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PubMed1992

A pooled cross-section analysis of the health care expenditures of the OECD countries.

This paper has two purposes. The first, empirical purpose is to estimate and evaluate the effects of aggregate income, institutional and socio-demographic factors on health care expenditures in the OECD countries. The second purpose is methodological, and comprises assessment of temporal instability, the choice of functional form, and misspecification of the estimated relationships. Data compiled over three years (1974, 1980 and 1987) from 19 OECD countries are used in a pooled cross-section regression analysis. Like previous studies, this one concludes that aggregate income measured by Gross Domestic Product per capita is the statistically most important factor in cross-national variation in health care expenditures, and that the aggregate income elasticity exceeds one. However, the data analyzed in this study also show some evidence that public financing of health care services is associated with lower expenditures per capita, and that countries with fee for service as the dominant form of remuneration have higher expenditures. The examined relationships appear to be temporally stable over the three years except for upward shifts, and there is no indication of statistical misspecification. This does not necessarily imply a correct specification, and we do note the presence of measurement errors in some of the variables. Moreover, the selected log-linear functional form appears to be non-optimal according to a likelihood criterion, and is rejected against a quadratic form. Based on the analyses from this study the results do not appear to be sensitive to use of the quadratic form specification.

Europe↗
PubMed1985

Medicaid program characteristics: effects on health care expenditures and utilization.

Relationships between State Medicaid program characteristics and program outputs are analyzed in this statistical report, using 1980 cross-sectional data from a variety of sources. The year 1980 furnishes a baseline against which program changes following the Omnibus Budget Reconciliation Act of 1981 and the 1982 economic recession can be evaluated. Utilization and expenditures are modeled separately for each aid category and each major service category. This use of multiple models allows for measurement of the effect of program controls that might not appear in models of total utilization and expenditures.

Adult↗
PubMed1991

Health care expenditure and mortality from amenable conditions in the European Community.

This paper addresses the question whether within the European Community a higher national level of health care expenditure is associated with a larger degree of success in eliminating mortality from preventable and curable conditions. An aggregate measure of mortality from 12 amenable conditions was derived, incorporating an adjustment for the level of socio-economic development. In 1980-84, between country variation in this measure was almost 2-fold and showed surprising patterns. Rates are relatively low in Greece, The Netherlands and Denmark, and relatively high in Portugal, Italy and Germany. There was no association at all between this measure and the level of health care expenditure. These disturbing findings, which suggest substantial variation in the cost-effectiveness of different health service systems, warrant further investigation.

Cause of Death↗
PubMedDate not supplied

[Effects of population aging on health care expenditure: myths and facts].

Over the last 30 years, the elderly population of developed countries has shown an unprecedented increase. This process has raised alarm about the future affordability of health care systems. In this context, we consider the effects of population aging on health care expenditure within a process involving several elements: the increasing number of elderly persons, variations in the health status of the elderly and the evolution of the cost of medical treatment. The main conclusion is that only a small part of the increase in expenditure is due to population aging. Furthermore, because the average health status of the elderly has improved with greater longevity, we suggest that most of the increase in health care expenditure can be attributed to the evolution of non-demographic factors. Such as health services utilization, treatment cost and the development of new medical technology. Unlike populations aging, these factors can be subjected to future regulation and consequently, can to a large extent be controlled.

Age Factors↗
PubMed2004

The effect of HMOs on fee-for-service health care expenditures: evidence from Medicare revisited.

This paper implements a new method for calculating the extent of selection in the aged Medicare HMO market. Selection is measured as the difference in average costs between new Medicare HMO enrollees and Medicare fee-for-service stayers with data from 1990 to 1994. Results suggest Medicare HMO enrollees were 1030 US dollars cheaper in their first year of enrollment. The effect is found entirely in Part A (hospital) expenditures, confirming selection is based on inpatient rather than outpatient or preventive care. These results are consistent with previous work.

Aged↗
PubMedDate not supplied

Health care expenditure, laboratory services and IVD market.

