper discusses the relationship between the adjustment policies adopted to confront these crisis and public expenditure in health care for the non-insured population, as well as the regional distribution of this expenditure. In part one, the evolution of general public expenditure, public expenditure in social welfare, and public expenditure in health between 1980 and 1995 is described. In part two, the distribution of public health expenditure for the non-insured population among the five regions in which the country was divided by the National Health Survey II is discussed. The main conclusion of this paper is that, between 1980 and 1995, the public expenditure gaps that have existed for a long time in Mexico among regions remained unchanged. These gaps basically affect the southern states of the country, are not related to health needs, and may deepen in view of the new relative cuts in public expenditure in social welfare announced by the new administration.
The purpose of this study was to investigate the level and distribution of household health care expenditures in Morocco, and to compare the level of health care funds provided by households with the levels provided by the government and international donors. In addition, the reliance of poor and non-poor households on both public and private providers was investigated. The study was based on data collected in the 1995 Demographic and Health Survey, which included a special supplement on health care expenditures. Descriptive statistics are presented on utilization of out-of-pocket expenditures for antenatal and obstetric care, chronic care, and non-chronic care associated with illness and injury, by urban/rural status and by socio-economic status. The results indicate that government health care providers are an important source of modern health care not only for poor households, but for better-off households as well. While individuals who use private health care providers incur substantially higher costs than those who use public providers, an unexpected finding of the study is the degree to which public clients pay for health care services, despite the fact that public care is nominally priced in Morocco. We conclude by discussing the implications of our results on the design and implementation of health care reform policies.
BACKGROUND: Although the mental health care is a substantial component of the health system in the Czech Republic, there is a lack of information and research on mental health expenditures. Determining the level and profile of mental health expenditures is the first step in achieving awareness of the cost of mental illness to society. AIMS OF THE STUDY: To describe the mental health care financing and delivery system in the Czech Republic and to estimate the mental health expenditures in 2001. The paper examines expenditures with regard to structure by type of service, relative share of total health expenditures, and relative share of the gross domestic product. It also makes international comparisons of mental health expenditures between the Czech Republic and other countries. METHODS: The data discussed in this study come from the Institute of Health Information and Statistics of the Czech Republic and from the General Health Insurance Fund of the Czech Republic. Mental health expenditures are defined as expenditures on services for patients with primary or first-listed diagnoses from Chapter V, Mental and Behavioural Disorders (F00-F99), of the Tenth Revision of International Classification of Diseases (ICD-10). Different methods of allocation are used for various types of services. In addition, expenditures of sickness insurance related to mental illness are also estimated. RESULTS: Mental illness is diagnosed and treated in about 4% of the population. The share of mental illness on the total morbidity in the population is approximately 2%. The share of mental health expenditures on both the total health expenditures (3.54%) and the gross domestic product (0.26%) is low when compared to levels in other developed countries. Psychiatric hospitals consume 35.6% of mental health expenditures; prescribed drugs and medical aid consume 33.2%; specialized outpatient services consume 17.4%; and shares of other services are relatively low. IMPLICATIONS FOR HEALTH CARE POLICY FORMULATION: First, if the amount of expenditures allocated to mental health can be interpreted as an indicator of the government's commitment to mental health, then, in comparison to other developed countries, mental health has a low priority in the Czech Republic. Second, the improved availability of data on morbidity and regular analyses of these data are needed and should yield fast and valuable results.
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HIGHLIGHTS OF THE STUDY. Health expenditures in New York City totalled roughly $15.7 billion in 1983. Those expenditures represented 13.5 percent of the gross city product. Expenditures for personal health care services amounted to more than $1,900 per city resident. Despite comparatively high levels of health expenditures in New York City, such expenditures have risen much less dramatically over time than health expenditures nationally; from 1976 to 1983, city expenditures increased by 74.6 percent, compared with a national increase of 137.7 percent. More than one half (55.3%) of health expenditures in the city were accounted for by public funds. Nearly 50 percent of personal care expenditures were associated with the delivery of hospital services, for which expenditures totalled $6.9 billion. Fifty-five percent of Medicaid hospital outlays and 86 percent of Medicare hospital outlays went to private sector hospitals. More than $400 per capita was spent on physicians' services in New York City in 1983. Public sources of funds accounted for more than 80 percent of the $1.7 billion in long term care services expenditures; this contrasts with a much smaller proportion of public funding for such services nationally. More details on health expenditures in New York City follow. Data sources, definitions, study methods, and limitations are described in an appendix to this report.
Outlays for health care in the Nation reached $192.4 billion in calendar year 1978--13 percent higher than in 1977, according to preliminary figures compiled by the Health Care Financing Administration. This estimate represented $863 per person in the United States and was equal to 9.1 percent of the GNP. This latest report in the annual series representing national health expenditures provides detailed estimates of health care spending by type of service and method of financing. Revised estimates are presented extending back to 1965.
Outlays for health care in the nation reached $212.2 billion in calender year 1979--12.5 percent higher than in 1978, according to preliminary figures compiled by the Health Care Financing Administration. This estimate represented $943 per person in the United States and was equal to 9.0 percent of the Gross National Product. This latest report in the annual series representing national health expenditures provides detailed estimates of health care spending by type of service and method of financing.
Japan's national health expenditure has been increasing by 5% annually (approximately 1.3 trillion yen) and is expected to reach 30 trillion yen in the 1999 fiscal year. This increase is mostly due to the country's rapid aging rate. However, Japan's current slow economic growth, combined with a decrease in the average number of children per family, raises the issue of how these health-expenditure increases can be afforded as the health care system continues to provide appropriate levels of essential health care services. To understand these health-expenditure trends, one must first recognize that the Japanese health care system is characterized by the country's social health insurance system, which is based on the Social Insurance Act. It is also important to consider the impact the medical fee schedule has on clinical practices. This article reviews the situation surrounding national health-care expenditures and the related issue of social health-insurance reform. In this, several topics closely connected with cancer therapies are also examined.
