Health care expenditures in the united states: rationing of health care and mandatory preadmission authorization.
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Health Benefit Plans, Employee↗
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Tests of stationarity and cointegration of health care expenditure and gross domestic product: an application to Turkey.
This study examines the long-run relationship among the per capita private, public, and total health care expenditure and per capita gross domestic product and population growth of Turkey. We find some evidence of multivariate cointegrating relationships among the health care expenditure and gross domestic product, and population growth. We further find a bivariate cointegrating relationship between private health care expenditure and per capita gross domestic product. Accordingly, a 10% increase in gross domestic product would translate into a 21.9% increase in total health care expenditure while controlling population growth. The income elasticity of health expenditure is found to be greater than 1, implying that health care is a luxury good in Turkey. Finally we note that there exists one-way causality running from per capita gross domestic product to various definitions of health care expenses.
Economics↗
Analysis of structural changes in Japan's health care expenditure.
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Data Collection↗
Projections of health care expenditures as a share of the GDP: actuarial and macroeconomic approaches.
STUDY QUESTION. Can the steady increases in health care expenditures as a share of GDP projected by widely cited actuarial models be rationalized by a macroeconomic model with sensible parameters and specification? DATA SOURCES. National Income and Product Accounts, and Social Security and Health Care Financing Administration are the data sources used in parameters estimates. STUDY DESIGN. Health care expenditures as a share of gross domestic product (GDP) are projected using two methodological approaches--actuarial and macroeconomic--and under various assumptions. The general equilibrium macroeconomic approach has the advantage of allowing an investigation of the causes of growth in the health care sector and its consequences for the overall economy. DATA COLLECTION METHODS. Simulations are used. PRINCIPAL FINDINGS. Both models unanimously project a continued increase in the ratio of health care expenditures to GDP. Under the most conservative assumptions, that is, robust economic growth, improved demographic trends, or a significant moderation in the rate of health care price inflation, the health care sector will consume more than a quarter of national output by 2065. Under other (perhaps more realistic) assumptions, including a continuation of current trends, both approaches predict that health care expenditures will comprise between a third and a half of national output. In the macroeconomic model, the increasing use of capital goods in the health care sector explains the observed rise in relative prices. Moreover, this "capital deepening" implies that a relatively modest fraction of the labor force is employed in health care and that the rest of the economy is increasingly starved for capital, resulting in a declining standard of living.
Actuarial Analysis↗
Pooling international health care expenditure data.
The purpose of this paper is twofold. The first is to analyse the statistical relationship between real health care expenditure per capita and aggregate income, public share in finance, age-dependency ratio and inflation. The second purpose deals with methodological problems involved in pooling health care expenditure data. The empirical work is based on pooled cross-sectional, time-series data for 22 OECD countries from 1972 to 1987. Public finance share and inflation were found to be associated with lower per capita health care expenditure. No consistent correlation was found between the age-dependency ratio and health care expenditure. Contrary to results of earlier studies, we found that health care expenditure does not appear to be income (GDP) elastic. However, the results do not appear to be robust to changes in the time periods and countries included.
Age Factors↗
Alternative definitions of disability: relationship to health-care expenditures.
The purpose of this study is to investigate the relationship between different definitions of disability and health-care expenditures in the working aged population in the United States using the 1987 National Medical Expenditure Survey (NMES). Five different definitions of disability were identified and the health-care expenditures for each group were compared using descriptive analyses. Results reveal that estimates of the prevalence of disability vary dramatically by the definition of disability. A more than three-fold difference in average total health-care expenditures is observed using different specifications of disability. These results suggest that estimates of health-care expenditures should be interpreted cautiously, since the definition influences the magnitude of estimates. Researchers and policy-makers should consider the standardization of the term 'disability'.
Activities of Daily Living↗
Conversion factor instability in international comparisons of health care expenditure.
Parkin, McGuire and Yule (1987) (hereafter PMY) report that a regression of per capita health care expenditure on per capita income using different conversion factors (exchange rates, GDP PPPs, health PPPs) gave rise to different results. In this note we apply updated data to the same empirical relationship. In contrast to PMY, we find no noticeable conversion factor instability in that relationship either with respect to the health care income elasticity or with the magnitude of multiple correlation coefficient.
