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PubMed2002

[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↗
PubMed2004

Outpatient drug expenditures and prescription policies for diseases with high cost to the National Health Insurance system in Taiwan.

BACKGROUND AND PURPOSE: The high cost of drugs, particularly those used to treat upper respiratory tract infections, is an increasingly important problem for the National Health Insurance system in Taiwan. This study proposed a new classification scheme for reimbursing drug cost and estimated its impact on expenditures and health care utilization. METHODS: Data were obtained from the National Health Research Institutes' year 2000 computer file of the National Health Insurance Academic Research Database in Taiwan. Two factors were used to classify medications: 1) urgency of medications required; and 2) patient's self-care ability. RESULTS: Among the 10 diseases with the highest number of outpatient department (OPD) visits, 7 were upper respiratory diseases. Acute upper respiratory infections (URIs) and acute nasopharyngitis were the 2 diseases with the highest number of OPD visits. Drug expenditure for acute URIs is about 6% of total expenditure for drugs. Medications suitable for URIs patients' self-care accounted for 42.8% of the total cost of prescribed drugs for these illnesses, and treatment medications unsuitable for patients' self-care accounted for 48.6%. Other medications used for URIs could not be grouped into these categories. The total expenditure for acute nasopharyngitis was about 1.3% of total expenditure for drugs. Medications suitable for self-care in patients with nasopharyngitis accounted for 51.8% of the total cost of medication prescribed for this illness, and medications unsuitable for patients' self-care accounted for 36.8%. CONCLUSIONS: Reducing the medications suitable for patients' self-care and enforcing different levels of payment rates on medications unsuitable for patients' self-care may reduce the excessive use of OPD drugs, improve the appropriateness of utilization for acute URIs and the common cold, and allow medical resources to be distributed more efficiently.

Adolescent↗
PubMed1992

The effects of utilization review on hospital use and expenditures: a covariance analysis.

Hospital utilization review (UR) has expanded rapidly in recent years and is now widely used by private payers as an approach to cost containment. This article reports estimates of the effects of UR on hospital utilization and medical expenditures based on a covariance estimation procedure. Claims data on 223 privately insured groups were analyzed covering a three-year period, 1984 through 1986. UR was associated with an approximate 12 percent decrease in admissions, a 14 percent decrease in hospital routine expenditures, and a 6 percent decrease in total medical expenditures. UR appears to reduce expenditures mainly by reducing admissions; hospital inpatient expenditures per admission were unaffected by the review activity. Analysis showed the effect of UR to have been greatest during the quarters immediately following implementation of the review activity. This finding underscores the need to analyze longitudinal data having sufficient time-series observations to obtain reliable estimates of long-term program impact. The analysis described here offers a computationally efficient alternative specification to the standard fixed-effects approach for analyzing pooled data, and is especially useful when the number of cross-section units is large.

Analysis of Variance↗
PubMed2005

[Private expenditure in health by state in Mexico].

OBJECTIVE: Present information on the magnitude and composition of private health expenditure (PHE) in Mexico. MATERIAL AND METHODS: Total PHE by state was calculated using the System of National Health Accounts and National Performance Assessment Survey 2002-2003 by means of elasticities and growth relative contributions. RESULTS: 58% of the total PHE was private and 90% of this was out-of-pocket expenditure. Most of the latter is expenditure in ambulatory care and drugs. 60% of the PHE was concentrated in only six states. PHE was lower than public expenditure in six states. CONCLUSIONS: The magnitude of out-of-pocket expenditure in health is worrying, since it is the most unfair, inefficient and regressive way of financing health care. Health authorities should look for alternative ways to finance health care, like the Popular Health Insurance.

Ambulatory Care↗
PubMed2005

[Out-of-pocket health expenditures by non-elderly and elderly persons in Korea].

