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PubMed1995

Trends in state agency oral health and public health expenditures, 1984 through 1989.

This paper documents oral health and public health expenditures for fiscal years 1984, 1986, 1988, and 1989, as reported by state health agencies. During this period, reported national expenditures for public and oral health increased 68% and 46%, respectively; between successive fiscal years, fewer states (73%, 67%, 57%) reported increased oral health expenditures, while increasingly more states reported no categorical oral health expenditures. Block grant expenditures for oral health increased overall but decreased as a percentage of total oral health expenditures; 16 states reported no block grant expenditures for oral health in fiscal year 1989, perhaps reflecting either substantial state support, or marginal to nonexistent oral health programs in these states.

Data Collection↗
PubMed1980

Projections of national health expenditures, 1980, 1985, and 1990.

This paper presents projections of national health expenditures by type of expenditure and sources of funds for 1980, 1985, and 1990. A major purpose of these projections is to provide a baseline for health care expenditures in the absence of national health insurance and cost containment. Rapid growth in health expenditures is projected to continue to 1990. National health expenditures increased 350 percent between 1965 and 1978, reaching $192 billion in 1978. They are projected to reach $245 billion in 1980, $440 billion in 1985 and $760 billion in 1990, under current legislation. As a proportion of the Gross National Product (GNP), health expenditures rose from 6.2 percent to 9.1 percent between 1965 and 1978. They are projected to continue to rise, reaching 10.5 percent by 1985 and 11.5 percent by 1990. Sources of payments for these expenditures are also shifting. From 1965 to 1978, the percentage of total health expenditures that was government financed increased 16 percentage points, from 25 to 41 percent. The Federal share of public funds during the same period grew rapidly, from 53 percent in 1965 to 69 percent in 1978. In 1985, approximately 42 percent of total health spending is projected to be financed from public funds, of which 72 percent will be paid by the Federal government. Public funds are expected to account for 43 percent of total national health expenditures by 1990.

Financing, Government↗
PubMed1988

National health expenditures, 1987.

The 1987 national health expenditure estimates are examined from different perspectives in the following two articles. In the first article, revised expenditure estimates for 1984-87 are presented. A breakdown of the type of services and products purchased is included, as well as the source of funds used to finance health care. In the second article, health care expenditure estimates are used to explore marginal analysis as a policy tool for understanding health spending in relation to our Nation's ability to finance that spending. The concept of marginal analysis is also used to examine selected periods that were relevant to health policy and the timing of public and private changes in health policy in the past.

Health Expenditures↗
PubMed1997

Public health expenditures: developing estimates for improved policy making.

The Public Health Foundation (PHF), under contract to the U.S. Department of Health and Human Services, Public Health Service (PHS), worked with federal, state, and local public health, mental health, substance abuse, and environmental agencies in nine states to develop and successfully test a methodology for estimating investments in essential public health services. Estimates from the nine-state sample revealed the predominance of personal health expenditures in the public health system. Of total state health care dollars, only 1 percent was spent on population-based health services by participating agencies. This pilot provides a rational starting point toward a uniform methodology for highlighting public health expenditures that may be critical in revealing the effects of a changing health care environment on the nation's health. In combination with other data, results are expected to lead to a more informed policy-making process.

Financing, Government↗
PubMed1995

Estimating health expenditure growth under managed competition. Science, simulations, and scenarios.

The estimated impact of health system reform proposals on health expenditures influences the health system reform debate. Health expenditure growth rate (HEGR) estimates are particularly critical because small differences in rates over time create large differences in health expenditures. There currently is no hard scientific basis for estimating the impact of managed care/managed competition legislation and market developments on the HEGR. For the 1994 health system reform debate, the two leading nonpartisan modelers developed qualitative scenarios about future health system developments in which managed care/managed competition would have little or no impact on the HEGR. We conclude that there are alternative plausible scenarios, based on current health system changes interacting with potential legislation, in which managed care/managed competition will substantially lower the HEGR. We recommend that simulation models should provide a range of estimates that better reflect both market trends and the profound uncertainty about the effects of health system reform.