One of the limitations of cross-country health expenditure analysis refers to the fact that the financing, the internal organization and political restraints of health care decision-making are country-specific and heterogeneous. Yet, a way through is to examine the influence of such effects in those countries that have undertaken decentralization processes. In such a setting, it is possible to examine potential expenditure spillovers across the geography of a country as well as the influence of the political ideology of regional incumbents and institutional factors on public health expenditure. This paper examines the determinants of public health expenditure within Spanish region-states (Autonomous Communities, ACs), most of them subject to similar financing structures although exhibiting significant heterogeneity as a result of the increasing decentralization, region-specific political factors along with different use of health care inputs, economic dimension and spatial interactions.
BACKGROUND: This paper analyses the share of the family private health expenditures in the Brazilian GDP and in personal income; and the distribution of the family private health expenditures among social groups. METHODS: The research utilized the 1998 Brazilian Home Sample Survey (Pesquisa Nacional por Amostra de Domicilios) with the division of the population into four social groups according to the family income per capita; and the distribution of the family private health expenditures among health insurance, physicians, other health professionals, medical tests, drugs, orthopedic and other medical durables, vision products, dental services, hospital care, nursing home care and other health spending. RESULTS: In 1998, only 7.2% of the population with family income per capita up to 1 minimum wage had health insurance and the health expenditures of this group, that represented 52.5% of the population, was US$ 4.62 per capita. For the people with 9 and more minimum wages per capita the health insurance coverage was 83.2% and the health expenditures was US$ 114.66 per capita. CONCLUSIONS: The implementation of the Brazilian public universal health care system in 1988 denominated "Sistema Unico de Saude" was followed by an expressive expansion of private insurance coverage in the 1990's. Even if all public health expenditures had been exclusively directed to the population without any private insurance, these people's health expenditures would only reach 43% of the health expenditures of those with private insurance.
Spending for health care in the United States grew to $604.1 billion in 1989, an increase of 11.1 percent from the 1988 level. Growth in national health expenditures has been edging upward since 1986, when the annual growth in the health care bill was 7.7 percent. Health care spending continues to command a larger and larger proportion of the resources of the Nation: In 1989, 11.6 percent of the Nation's output, as measured by the gross national product, was consumed by health care, up from 11.2 percent in 1988.
The national health expenditures (NHE) series presented in this report for 1960-96 provides a view of the economic history of health care in the United States through spending for health care services and the sources financing that care. In 1996 NHE topped $1 trillion. At the same time, spending grew at the slowest rate, 4.4 percent, ever recorded in the current series. For the first time, this article presents estimates of Medicare managed care payments by type of service, as well as nursing home and home health spending in hospital-based facilities.
Over the last decade, there has been a growing interest in examining health expenditures. In this paper, we study the behaviour of health expenditures in the G3 countries (USA, the UK, and Japan) and three European countries (the UK, Switzerland and Spain) over the period 1960-2000 from a different perspective, in that we examine: (1) whether there is a common structural break in health expenditures across the G3 and European countries; (2) whether structural breaks have slowed down health expenditure growth rates in these countries or vice versa. Our main findings are that: (1) health expenditures share a common break in both bivariate and trivariate cases, and structural breaks and break intervals suggest that either one or a combination of events (second oil price shock, the 1987 stock market crash and/or recessions) have contributed to the commonality of break in health expenditures in the G3, while the oil price shocks have been instrumental in the commonality of breaks for the European countries; (2) except for the UK, structural breaks have slowed down growth rates in health expenditures for the USA, Japan, Switzerland and Spain.
Spending for health care rose to $751.8 billion in 1991, an increase of 11.4 percent from the 1990 level. National health expenditures as a share of gross domestic product increased to 13.2 percent, up from 12.2 percent in 1990. The health care sector exhibited strong growth, despite slow growth in the overall economy. This combination resulted in the largest increase in the share of the Nation's output consumed by health care in the past three decades. In this article, the authors present estimates of health spending in the United States for 1991. The authors also examine reasons for the unusually large growth in Medicaid expenditures and highlight recent trends in the hospital sector.
In 1997 health spending in the United States increased just 4.8 percent to $1.1 trillion. As a share of gross domestic product (GDP), national health expenditures (NHE) absorbed 13.5 percent of the country's output in 1997--a share that has remained relatively constant for 5 years. Despite the relative stability in recent years, signs of changing trends are emerging.
This paper presents projections of national health expenditures by type of expenditure and source of funds for 1981, 1985, and 1990. Rapid growth in national health expenditures is projected to continue through 1990. National health expenditures increased 400 percent between 1965 and 1979, reaching $212 billion in 1979. As a proportion of the Gross National Product (GNP), health expenditures rose from 6.1 percent to 9.0 percent between 1965 and 1979. They are expected to continue to rise, reaching 10.8 percent by 1990. This study projects that, under current legislation, national health expenditures will research $279 billion in 1981, $462 billion in 1985, and $821 billion in 1990. Sources of payments for these expenditures are shifting. From 1965 to 1979, the percentage of total health expenditures financed by public funds increased 17 percentage points--from 26 to 43 percent. The Federal share of public funds during this same period grew rapidly, from 51 percent in 1965 to 67 percent in 1979. This study projects that in 1985 approximately 45 percent of total health spending will be financed from public funds, of which 68 percent will be paid for by the Federal government. Public funds will account for 46 percent of total national health expenditure by 1990.