What has been written until now should not be misinterpreted: without doubt there is wastage in the Italian health care expenditure which must be rationalized. Moreover, the public deficit-now over two million billion lira-will probably prevent any reinvestment in health care of resources liberated through the above-mentioned rationalization process. In the near future, the attention of the authorities should be focused on how to reduce public spending, which probably also includes spending on health care. The message which needed to be passed on here does not refuse to recognize the possibility of rationalizing health care expenditure in Italy nor does it reject the need for this course of action. Instead it tries to give the following warning: in the light of the above circumstances-or the fact that even now the authorities cannot admit to spending "much" in the absolute sense, especially with regard to technology, or the fundamental role of IVDs in health care processes, or the difficulties in which the companies of the sector have been placed-it is possible to state that any blind, or worse still, ill-equipped, intervention in this field would have the undoubted effect of damaging the health care sector, or even place many companies on their knees, without receiving the expected benefits on the balance sheet. Benefits in the form of efficiency and saving can only be obtained from an effective reorganisation of the health structures, in line with the reforms provided for by legislative decree n. 502/92 (and subsequent modifications)--which, due to aspects too numerous to mention, is still a dead letter--and by taking steps towards valuing the laboratory services. As already stated, to talk of inefficiency in general terms means talking of unproductive expenditure: this occurs when utilizing factors whose cost is "too high" and/or productivity is "too low". It is with this distinction in mind that intervention must come; assessing factors not individually but rationally integrated in the production process of which they are part. Given the values at issue, any action not specifically aimed at the elimination of process inefficiency penalizes the already "healthy" elements, causes damage to the system and does not result in any significant benefits for expenditure. To summarize further, the need is for: a definition of what and how much to guarantee that can be taken from the National Budget; the realization of models which, surpassing the current macroscopic causes of inefficiency (which reside in structural and process type diseconomies), would make a correct economic assessment of investments and expenditure viable. In this respect, clinical pathology could play a fundamental role, in that the investments in this particular sector, if well programmed, would lead to significant savings for the entire health care system. The path followed until now must be abandoned at all costs; a path which starts by underestimating the needs and continues with the utilization of resources in an irrational manner, finishing with a proposal for the following year to allocate fewer resources to technology, almost as if it were on the same level as the potatoes (with or maybe even get hungry), at least this would resolve balance sheet problems without affecting the running of the services.

Clinical Laboratory Techniques↗
PubMedDate not supplied

Dr. B. C. Dasgupta Memorial Oration. Priorities, issues, inter-state variations and challenges.

India spends only 1.5% of GDP on health as against the recommended 5% by W.H.O. for equity and universal coverage. States have a high share (89%) of funding their health care activities as against 9% by centre and 2.8% by U. T.'s. Increasing proportion of health expenditure on salaries (60-90%) and a markedly reduced (29%-5%) proportion on non-salary components is reflected in low-level of utilization of health services. Committed involvement by others in selected crucial areas is lacking. Health financing seems to be directed towards the urban sector with maximum outlays to curative care. There are high inter-state variations in health expenditure and health status. Higher share of SDF on public health does not guarantee a better health status. Health services sector urgently & legitimately needs additional resources. There is need to set up technical committee and research cells to sensitise policy makers, academicians and others and to steer and guide research. Health Financing and Management must be considered together to address issues of equity, efficiency and effectiveness in health care services.

Developing Countries↗
PubMed2002

The impact of hospices on health care expenditures--the case of Taiwan.

Cancer has been the leading cause of death in Taiwan since 1982, with nearly one out of four deaths caused by malignant neoplasm. The huge amount of money being spent in the acute care setting for terminally ill cancer patients does not increase their wellbeing. In this study, we employ an Instrumental Variable (IV) model to correct for the self-selection problem and use population-based insurance claim data to test two null hypotheses: there is no difference in total expenditures between hospice care and conventional care, and that there is no difference in total expenditures between hospital-based hospice care and home hospice care. Both null hypotheses are rejected.

Adolescent↗
PubMed1985

Health care expenditure containment in the United States: strategies at the state and local level.

The current status of state and local strategies to contain health care expenditures in the United States is described. These strategies are classified as predominantly regulatory, competitive or voluntary. The actions of two major groups of purchasers of care--state government programs for the indigent and private employers--in support of expenditure containment strategies are discussed as well. The large number of approaches to expenditure containment currently being attempted, and their diverse character, are hypothesized to be a result not only of increased health care inflation and the concern it causes purchasers of care, but also of fundamental changes in the health care industry in the United States which have realigned traditional provider interest groups.

Budgets↗
PubMed2002

[Health care expenditures among the offspring of cocaine base paste consumers].

BACKGROUND: Health care costs of the offspring of mothers addicted to cocaine are three times higher than those of children not exposed to cocaine during gestation. AIM: To calculate the health care costs of the offspring of addict mothers that consumed cocaine during gestation. To verify the diseases or health conditions in these children, that generated the expenses. MATERIAL AND METHODS: One hundred offspring of addict women consuming cocaine base paste were studied. The health care expenses generated by hospital admissions and ambulatory follow up were calculated. Expenses were expressed in Chilean pesos, according to the value at June, 2000. The fares of the South Orient Metropolitan Health Service were used as a reference. RESULTS: Twenty four of the 100 children were lost from follow up. Among the 76 followed children, 48 were admitted to hospitals in 2.3 (range 1.2) occasions. Mean hospital stay was 21.7 days (range 1-186) and hospital mortality was 4%. Mean expense per hospital discharge was $1,556,098 and per patient was $3,457,995. The monthly expenses per children during ambulatory follow up were $120,372 that increased to $395,200 if family placing was added. CONCLUSIONS: These figures confirm that health care expenses of cocaine addicts offspring are more than three times the cost of a normal child. Primary and secondary prevention of cocaine addiction is urgently needed.

Adolescent↗
PubMed1984

Selected myths guiding the Reagan Administration's health policies.

