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PubMed2004

Estimates and patterns of direct health care expenditures among individuals with back pain in the United States.

STUDY DESIGN: Secondary analysis of the 1998 Medical Expenditure Panel Survey. OBJECTIVE: To estimate total health care expenditures incurred by individuals with back pain in the United States, calculate the incremental expenditures attributable to back pain among these individuals, and describe health care expenditure patterns of individuals with back pain. SUMMARY OF BACKGROUND DATA: There is a lack of updated information on health care expenditures and expenditure patterns for individuals with back pain in the United States. METHODS: This study used data from the 1998 Medical Expenditure Panel Survey, a national survey on health care utilization and expenditures. Total health care expenditures and per-capita expenditures among individuals with back pain were calculated. Multivariate regression models were used to estimate the incremental expenditures attributable to back pain. The expenditure patterns were examined by stratifying individuals with back pain by sociodemographic characteristics and medical diagnosis, and calculating per-capita expenditures for each stratum. RESULTS: In 1998, total health care expenditures incurred by individuals with back pain in the United States reached 90.7 billion dollars and total incremental expenditures attributable to back pain among these persons were approximately 26.3 billion dollars. On average, individuals with back pain incurred health care expenditures about 60% higher than individuals without back pain (3,498 dollars vs. 2,178 dollars). Among back pain individuals, at least 75% of service expenditures were attributed to those with top 25% expenditure, and per-capita expenditures were generally higher for those who were older, female, white, medically insured, or suffered from disc disorders. CONCLUSIONS: Health care expenditures for back pain in the United States in 1998 were substantial. The expenditures demonstrated wide variations among individuals with different clinical, demographic, and socioeconomic characteristics.

Adolescent↗
PubMed1995

Expenditure on health research in South Africa, 1991/1992.

OBJECTIVE: To determine expenditure on health research in South Africa in 1991/1992. DESIGN: Data from the financial statements of large statutory councils conducting research in South Africa, as well as other relevant reports, particularly the Department of National Education's (NATED) survey of research institutions, were analysed. RESULTS: A total of R198.7 million was spent on health research in 1991/1992, 56.1% by the tertiary education sector and 20.7% by the Medical Research Council. Only 1.1% of expenditure on health was spent on research. Less than 9% of health research expenditure by tertiary educational institutions is classified within the category of 'comprehensive medicine' (which includes community health, epidemiology and nutrition), whereas 82% of expenditure by autonomous government institutions is so classified. CONCLUSIONS: Given that expenditure on health research in South Africa is relatively low by international standards, an increase in expenditure by both the public and private sectors should be considered. Given the scarcity of research resources, there should be adequate planning, co-ordination, and particularly prioritisation of resource allocations, so that research can be directed towards addressing the country's health needs.

Health Expenditures↗
PubMed1993

Health care expenditure and income in Europe.

In this work we have tried to analyse the variations in health care expenditure in all the countries of the European Community except Greece and Portugal. We have wanted to provide additional evidence on the empirical relationship between expenditure on health care and income. Our analysis, starting from the approach of Fuchs and Baumol, has been an extension of the traditional studies on health care international comparisons, in at least three directions: we have not imposed any restrictions on the price effects, we have analysed dynamic models instead of the cross-sectional analysis and we have used proper deflators. We have deflated health care expenditure in each country by means of its sectoral price index and by the purchasing parity power of its currency, to allow international comparisons. In the former case we express health care in terms of 'expenditure', in the latter we express health care in terms of 'weighted quantity'. Income elasticities, in the short and in the long-run, have been estimated using econometric methods that allow us to obtain simultaneously equilibrium long-run relationships, if any, and adjustment processes in the short-run. We have found cointegrating relationships and we have estimated consistent estimators of the elasticities. The estimated income elasticities are greater than one in all the models analysed.

Bias↗
PubMed1986

Health care expenditures in a rural Indian community.

Financing health services is an increasing concern that looms as one of the major obstacles to achieving an equitable distribution of primary health care in developing communities. An important step in solving this problem is the assessment of current levels of health care expenditures in these communities in order to determine the extent to which local resources are being used for these purposes. Ways to maximize the effectiveness of these resources can then be sought. Village level studies carried out between 1968 and 1974 in Punjab, India, revealed that at least 80% of all health care expenditures in this rural area were for services of traditional practitioners or private 'modern' doctors. This paper explores various aspects of these expenditures including the source of services and the effect of individual characteristics such as caste on the amount spent on health care. Out-of-pocket expenditures are contrasted to expenditures in the government system. Assessment of the impact of 'free' village level primary care services in this setting revealed that the poor reduced their expenditures on health care more than the wealthy, but both groups took almost equal advantage of the 'free' services. The results raise the possibility of mobilizing some of the savings accruing to the community to help support the 'free' services as well as the potential of encouraging private traditional and modern practitioners to cooperate in achieving primary health care goals.