Costs and Cost Analysis↗
[Trends in health care expenditures in Lithuania].
The aim of the study was to analyze the tendencies of public and private health care expenditure in Lithuania during 1994-1999. Crude examination of statistical data show, that the growth rate of health care spending per capital is largely determined by growth of national gross domestic product (GDP). We have estimated that health care spending in Lithuania have risen twice faster than GDP during 1994-1999. (Percentage of rise in health care spending, divided by percentage rise of GDP, is +2.26). The introduction of compulsory health insurance in 1997, and the development of private health care sector in Lithuania, led to increase health care expenditure in total, and has influenced changes in public-private spending proportions. A source of private spending in national health account has increased from 15 per cent in 1994-1995 to 24 percent in 1996-1999. The tendency of increasing private spending shows, the evidence, that households are facing more financial risk of purchasing health care. This should be an implication for health care policy makers. Further decisions to increase private payments have to be based on evidence after detailed analysis of impact of consequences on health care access for various social economic groups of population.
Financing, Government↗
Personal health care expenditures, by State: 1966-82.
Spending per capita for health care in the United States varies dramatically by State and region. In 1982, personal health care costs per capita ranged from a low of $857 in South Carolina to a high of $1,508 in Massachusetts. The focus of this article is State and regional variation in spending levels and the mix of health care services purchased. Possible causes for these differences are presented.
Catchment Area, Health↗
Health care expenditures for the elderly. Who pays for them?
The degree to which Medicare and Medicaid programs provide health coverage for the elderly still leaves a large financial burden on this population. Although the sale of supplementary health insurance to the elderly has been fraught with abuse, a policy purchased from a reputable organization can be advantageous. Knowledge of the large amount spent on personal health care will hopefully stimulate the search for alternative, less expensive ways to provide health care.
Aged↗
[A comparative study of the expenditures on health research in 7 western countries in 1997 places the Netherlands at the bottom of the list].
OBJECTIVE: To compare the expenditures on health research in the Netherlands with those in other Western countries. DESIGN: Descriptive. METHOD: The expenditures on health research in 1997 were determined for the Netherlands, the United Kingdom, Germany, Norway, Denmark, Sweden and the USA and subsequently classified into: governmental funding for research in medical faculties or clusters; grants from MHRCs and other bodies; and private funding from industry and charities. The sources of information were the total research budgets 2002 of the Dutch Ministry of Education, Culture and Science, annual reports from charities, the Dutch Central Statistical Bureau and, for foreign countries, MHRCs or comparable institutions. RESULTS: In 1997, the Netherlands spent the equivalent of 855 million US dollars on health research (extremes of the investigated countries: 382 (Norway)-32,283 (USA)). This was less than in the other countries, whether calculated per capita, in US dollars (55 (Netherlands)-159 (Sweden)), as a promillage of the gross national product (2.27 (Netherlands)-5.84 (Sweden)), or as a percentage of the total expenditures for health care (2.62 (Netherlands)-7.54 (UK)). Especially the industrial expenditures on health research in the Netherlands were low, but the governmental expenditures were also lower than in the other countries.
Budgets↗
Health status and heterogeneity of cost-sharing responsiveness: how do sick people respond to cost-sharing?
This paper examines whether the responsiveness of health care utilization to cost-sharing varies by health status and the implications of such heterogeneity. First, we show theoretically that if health care utilization of those in poor health is less responsive to cost sharing, this, combined with the skewness of health expenditures in health status, leads to overestimates of the effect of cost sharing. This bias is exacerbated when elasticities are generalized to populations with greater expenditure skewness. Second, we show empirically that cost-sharing responsiveness does differ by health status using data from the Medicare Current Beneficiary Survey. Medicare beneficiaries are stratified into health status groups based on activity of daily living (ADL) impairments and self-reported health status. Separately, for each of the health status groups, we estimate the effect of Medigap insurance on Part B utilization using a two-part expenditure model. We find that the change in expenditures associated with Medigap is smaller for those in poorer health. For example, when stratified using ADLs, Medigap insurance increases expenditures for 'healthy' groups by 36.4%, while the increase for the 'sick' group is 12.7%. Results are qualitatively the same for different forms of supplemental insurance and different methods of health status stratification. We develop a test to demonstrate that adjusting our results for selection bias would result in estimates of greater heterogeneity. Our results imply that a lowerbound estimate of the bias from neglecting heterogeneity is about 2-7%.