This article analyzes four major assumptions that guide the Reagan Administration's health policies: 1) the Administration received an overwhelming popular mandate to reduce the federal role in the U.S. health sector; 2) the size and growth of federal social (including health) expenditures are contributing to the current economic recession; 3) the costs to business of federally imposed health and safety regulations have contributed to making the U.S. economy less competitive; and 4) market intervention is intrinsically more efficient than government intervention in regulating the costs and distribution of health resources. Based on these assumptions, the main characteristics of the Reagan Administration's health policies have been 1) a reduction of federal health expenditures and, very much in particular, expenditures to the poor, handicapped, and elderly; 2) a weakening of federal health and safety regulations to protect workers, consumers, and the environment; and 3) the further privatization and commodification of medical services. This article shows that there is no evidence to support the assumptions on which these policies are based. Quite to the contrary, all available evidence shows the opposite: 1) the majority of Americans want an expansion of federal health expenditures and a strengthening of federal health regulation; 2) U.S. government expenditures and regulations are much more limited than those of other countries whose economies are performing more satisfactorily; and 3) those countries with larger government interventions have more efficient health care systems than the American one, where the "free market" forces are primarily responsible for the allocation of resources. Thus, major Reagan Administration health policies are based on myth rather than reality.

Economic Competition↗
PubMed1996

Why health care costs more in the US: comparing health care expenditures between systemic lupus erythematosus patients in Stanford and Montreal.

OBJECTIVE: Recent studies to identify the causes of higher health care expenditure in the US versus Canada have relied on population-based measures of health care utilization and have restricted their analysis to one sector, such as physician or hospital expenditures. We present a detailed comparative analysis of the direct costs (health services utilized) of treating systemic lupus erythematosus (SLE) patients in Stanford, CA and Montreal, Quebec. METHODS: Using the self-report Stanford Health Assessment Questionnaire, we assessed 6-month direct costs incurred by 174 American and 164 Canadian SLE patients. We explored 3 potential reasons for the differential expenditure. These were 1) higher prices for health care inputs, 2) more severe disease in the patient case mix, and 3) greater resource utilization. RESULTS: The direct health care costs for the American SLE patients exceeded those for the Canadian patients by almost 2-fold ($10,530 versus $5,271, expressed in 1991 US dollars). The higher direct costs were explained by the higher price of health services in the US and the more severe disease mix. In fact, for all health resources categories studies, Canadians utilized at least as many services as their American counterparts. Canadians had longer hospital stays, made more emergency room visits, and used more medications. CONCLUSION: Despite significantly greater per capita health care expenditure in the US, our data show that Canadian SLE patients actually receive more medical services.

California↗
PubMed1999

[Health service use and age among the elderly].

The purpose of this study was to analyze differences in health service use among Japanese elderly by age group or by region through patient category, and to evaluate the impact of long-term elderly inpatient on the national health expenditure. We used a large scale data of 1993, based on medical fee claim records. Patient category was made by classifying elderly patients into 12 categories according to their annual inpatient, and outpatient days. Per capita health expenditure of the elderly changed according to age or region, and the main cause of this was the difference in percentage distribution of patient category, A typical example of those who use most of health services was the long-term inpatient, and both age difference and regional differences in per capita health expenditure of the elderly reduced remarkably by excluding such expenditure. Therefore, the impact of long-term elderly inpatient on the national health expenditure was already significant. In considering the effective use of health expenditure for the elderly, it is necessary to focus on those who use health service heavily, but at the same time it is also necessary to keep the entire patient population in mine.

Age Factors↗
PubMedDate not supplied

Out-of-pocket health-care expenditures among older Americans with cancer.

OBJECTIVE: There is currently limited information regarding the out-of-pocket expenditures (OOPE) for medical care made by elderly individuals with cancer. We sought to quantify OOPE for community-dwelling individuals age 70 or older with: 1) no cancer (No CA), 2) a history of cancer, not undergoing current treatment (CA/No Tx), and 3) a history of cancer, undergoing current treatment (CA/Tx). METHODS: We used data from the 1995 Asset and Health Dynamics Study, a nationally representative survey of community-dwelling elderly individuals. Respondents identified their cancer status and reported OOPE for the prior 2 years for: 1) hospital and nursing home stays, 2) outpatient services, 3) home care, and 4) prescription medications. Using a multivariable two-part regression model to control for differences in sociodemographics, living situation, functional limitations, comorbid chronic conditions, and insurance coverage, the additional cancer-related OOPE were estimated. RESULTS: Of the 6370 respondents, 5382 (84%) reported No CA, 812 (13%) reported CA/No Tx, and 176 (3%) reported CA/Tx. The adjusted mean annual OOPE for the No CA, CA/No Tx, and CA/Tx groups were 1210 dollars, 1450 dollars, and 1880 dollars, respectively (P < .01). Prescription medications (1120 dollars per year) and home care services (250 dollars) accounted for most of the additional OOPE associated with cancer treatment. Low-income individuals undergoing cancer treatment spent about 27% of their yearly income on OOPE compared to only 5% of yearly income for high-income individuals with no cancer history (P < .01). CONCLUSIONS: Cancer treatment in older individuals results in significant OOPE, mainly for prescription medications and home care services. Economic evaluations and public policies aimed at cancer prevention and treatment should take note of the significant OOPE made by older Americans with cancer.

Aged↗