Developing Countries↗
PubMed1993

The distribution of household expenditures on health care.

AIMS: To find out whether New Zealand household expenditures on health care services vary according to the income of the household. To compare expenditures on health care in 1987 with 1991. METHODS: Information about household income and expenditure on health services was obtained from the Department of Statistics annual household expenditure and income surveys for the 1987 and 1991 financial years. Four categories of health expenditure were examined: general practitioner fees, dental fees, optician and optometrist fees, and spending on all health services combined. RESULTS: Spending on health care is unequally distributed across income groups. In particular, the highest income households spend six times as much on dental care as the lowest income households. The difference between high and low income households in the amount spent on all health services was greater in 1991 than in 1987. In 1991 high income households spent 3.6 times as much on health services as low income households, compared with three times as much in 1987. CONCLUSIONS: High income households spend substantially more on health care than do low income households. Households appear to assign a higher priority to medical care than dental care, although this may reflect the lack of any state subsidy on adult dental care.

Costs and Cost Analysis↗
PubMed2003

Health care expenditure burdens among elderly adults: 1987 and 1996.

OBJECTIVES: Concerns about the health care expenditure burdens of elderly adults underlie the ongoing debate over expanding Medicare benefits and strengthening Medicare+Choice. We examine burdens for this population using data from the 1987 National Medical Expenditure Survey (NMES) and the 1996 Medical Expenditure Panel Survey (MEPS). METHODS: We estimate how frequently elderly adults live in families whose health expenditures exceed 20% or 40% of their after-tax disposable incomes. Our methodology reduces bias due to errors in income while providing an intuitive measure of exposure to the risk of high burdens. RESULTS: Despite rapid increases in medical care prices, the percentage of elderly adults facing burdens over 20% of disposable income remained essentially constant at 20.9% in 1987 and 22.9% in 1996. The percentage with burdens exceeding 40% of disposable income was 7.3% in 1987 and 7.9% in 1996. High expenditure burdens were more prevalent among elderly adults who were poorer, older, female, higher risk, and covered only by traditional Medicare. Medicaid coverage helped to reduce burdens among the elderly poor, yet incomplete Medicaid take-up in 1996 left approximately 1.3 million elderly adults eligible for Medicaid but covered only by traditional Medicare. CONCLUSIONS: Our results highlight the widespread prevalence of high health care expenditure burdens among elderly adults and the varying extent to which insurance coverage helped to protect them from rising health care expenditures between 1987 and 1996.

Aged↗
PubMed1994

Health care expenditure in the Nordic countries.

International comparisons of health care expenditure are associated with many different kinds of problems. One type of problem is due to heterogenous definitions and to difficulties with conversion to common prices. Such problems are present also if one selects homogeneous countries as, for example, the Nordic countries, which have a similar GDP per capita and social system. In this paper we compare the health care expenditure in the Nordic countries to illustrate the significance of these problems in international comparisons. We also correct the latest available OECD statistics for local nursing homes, which are not included in health care expenditure for Denmark but are included for the other Nordic countries, and also for the care of the mentally retarded, which is not included in health care expenditure for Denmark or, after 1985, for Sweden. In addition, comparisons of health care expenditure are presented with different currency conversion factors. The comparisons show, for example, that Sweden has a higher expenditure share of gross domestic product (GDP) than Denmark, even after corrections have been made, but that the difference between the countries becomes considerably smaller, from 37% higher expenditure for Sweden without correction to 12-15% after correction.

Commerce↗
PubMed1991

Evaluation from population registry data of health care expenditure during the 6 months after cancer diagnosis.

It is currently estimated in France, that the cost of cancer has risen to $3.8 billion, with an annual growth of 5-10%. This represents approximately 6% of all health expenditure. The data from the Registry of Tumors in the Doubs region have enabled us to make an evaluation of health expenditure, reimbursed by the French Securite Sociale (S.S.), and its distribution in relation to different activities (diagnosis, type of treatment, follow-up, transport), according to cancer site. In 1984, the average cost per patient within the first 6 months of the illness was evaluated at $4,000. The results show major differences for the cancer sites, care facilities and budget items. Diagnosis assessment represents 27% of all expenditure, surgery 37%, radiotherapy, chemotherapy and transport, 11% each. All kinds of expenses are fully reimbursed by the French S.S. and transportation, which at the beginning used to avoid hospitalization, is now used as a comfort system and represents a high cost to the S.S. The different costs for the same illness between private, general public and university hospitals do not reflect a difference in care, but rather different systems of calculating and functioning. Till now there has not been any logical evaluation of care in the French health system.

