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PubMed1995

Impact of the clinical laboratory on health-care expenditures in Argentina.

This article describes how the Argentinian health-care system is organized and funded, and how it has developed. The provision of laboratory services in Argentina is the result of a unique approach involving negotiations between health-care organizations and professional associations. As a result, the professional associations, such as the Buenos Aires Province biochemists' federation, wield considerable economic power. This paper describes the roles played by biochemists and physicians, and how these and other professionals are remunerated. The attempts of the government to legislate the health-care system are discussed.

Argentina↗
PubMed1989

[Determinants of income and expenditure development in the annual reports of the health insurance of the Federal Republic of Germany].

Contribution rates to the German statutory health insurance differ considerably between different sickness funds. While insurance benefits are largely standardized, these differences are widely regarded as a problem for the state's social policy. The health insurance bodies often offer hasty interpretations to justify the differences of contribution rates. These interpretations, however, cannot be checked on the basis of data from the annual reports of the health insurance. In reality, there is a number of determinants of the contribution rate which lie as well inside as outside the sphere of influence of the health insurance bodies. In order to estimate the respective impact of single determinants it is important to differentiate the health expenditures by age and sex of all insured persons (both the contribution paying members and their co-insured dependents). A further disentanglement of health expenditures into prices, quantities and structural components allows to identify the reasons of increases in health costs. This is also a necessary precondition for creating and implementing suitable measures that are directed to control health costs. At the same time, the improved information system of the statutory health insurance would contribute to a better understanding of the performance of the health system in general.

Age Factors↗
PubMedDate not supplied

[Expenditures for dental care in Greece. Comparison with other countries].

The health expenditures in developed countries show a remarkable increase over the last two decades representing 7-10% of their G.N.P. In Greece, the public health expenditures amounted to an average of 3.5% of the G.N.P. for the period 1977-1983. The private sector represents a very significant component, amounting to 2.4% of the G.N.P. Dental health expenditures in Greece are considered significantly low. They account 2% of the total health expenditures. For comparison, in other developed countries this percentage is quite higher of the order of 5 to 10%. It follows that there is a great need to increase the dental health expenditures in Greece so that the needs for dental treatment of the population can be met more easily achieved by increasing the emphasis of the dental care in preventive measures starting especially with the younger segment of the population.

Dental Health Services↗
PubMed2003

Parental depression, child mental health problems, and health care utilization.

BACKGROUND: Small controlled studies suggest that depression and other mental health problems are more common in children of parents with depression than in children of parents without depression. OBJECTIVES: This article examines relationships between parental depression and children's mental health problems and health care utilization in a nationally representative household sample of parents and their children. RESEARCH DESIGN: Cross sectional comparisons of sociodemographic characteristics, mental health problems and health expenditures of children whose parents either do or do not report depression in the 1997 Medical Expenditure Panel Survey data. SUBJECTS: A nationally representative sample of children, 3 to 18 years of age (n = 8,360) with one or more parents living in the household. MEASURES: Mental health problems, total health expenditures, and mental health expenditures. RESULTS: Children of parents with depression were approximately twice as likely as children of parents without depression to have a variety of mental health problems and were 2.8 times more likely to use mental health services in adjusted analyses. Among children with health and mental health expenditures, those whose parents report depression had significantly higher mean total annual child health expenditures ($282 vs. $214, t = 3.5, P = 0.0006) and child mental health expenditures ($513 vs. $338, t = 2.0, P = 0.05) than children whose parents did not report depression. CONCLUSIONS: Children of parents with depression are at increased risk for a range of health problems. Parental depression is also related to an increased child health and mental health service utilization and expenditure.

Adolescent↗
PubMed2003

National estimates of health services expenditures for children with behavioral disorders: an analysis of the medical expenditure panel survey.