Competitive Medical Plans↗
PubMed1992

Population aging and the growth of health expenditures.

To what extent can rising per capita health expenditures be attributed to the changing age composition of the population? While numerous projections have been made, all have been based on cross-sectional spending differences between individuals at a single point in time, rather than on national expenditures as the age structure of the population changes over time. Cross-sectional and time series analyses of 20 countries in the years 1960-1988 show population aging is associated with higher health expenditures if no other variables are allowed in the equation; this "effect," however, is due to the secondary association of aging with rising per capita income and other omitted trend variables. Once these factors are controlled for, there is no longer any discernible association between age structure and health care costs. Age affects the allocation of spending, but not the total amount of funds available. The increasing burden of health expenditures is largely a policy and cost management problem rather than a demographic one.

Aged↗
PubMed1998

The determinants of health expenditure in the OECD countries: a pooled data analysis.

This paper uses international health expenditure and the latest OECD data to investigate the determinants of aggregate health expenditure. The study differs from most previous studies in two principal ways. First, it uses a somewhat larger sample for estimation, with pooled time-series, cross-section data for 22 OECD countries for a 20-year period. Most previous work has used a purely cross-section approach: in this case, the small sample size reduced the statistical reliability of results and limited the number of hypotheses that can be tested simultaneously. Second, and following from this, a more extensive range of hypotheses is tested, with particular emphasis on those relating to the contractual relations between payers, providers and patients. The findings show, for example, that the use of primary care "gatekeepers" seems to result in lower health expenditure and also that the way of remunerating physicians in the ambulatory care sector appears to influence health expenditure; capitation systems tend to lead to lower expenditure than fee-for-service systems.

Cross-Cultural Comparison↗
PubMed2005

[Catastrophic health expenditures in Mexico: comparative study by social exclusion level].

OBJECTIVE: To describe the differences in catastrophic health expenditures in five Mexican states. MATERIAL AND METHODS: This study included five states selected by convenience according to their social exclusion level. Household catastrophic health expenditures attributable to the three components of out of pocket health expenditures (ambulatory care, medication, and inpatient care) were calculated. RESULTS: The risk of impoverishment at the national level was greater in the most vulnerable households, namely, in the 20% poorest, rural, and uninsured households. Nevertheless, in states like Aguascalientes, Guerrero, Sinaloa, and Morelos the results were different. Over 70% of catastrophic health expenditures were attributable to medication and outpatient care expenditures in the poorest states. CONCLUSIONS: The differences found among states show that the implementation of local health policies to reduce catastrophic health expenditures should be based on evidence generated from analyses at the state level.

Adult↗
PubMed1992

Health expenditures in Texas, 1988.

Expenditures for health care in Texas during 1988 totaled $32.4 billion. Health spending by category of service and sources of payment was estimated and compared with estimates for prior years and with national trends. Texas differed from the nation as a whole in average annual increases in total spending, the percentage of spending for prepayment and administration, and the percentage of spending paid by consumers, the federal government, and private insurance. Proposed expansions in insurance coverage for the large proportion of uninsured Texans will probably require strong efforts to contain costs.

Health Expenditures↗
PubMed2000

On stationarity and cointegration of international health expenditure and GDP.

This paper examines stationarity and cointegration of health expenditure and GDP, for a sample of 21 OECD countries using data for the period 1960-1997, by applying a test battery that allows robust inference to be made on the stationarity and cointegration issue. Trend stationarity and no-cointegration are tested using new country-by-country and panel tests, not previously applied in this setting. New results for country-by-country and panel tests of non-stationarity and cointegration are presented. Our unit root and trend stationarity results indicate that both health expenditure and GDP are non-stationary. The no-cointegration and cointegration results indicate that health expenditure and GDP are cointegrated.

Data Interpretation, Statistical↗
PubMed1994

Developing countries' health expenditure information: what exists and what is needed?