Data Collection↗
PubMedDate not supplied

The concentration of health care expenditures, revisited.

In two previous publications, we described the distribution of health care expenditures among the civilian, noninstitutionalized U.S. population, specifically in terms of the share of aggregate expenditures accounted for by the top spenders in the distribution. Our focus revealed considerably skewed distribution, with a relatively small proportion of the population accounting for a large share of expenditures. In this paper we update our previous tabulations (last computed using data more than a decade old) with new data from the 1996 Medical Expenditure Panel Survey (MEPS). Our findings show that the skewed concentration of health care expenditures has remained very stable; 5 percent of the population accounts for the majority of health expenditures.

Age Factors↗
PubMed2004

[Health care expenditure in Spain compared with developed Europe, 1985-2001. The Spanish primary health care, the European Cinderella].

OBJECTIVE: To describe the evolution of the funds distribution in our health care system since the start of the primary care reform to 2001, in comparison with the European countries members of the Organisation for Economic Co-operation and Development (OECD). DESIGN: A longitudinal descriptive and retrospective study. PARTICIPANTS: European countries members of the OECD. SETTING: Countries members of the OECD. METHODS: The data come from the OECD database Health Data 2003. The data refer to period 1985-2001, and to a group of variables of health care expenditure by sectors and of income (Gross Domestic Product [GDP] per capita). We compare Spanish data series with those of the group of 22 European members countries of the OECD. RESULTS: Europe increased public expenditure on out-patient care both as a percentage of public health care expenditure and as a percentage of GDP. Spain reduced public expenditure on out-patient care in both senses. Spanish public expenditure on in-patient care reduced a great part of its difference with Europe so that since 1995 it is found, as a percentage of GDP, in the European average and, as per capita, it is according with the Spanish income. In contrast, public expenditure on out-patient care as a percentage of GDP in Spain is very much lower than the European average and, as per capita, is very much lower than the Spanish income. The Spanish private expenditure on out-patient is found among the highest in Europe and, compared with Europe, exceeds very much Spanish income, in contrast with his homonymous public. The Spanish private expenditure on in-patient care is found among the lowest in Europe and, compared with Europe, is very much lower than Spanish income level. CONCLUSIONS: With respect to public resources assigned, the reform of primary care in Spain has not been useful to approach Spanish primary health care level to Europe, in contrast with the Spanish hospital level. The difference between Spain and Europe in public expenditure on out-patient care as a percentage of GDP is, even, bigger than the one there was when the reform of Spanish primary care started.

Delivery of Health Care↗
PubMedDate not supplied

Quantifying tobacco related health care expenditures in the Republic of the Marshall Islands: a case study in determining health costs in a developing US associated island nation.

OBJECTIVES: This case study examines the advantages, disadvantages, and utility of three research methods to measure the medical costs of tobacco use in the Republic of the Marshall Islands (RMI). METHODS: The authors used the morbidity-based models, models based on the difference in utilization of medical facilities between smokers and non-smokers, and models of inter-country comparisons. FINDINGS: In the RMI, morbidity models would have a propensity to grossly under-estimate the medical costs of tobacco use. Models that measure the difference in medical service utilization between smokers and non-smokers can be confounded by cultural factors and by the level of health care that is provided. The RMI population structure affected the sampling methods. The external validity of the survey instrument may be increased through measuring more parameters with greater precision. Inter-country comparisons may be used to approximate and set upper and lower limits of costs for past medical costs, and may be the only method to determine future health care costs from tobacco use. CONCLUSIONS: Determining medical costs of tobacco use in an US Associated island nation with an under-developed health care infrastructure has not been previously attempted. There were significant methodological challenges that were encountered. Health, economic, cultural, and research environments in the RMI are unique and require innovative methods to determine medical costs associated with tobacco use. Direct application of the methodologies utilized in the United States to determine medical costs of tobacco use may grossly under-estimate the medical cost of tobacco use in the RMI. The research challenges can be addressed.

Developing Countries↗
PubMed1998

Health care expenditures after introduction of a gatekeeper and a global budget in a Swiss health insurance plan.