Activities of Daily Living↗
Health care expenditures associated with overweight and obesity among US adults: importance of age and race.
OBJECTIVES: We estimated health care expenditures associated with overweight and obesity and examined the influence of age, race, and gender. METHODS: Using 1998 Medical Expenditure Panel Survey data, we employed 2-stage modeling to estimate annual health care expenditures associated with high body mass index (BMI) and examine interactions between demographic factors and BMI. RESULTS: Overall, the mean per capita annual health care expenditure (converted to December 2003 dollars) was $3338 before adjustment. While the adjusted expenditure was $2127 (90% confidence interval [CI]=$1927, $2362) for a typical normal-weight White woman aged 35 to 44 years, expenditures were $2358 (90% CI=$2128, $2604) for women with BMIs of 25 to 29.9 kg/m(2), $2873 (90% CI=$2530, $3236) for women with BMIs of 30 to 34.9 kg/m(2), $3058 (90% CI=$2529, $3630) for women with BMIs of 35 to 39.9 kg/m(2), and $3506 (90% CI=$2912, $4228) for women with BMIs of 40 kg/m(2) or higher. Expenditures related to higher BMI rose dramatically among White and older adults but not among Blacks or those younger than 35 years. We found no interaction between BMI and gender. CONCLUSIONS: Health care costs associated with overweight and obesity are substantial and vary according to race and age.
Adult↗
Health-related expenditure patterns in selected migrant groups: data from the Australian Household Expenditure Survey, 1984.
Australians born in Italy, Greece and East and South East Asia all have substantially lower mortality levels than those born in Australia, the British Isles or Holland and Germany. Using data from the 1984 Household Expenditure Survey, the health-related consumption expenditure of these six groups was compared (excluding expenditure on medical care). The heterogeneity of household types was largely removed by confining attention to married couple households with dependent children. The two groups with mortality levels comparable to those of the Australian-born (British Isles and Holland/Germany) also shared a similar pattern of consumption expenditures. There was a tendency (not always fully consistent), for the low mortality groups to spend more on fruits, vegetables, cereal products and fish and substantially less on alcohol. Patterns that might be 'unexpected' in low mortality groups are the (presumptively) substantial expenditures on tobacco among males (especially in the Greek group) and the substantial expenditures on red meat in all three groups. Analysis of available data sets such as this can provide useful descriptions of the distribution of health-influencing behaviour in our population.
Adolescent↗
An econometric analysis of health care expenditure: a cross-section study of the OECD countries.
This paper is an empirical examination of the determinants of aggregate health care expenditure. The paper presents a systematic analysis of relationships across 19 OECD countries, showing the effects of aggregate income, institutional and socio-demographic factors on health care expenditure. The results indicate that institutional factors of the health systems, in addition to per capita Gross Domestic Product (GDP), contribute significantly to the explanation of the health care expenditure variation between countries; for example the way physicians in outpatient care are paid, and the mixture of public/private funding and inpatient/outpatient care.
Ambulatory Care↗
Controlling national health care expenditures.
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Aged↗
More myths and misconceptions: a reply to comments on an article.
Two issues in the debate about the relative economic success of Canada's health care system require clarification. First, while the upward trends in the share of health expenditures in GNP and in real per capita health expenditures have been similar in Canada and the United States for the last 30 years, only the latter has increased at a significantly lower rate since the early 1970s. Second, the trends in health expenditures are similar in Canada and the United States. The author therefore speculates that an explanation for the similarity in health expenditure trends may transcend international borders.
Canada↗
Health care expenditure in the last months of life.
In OECD countries, a considerable share of health care expenditure (HCE) is spent for the care of the terminally ill. This paper derives the demand for HCE in the last 2 years of life from a model that accounts for age, mortality risk and wealth. The empirical tests are based on data of deceased members of a major Swiss sick fund. The empirical evidence confirms most of the hypotheses derived from the model, i.e., (i) HCE increases with closeness to death, (ii) for retired individuals, HCE decreases with age, and (iii) low-income individuals, as compared to high-income individuals, incur lower HCE in the last months of life.
Aged↗