In the past decade, the scarcity of financial resources for the health sector has increasingly led countries to take stock of national health resources used, review allocation patterns, assess the efficiency of existing resource use, and study health financing options. The primary difficulties in undertaking these analyses have been 1) the lack of information on health expenditures and 2) not using existing information to improve the planning and management of health sector resources. The principle sources of available health expenditure information are reported by organizations such as the World Bank, WHO, UNICEF and OECD. Special studies and non-routine information are a second major source of information. This existing data has a number of difficulties, including being sporadic, inconsistency, inclusion of only national level public expenditure, high opportunity and maintenance costs, quantitative and qualitative differences across countries, and validity and interpretability problems. Reliable health expenditure data would be useful not only for in-country, national purposes, but also for cross-national comparisons and for development agencies. Country uses of health expenditure data include policy formulation and planning and management, while international uses would facilitate examination of cross-national comparisons, reviews of existing programmes and identification of funding priorities. Collaborative efforts between countries and international development agencies, as well as between agencies, are needed to establish guidelines for health expenditure data sets. This development must ensure that the resulting information is of direct benefit to countries, as well as to agencies. Results of such collaborative efforts may include a set of standardized methodologies and tools; standardized national health accounts for developing countries; and training to enhance national capabilities to actively use the information. The opportunities for such collaboration are unique with the issuance of the World Development Report 1993, to build on this work in clearly identifying what is needed and proposing a standardized data set and the tools necessary to regularly and economically gather such data.

Data Collection↗
PubMed2005

[Fair health financing and catastrophic health expenditures: potential impact of the coverage extension of the popular health insurance in Mexico].

OBJECTIVE: To assess the impact on fair health financing and household catastrophic health expenditures of the implementation of the Popular Health Insurance (Seguro Popular de Salud). MATERIAL AND METHODS: Data analyzed in this study come from the National Income and Expenditure Household Survey (Encuesta Nacional de Ingresos y Gastos de los Hogares, ENIGH), 2000, and the National Health Insurance and Expenditure Survey, (Encuesta Nacional de Aseguramiento y Gasto en Salud, ENAGS), 2001. Estimations are based on projections of extension of the Popular Health Insurance under different conditions of coverage and out-of-pocket expenditure reductions in the uninsured population. The mathematic simulation model assumes applying the new Popular Health Insurance financial structure to the 2000 expenditure values reported by ENIGH, given the probability of affiliation by households. RESULTS: The model of determinants of affiliation to the Popular Health Insurance yielded three significant variables: being in income quintiles I and II, being a female head of household, and that a household member had a medical visit in the past year. Simulation results show that important impacts on the performance of the Mexican Health System will occur in terms of fair financing and catastrophic expenditures, even before achieving the universal coverage goal in 2010. A reduction of 40% in out-of-pocket expenditures and a Popular Health Insurance coverage of 100% will decrease catastrophic health expenditures from 3.4% to 1.6%. CONCLUSIONS: Our results show that the reduction of out-of-pocket expenditures generated by the new financing and health provision Popular Health Insurance model, will improve the financial fairness index and the financial contribution to the health system, and will decrease the percentage of households with catastrophic expenditures, even before reaching universal coverage. A greater impact may be expected due to coverage extension initiating in the poorest communities that have a very restricted and progressive financial contribution.

Adolescent↗
PubMed1992

U.S. health expenditure performance: an international comparison and data update.

In this article, the authors present the most recently available data on the health care financing and delivery systems of the 24 industrialized member countries of the Organization for Economic Cooperation and Development (OECD). U.S. health expenditure performance is compared with the performance of other OECD countries. Thirty-six tables of data from 1960-90 are presented on health expenditures, health care prices, availability and utilization of health care services, health outcomes, and basic economic and demographic factors.

Aged↗
PubMedDate not supplied

[Health expenditures in Spain at the dawn of the 3d millennium].