STUDY OBJECTIVES: To assess whether the introduction of "managed care" (capitated budget and utilisation control by general practitioners) in a Swiss health insurance plan caused a selective disenrolment of plan members, and whether it achieved its goal of reducing health care expenditures. DESIGN: Controlled before-after analysis of health insurance claims. SETTING: Health insurance plan of the University of Geneva, Switzerland, which introduced managed care at the end of 1992, and comparison plan, which reimbursed health care expenditures without setting a budget or controlling access. PARTICIPANTS: Analysis of self selection: university plan members who accepted (3993) or refused (659) transfer to managed care. Analysis of change in expenditures: cohorts of persons continuously enrolled in the university (1575) and comparison (3384) plans in 1992 and 1993. MAIN RESULTS: During 1992, the year before the transformation of the university plan, persons who refused managed care had generated 35% higher expenditures than those who accepted managed care (p < 0.001). Between 1992 and 1993, expenditures per member decreased by 9% in the university cohort and increased by 11% in the comparison cohort (p = 0.004). Technical procedures (laboratory tests, physical therapy, drugs) decreased most in the university plan. No impact on hospital admissions was detected. CONCLUSIONS: Introduction of gatekeeping and budget management by physicians caused a favourable self selection process for the university plan. In addition, the managed care plan achieved a substantial decrease in overall health care expenditures in its first year of operation, chiefly by reducing outlays for technical procedures.

Adult↗
PubMed2000

Health care expenditure inertia in the OECD countries: a heterogeneous analysis.

Health care expenditure studies of the Organization for Economic Cooperation and Development (OECD) countries remain important because their findings often suggest cost containment and other policy initiatives. This paper focuses on the compatibility of OECD health data with the "expenditure inertia" (or lagged adjustments) hypothesis, by modeling individual country time-series data of 21 nations for the 1960-1993 period. Maximum likelihood estimates of the Box-Cox transformation regression models reveal that: (a) the hypothesized impact of health "expenditure inertia" is both pervasive and strong, averaging 0.64 across the countries; (b) the real GDP elasticities of health care expenditures vary widely among the countries and average 0.34 in the short run--implying that health care is a necessity; (c) the long run GDP elasticities are less than 1 in 8 countries, unitary elastic in 8 countries and elastic in 5 countries--suggesting that health care is not universally a necessity or a luxury commodity for the OECD countries; (d) physician-inducement effects (dis-inducement in a few countries) are weak, with a mean elasticity estimate of 0.17; and (e) no unique functional form approximation model is globally compatible with the data across the countries. Health care cost containment policy implications of these findings are explored.

Benchmarking↗
PubMed2000

A case for user charges in public hospitals.

The present decline in per capita expenditure on health in Saudi Arabia requires private funding to reduce pressure of health expenditure on the government budget. User charges would be an important source of revenue in the Kingdom where services cannot be cut and taxes are not imposed. User charges in public facilities would curtail over-utilization and reduce inefficient use of resources by providing a link between financial responsibility and the provision of services. The financial implication facing patients would encourage them to be more cost-conscience, and therefore their physicians would be encouraged to limit practices such as over prescribing drugs and the use of highly specialized diagnostic procedures for routine investigation or minor illnesses. Lack of economic incentives have led to a lack of concern for the cost of medical care. User charges would not only encourage both consumers and providers to be cost-conscious, but would raise revenue to ease pressure on the health budget, combat moral hazards and assert priorities. However, to be effective, and in order to make a serious impact on the health system, user charges must be extended to all government sectors and specialist hospitals and charges must be high enough to discourage inappropriate use of services.

Attitude of Health Personnel↗
PubMed1984

Health care expenditures for major diseases in 1980.

Health care expenditures in the United States were 10.5 percent of the gross national product in 1982, and growing rapidly. The magnitude and continuing growth make health care costs an important issue in public policy. Knowledge of costs for specific diseases is necessary for ascertaining the effectiveness and efficiency of various health programs. In this article, medical care expenditures for major diseases are estimated from readily available data and it is shown that expenditures for more specific disease categories can be derived.

Age Factors↗
PubMed1993

The impact of aging on health care expenditure in Sweden.

This study measures the impact of aging on health care expenditure in Sweden in 1970-1985 and the projected impact for 1985-2005. In addition, the distribution of health care expenditure over different age groups is analysed. The study shows that changes in population aging account for barely 13% of the total increase in health care expenditure during the period 1970-1985, and that is the combined effect of changes in population aging plus the faster increase in health care expenditure per capita in older age groups that governs the development of an increasing concentration of health care expenditure to older age groups. During the period 1976-1985 the per capita health care expenditure increased modestly for the ages 0-74, but 54% for persons older than 74 years.

Age Factors↗
PubMed1998

Health care expenditure on schizophrenia patients in Belgium.

Schizophrenia generates a great deal of cost and burden. The aim of this study was to assess the direct costs for schizophrenia patients receiving standard treatment in different settings in Belgium. Costs were calculated for patients and for the Belgian insurance system. Data from Belgium's largest sickness fund were used to estimate health expenditures for all schizophrenia patients in Belgium. The mean direct treatment cost was $12,050 per patient per year, or $304 million for all schizophrenia patients per year. This cost constitutes 1.9 percent of the Belgian Government's total health expenditure. Government expenditure per schizophrenia patient is 10 times that of an average citizen.

Adult↗