BACKGROUND: Children with attention-deficit/hyperactivity disorder and asthma incur similar health care costs that are greater than those of most children without these conditions. Preliminary findings suggest that children with emotional behavioral disorders, anxiety and depression, incur even greater costs. OBJECTIVE: To determine if children with behavioral disorders have similar health services expenditures as children with physical conditions and to assess whether children with emotional behavioral disorders incur greater expenditures than children with disruptive behavioral disorders. METHODS: Children 2 to 18 years old who were members of households participating in the 1996 Medical Expenditure Panel Survey were eligible for this retrospective cohort study. Children with common behavioral disorders selected a priori were identified by using truncated International Classification of Diseases (Ninth Revision) codes obtained from household interviews. Children with common physical conditions (asthma, epilepsy, and diabetes) and children without these conditions served as controls. Estimates were weighted to reflect the complex sampling scheme. Expenditures for health services were compared. RESULTS: Of 3955 eligible children weighted to represent >44 million, 7.1% were identified with a behavioral disorder: 4.5% with disruptive disorders; 2.1% with emotional disorders; and 0.5% with miscellaneous disorders. Children with behavioral disorders incurred overall expenditures similar to children with physical conditions (adjusted 1492 dollars vs 1245 dollars; P =.18) but greater than children without these conditions (adjusted 1492 dollars vs 834 dollars; P =.001). Children with behavioral disorders had greater expenditures for office-based visits (adjusted 410 dollars; 95% confidence interval: 146-672 dollars) and prescription medications (adjusted 361 dollars; 95% confidence interval: 72-648 dollars) than those of children in either control group. Among children with behavioral disorders, children with emotional disorders incurred substantially greater overall expenditures (adjusted 2152 dollars vs 1026 dollars; P =.003) than children with disruptive disorders. Children with emotional disorders incurred greater hospitalization expenditures (664 dollars vs 43 dollars; P =.01) but lower pharmacy expenditures (154 dollars vs 307 dollars; P =.001) than children with disruptive disorders. CONCLUSIONS: In this nationally representative sample, children with behavioral disorders incurred overall health care costs similar to children with physical conditions but greater than children without any of these conditions because of increased costs for office-based visits and prescription medications. However, costs were not uniform among children with behavioral disorders. Children with emotional disorders incurred twofold higher costs than children with disruptive disorders. Greater recognition of children with emotional disorders and efforts to address the high rate of hospitalizations in this population are warranted.

Adolescent↗
PubMed2001

Econometric issues in testing the age neutrality of health care expenditure.

A recent study by Zweifel et al. (Zweifel P, Felder S, Meiers M. Ageing of the population and health care expenditure: a red herring? Health Economics 1999; 8: 485-496) suggests that age is not related to health care expenditure among the elderly once 'closeness to death' is controlled for. If correct, this finding has major policy implications, but flaws in the econometric analysis undermine its credibility. We highlight two in particular, and propose methods to deal with them.

Age Factors↗
PubMedDate not supplied

[Health economic: the health systems and reforms in action].

Health Expenditure and Basic Models of Health Systems. The first part of this monographic study deals with the problems concerning health expenditure in industrialized countries (on average, 8% of home product in the countries belonging to Organization for Cooperation and Economic Development). The Author analyzes the structural factors causing the increase of health expenditure such as a population aging, scientific and technological progress, gap between consumption and expenditure, and demand for health service. The Author finally takes into consideration the two basic models of health systems, the solidarity model, born and widespread in Europe, and the individualistic model, mainly widespread in the U.S.A. The second part of the monographic studies deals with the evolution of the Italian Health System from the introduction of the National Health Service to the managerial reform. In particular, the authors analyze the mechanism of health planning, the financial support of the Italian Ministry of Health and the organization of health enterprises.

Age Factors↗
PubMed2006

Life expectancy and health care expenditures: a new calculation for Germany using the costs of dying.

Some people believe that the impact of population ageing on future health care expenditures will be quite moderate due to the high costs of dying. If not age per se but proximity to death determines the bulk of expenditures, a shift in the mortality risk to higher ages will not affect lifetime health care expenditures as death occurs only once in every life. We attempt to take this effect into account when we calculate the demographic impact on health care expenditures in Germany. From a Swiss data set, we derive age-expenditure profiles for both genders, separately for persons in their last 4 years of life and for survivors, which we apply to the projections of the age structure and mortality rates for the German population between 2002 and 2050 as published by the Statistische Bundesamt. In the extreme case, we assume that morbidity is compressed at the end of life in such a way that a 60-year old in 2050 is as healthy as a 56-year old today if his life expectancy is 4 years higher. We calculate that at constant prices, per-capita health expenditures of Social Health Insurance would rise from 2596 Euro in 2002 to between 2959 Euro and 3102 Euro in 2050 when only the age structure of the population changes and everything else remains constant at the present level, and to between 5232 Euro and 5485 Euro with a technology-driven exogenous cost increase of 1% per annum. A "naïve" projection based only on the age distribution of health care expenditures, but not distinguishing between survivors and decedents, yields values of 3217 Euro and 5688 Euro for 2050, respectively. Thus, the error of excluding the "costs of dying" effect is small compared with the error of underestimating the financial consequences of expanding medical technology.