In 1997, per capita health expenditures reached in Spain 805 Euros as compared to 1146 Euros in the entire European Union. In terms of percent GDP, Spanish health expenditures amounted to 7.4 percent, as compared to 7.9 in the European Union. About 80% of Spanish health expenditures are public-funded. Since 1993 onwards, there is a political consensus for keeping at the same pace health expenditures increase and GDP growth. However it is not certain that such a consensus can be maintained, as trade unions are increasingly voicy for a strong growth of salaries in the public sector. There will be also pressure on the demand side, both in the short term (the Spanish people are increasingly expecting to raise their consumption of health services to the level of other European countries) and in the long run (impact of population aging).

European Union↗
PubMed1996

Value for money in South African health care: findings of a review of health expenditure and finance.

This article highlights the most striking findings of a review of health expenditure and finance in South Africa in 1992/3. The level of national expenditure on health care, and the distribution of resources between the public and private sectors, are discussed first. Then the article highlights the maldistribution of financial, physical and human resources on a geographic basis, racially and between levels of care. The cost of redressing inequities, at least at the primary care level, is mentioned in the context of seeking options for additional sources of finance. The article concludes by examining the planning prerequisites for successful reform.

Financial Support↗
PubMed2003

Household catastrophic health expenditure: a multicountry analysis.

BACKGROUND: Health policy makers have long been concerned with protecting people from the possibility that ill health will lead to catastrophic financial payments and subsequent impoverishment. Yet catastrophic expenditure is not rare. We investigated the extent of catastrophic health expenditure as a first step to developing appropriate policy responses. METHODS: We used a cross-country analysis design. Data from household surveys in 59 countries were used to explore, by regression analysis, variables associated with catastrophic health expenditure. We defined expenditure as being catastrophic if a household's financial contributions to the health system exceed 40% of income remaining after subsistence needs have been met. FINDINGS: The proportion of households facing catastrophic payments from out-of-pocket health expenses varied widely between countries. Catastrophic spending rates were highest in some countries in transition, and in certain Latin American countries. Three key preconditions for catastrophic payments were identified: the availability of health services requiring payment, low capacity to pay, and the lack of prepayment or health insurance. INTERPRETATION: People, particularly in poor households, can be protected from catastrophic health expenditures by reducing a health system's reliance on out-of-pocket payments and providing more financial risk protection. Increase in the availability of health services is critical to improving health in poor countries, but this approach could raise the proportion of households facing catastrophic expenditure; risk protection policies would be especially important in this situation.

Catastrophic Illness↗
PubMed1983

National health expenditure growth in the 1980's: an aging population, new technologies, and increasing competition.

Health care spending in the United States more than tripled between 1971 and 1981, increasing from $83 billion to $287 billion. This growth in health sector spending substantially outpaced overall growth in the economy, averaging 13.2 percent per year compared to 10.5 percent for the gross national product (GNP). By 1981, one out of every ten dollars of GNP was spent on health care, compared to one out of every thirteen dollars of GNP in 1971. If current trends continue and if present health care financing arrangements remain basically unchanged, national health expenditures are projected to reach approximately $756 billion in 1990 and consume roughly 12 percent of GNP. The focal issue in health care today is cost and cost increases. The outlook for the 1980's is for continued rapid growth but at a diminished rate. The primary force behind this moderating growth is projected lower inflation. However, real growth rates are also expected to moderate slightly. The chief factors influencing the growth of health expenditures in the eighties are expected to be aging of the population, new medical technologies, increasing competition, restrained public funding, growth in real income, increased health manpower, and a deceleration in economy-wide inflation. Managers, policy makers and providers in the health sector, as in all sectors, must include in today's decisions probable future trends. Inflation, economic shocks, and unanticipated outcomes of policies over the last decade have intensified the need for periodic assessments of individual industries and their relationship to the macro economy. This article provides such an assessment for the health care industry. Baseline current-law projections of national health expenditures are made to 1990.

Costs and Cost Analysis↗