Aged↗
PubMed2004

Health services use and health care expenditures for children with disabilities.

OBJECTIVE: To examine health care utilization and expenditure patterns for children with disabilities. METHODS: Secondary data analysis was conducted of the 1999 and 2000 editions of the Medical Expenditure Panel Survey (MEPS), a nationally representative survey conducted in 5 rounds by household interview. Two years of MEPS data were combined in this analysis to improve the precision of estimates. Disability was defined by the presence of a limitation in age-appropriate social role activities, such as school or play, or receipt of specialized services through the early intervention or special education programs. The survey sample included 13,792 children younger than 18 years. The overall response rate was 65.5%. RESULTS: Our findings demonstrate that the 7.3% of US children with disabilities used many more services than their counterparts without disabilities in 1999-2000. The largest differences in utilization were for hospital days (464 vs 55 days per 1000), nonphysician professional visits (3.0 vs 0.6), and home health provider days (3.8 vs 0.04). As a result of their greater use, children with disabilities also had much higher health care expenditures (2669 dollars vs 676 dollars) and higher out-of-pocket expenditures (297 dollars vs 189 dollars). We also found that the distributions of total and out-of-pocket expenses were highly skewed, with a small fraction of the disabled population accounting for a large proportion of expenditures: the upper decile accounted for 65% of total health care expenses and 85% of all out-of-pocket expenses for the population with disabilities. Health insurance was found to convey significant protection against financially burdensome expenses. However, even after controlling for insurance status, low-income families experienced greater financial burdens than higher income families. CONCLUSIONS: The skewed distribution of out-of-pocket expenses found in this and earlier studies indicates that the financial burden of childhood disability continues to be shared unevenly by families. Low-income families are especially vulnerable to burdensome out-of-pocket expenses. Additional efforts are needed to protect these high-risk families.

Adolescent↗
PubMed2006

The impact of community risks and resources on adolescent risky behavior and health care expenditures.

PURPOSE: To examine a nested model that predicts adolescent risky behavior, health care use, and health care expenditures from individual characteristics, such as age and gender, and community characteristics such as social capital and community-level risky behavior rates. METHODS: Claims and encounter data were used to classify adolescents enrolled in Florida's Healthy Kids Program into two groups: those who engaged in risky behavior (ARB) and those who did not (NRB). Hierarchical linear modeling techniques were used to predict the odds of risky behavior, the odds of health care use, and health care expenditures based on individual and community characteristics. RESULTS: ARB consumed significantly more health care services than NRB, and their higher use and charges were attributable not only to individual level factors (i.e., age, gender, presence of special health care need, metropolitan residence status), but also to community level factors (i.e., social capital, risky behavior rates, violence, and ethnic/racial composition) as well. In particular, community investment in social capital predicted lower levels of risky behavior as well as lower health care expenditures. CONCLUSIONS: This information is important in terms of policy efforts at providing health care for this vulnerable group of individuals, as well as in developing prevention and intervention programs that can be delivered through the health care system and via links to community supports.

Adolescent↗
PubMed1996

Gender differences in psychosocial adjustment to chronic pain and expenditures for health care services used.

Gender differences in reports of chronic pain, in coping responses to the consequences of painful conditions, and in the use of health care services have recently received considerable attention. This report examines the gender effects of referral practices to a chronic pain specialty clinic and the nature of the relationship between health care needs and use of health care services. This historical cohort analytic survey of 571 patients referred to the pain clinic assessed them by gender for selected referral variables through a chart review, and randomly sampled (n = 222) these patients' current adjustment and health service use through mailed questionnaires or telephone interview. The questionnaire consisted of psychosocial scales (PAIS-SR; Social Support); cognitions, including the Meaning of Illness Questionnaire (MIQ); and a health service utilization inventory designed to assess direct, out-of-pocket, indirect, and cash transfer expenditures. Selected referral demographic characteristics were similar between the gender groups at referral with the exception of three factors: distance from clinic, referring physician, and having a disability pension. At follow-up, the adjustment groups were similar to their gender counterparts on all sociodemographic and clinical variables including a high prevalence of poor psychosocial adjustment. Women's adjustment was accounted for by cognitive variables, whereas men's adjustment was by social variables. There were differential expenditures for health service use by gender with similar health care needs. Women used specific health care services more than men, which was explained in part by psychological need and meaning. Men's use of services, on the other hand, was explained in part by meaning alone. The importance of gender, differences in the role that social support and meaning variables play in predicting psychosocial adjustment to chronic pain is elaborated in this study. The interaction effects between health care need and gender to explain variations in use of health care services indicates that users of services varied in ways that suggest a bias or barrier of their own or of service providers to access services.

Adaptation, Psychological↗
PubMed1999

International comparisons of health care expenditures: what we know and what we do not know.

International comparisons of health care expenditures and their determinants have attracted considerable attention since the early 1960s and have since been used widely to compare countries. The impetus for this has been two-fold: firstly, to assess the macroeconomic efficiency of health systems by determining whether different methods of financing and delivering health care have contributed to the control of overall spending levels; and, secondly, to investigate the determinants of the level of health care expenditure. Empirical research has suggested that there is a causal and statistically significant relationship between growth in health spending and growth in gross domestic product (GDP), and that an increase in the latter brings about a proportionately larger increase in the former. This relationship holds even when other potential determinants, such as urbanisation and age structure of the population, are included in the analysis, leading to the conclusion that health care is a luxury good. This paper examines the extent to which this finding is valid from a methodological perspective and how far it assists policy analysis. We argue that there are significant problems in the measurement of health spending and GDP, discuss the methodological problems in the analysis and suggest that the observed relationship between GDP and health spending is unhelpful and almost certainly misleading for health policy development.

Cross-Cultural Comparison↗
PubMed1995

[The price of quality: health care expenditures and quality of life].

In an era where the substitution of health policy by budgetary arguments is imminent, this paper aims to offer some elements in the discussion on the relationship between health care expenditures and their effect on quality of life for individuals and society. Historical developments, present differences in medical consumption and in outcome, the growing interest in alternative medicine, the use of new medical technologies and observations on the expenditures for pharmaceuticals show that this relationship is not self-evident and that generalizations must be avoided. The observations lead to an argument of more efficiency in the use of health care resources.

Aged↗
PubMedDate not supplied

Health-care expenditures for tuberculosis in the United States.

BACKGROUND: The resurgence of tuberculosis (TB) and the increase in multidrug-resistant TB prompted this study, which estimates direct expenditures for TB treatment and public health activities in the United States. METHODS: This retrospective cost of illness study estimated 1991 direct expenditures for TB-related outpatient and inpatient diagnosis and treatment, screening, preventive therapy, contact investigations, surveillance, and outbreak investigations. Existing databases at the Centers for Disease Control and Prevention (Atlanta, Ga) and the Codman Research Group, Lebanon, NH, were supplemented by surveys of state and local TB programs and interviews of organizations that conduct large-scale screening. No estimates of indirect costs were made. RESULTS: The direct medical expenditures for TB in 1991 were estimated at $703.1 million. This cost includes $423.8 million for inpatient care, $182.3 million for outpatient care, $72.1 million for screening, $3.4 million for contact investigations, $17.9 for preventive therapy, and $3.6 million for surveillance and outbreak investigations. Sensitivity analyses yielded a range of expenditures between $515.7 million and $934.5 million. CONCLUSIONS: Treatment accounted for more than 86% of all TB-related expenditures; inpatient treatment accounted for 60% of the total. Prevention activities made up only 14% of all costs. Direct medical expenditures may be underestimated because of limitations in the database on hospital expenditures and health department cost-accounting systems and because of the lack of a national database on screening activities. Greater emphasis should be placed on outpatient treatment and prevention in high-risk populations, and improved cost-accounting systems should be developed in state and local health department TB control programs to facilitate economic evaluation and improve the allocation of health dollars.

Cost of Illness↗
PubMedDate not supplied

Shared 'features' in prices: income and price elasticities for health care expenditures.

The evidence found in most studies suggests a strong positive relationship between health care expenditure and gross domestic product. However, this evidence weakens with respect to the actual value of the income elasticity. There are two possible sources of these discrepancies, the use of arbitrary deflators and specification errors. We find that health PPP cannot be taken as a 'universal' price index. The problem is that its components do not move together. Nevertheless, we derive a 'universal' health price index from a dynamic system in which its components share both short and long run co-movements. The omission of relevant explanatory variables seems to be the main cause of the discrepancies. We confirm that there exists a strong positive relationship between per capita health care expenditure and per capita GDP. However we estimate a long run income elasticity at or around unity, although it is greater than unity for the countries with lower per capita income (Spain and Ireland). The results for income elasticity are the same regardless of whether health care expenditure is converted using the GDP PPP or the 'universal' health price index. The importance of non-income variables is also confirmed, in particular the relative price of health care. We find that relative price has a strong rationing effect on the quantity of health demanded and has no effect on the expenditures.

Data Interpretation, Statistical↗