OBJECTIVES: The purpose of this study was to determine the impact of the sociodemographic and health characteristics on the out-of-pocket health spending of the individuals aged 20 and older in Korea. METHODS: We used the data from the 2001 National Public Health and Nutrition Survey. The final sample size was 26,154 persons. Multiple linear regression models were used according to the age groups, that is, one model was used for those people under the age of sixty-five and the other was used for those people aged sixty-five and older. In these analyses, the expenditures were transformed to a logarithmic scale to reduce the skewness of the results. RESULTS: Out-of-pocket health expenditures for those people under the age of 65 averaged 14,800 won per month, whereas expenditures for those people aged 65 and older averaged 27,200 won per month. In the regression analysis, the insurance type, resident area, self-reported health status, acute or chronic condition and bed-disability days were the statistically significant determinants for both age groups. Gender and age were statistically significant determinants only for the non-elderly. CONCLUSIONS: The findings from this study show that the mean out-of-pocket health expenditures varied according to the age groups and also several diverse characteristics. Thus, policymakers should consider the out-of-pocket health expenditure differential between the elderly and non-elderly persons. Improvement of the insurance coverage for the economically vulnerable subgroups that were identified in this study should be carefully considered. In addition, it is necessary to assess the impact of out-of-pocket spending on the peoples' health care utilization.

Adult↗
PubMed2005

Refined method for estimating medical expenditures for liver disease using the patient survey and claim data in Japan.

OBJECTIVE: This study was performed to develop a estimation method for medical expenditures based on detailed data for the various kinds of liver disease. METHODS: Using claim data from the Survey of National Medical Care Insurance Services and the Patient Survey in Japan, we estimated the medical expenditures for various liver diseases using a refined method, in which the amount of expenditure by age and sex was multiplied by the respective numbers of patients. RESULTS: According to our estimates, the total medical expenditures per year for all liver diseases in Japan was 680 billion yen. The breakdown included: viral hepatitis (256 billion yen); malignant neoplasms of the liver and intrahepatic bile ducts (170 billion yen); cirrhosis of the liver (97 billion yen); other liver diseases (63 billion yen); chronic hepatitis (61 billion yen); and alcoholic hepatitis (33 billion yen). CONCLUSION: These are the first published estimates, not only for the total medical expenditure for all liver diseases, but also for individual categories. The method we employed in this study can readily be applied to estimate medical costs for other diseases.

Adolescent↗
PubMed1990

Trends in the distribution of South African health care expenditure.

The lack of critical distinction between the public and the private health sectors and what they represent has allowed the claim to be made that South African health care expenditure levels compare favourably with international standards. This paper considers the distribution of health expenditure between the public and the private sectors in South Africa, within these sectors and also on the basis of population group. The extent of maldistribution of health care resources among the people of South Africa is highlighted. The data analysed in this paper indicate that an increasing proportion of public sector expenditure has been spent on curative services, that the gap in real per capita expenditure between the 'homelands' and other public sector departments has been widening, and that per capita expenditure has been increasing more rapidly in the private sector than in the public sector, particularly in the 1980s.

Catchment Area, Health↗
PubMed1990

Israel's expenditure on health services.

In 1986, the State of Israel utilized 7.6% of its gross national product (GNP) for health care. At first glance this seems to be a reasonable level of expenditure when compared with the percentage of GNP devoted to health care in eight selected industrialized non-communist nations. However, Israel devoted fewer dollars per citizen on health care than any of the eight other nations. We investigate the role of three factors that contributed to this relatively low expenditure level: a) health personnel and bed supply levels, b) operations and procedure rates, and c) relative wage costs of health personnel. If Israel had the same level of per capita GNP as the USA, its annual health service per capita expenditure would increase from $472 to $1,328. If, in addition, its health personnel received the same wage differentials (in relation to the average wage levels) as those received by health personnel in the USA, it is estimated that Israel would spend around $1,842 annually per capita on health care (representing 10.7% of its GNP). This figure is only $98 less than what the USA spends, and creates a vastly different impression concerning the efficiency of the health system than does the original unadjusted expenditure of only $472 per head, which is $1,468 less than that spent by the USA. The Israeli health system can be said to be characterized by adequate manpower inputs, high bed occupancy rates, low surgery rates relative to the USA (not necessarily a negative phenomenon), and low relative wage inputs. The relatively limited available output indicators lead us to believe that productivity per person employed in the health services could be raised. The low absolute levels of health expenditures in Israel are mainly due to a combination of a low GNP per head and relatively low wage differentials between health service staff and other income earners.

Bed Occupancy↗
PubMed1987

South African health care expenditure, 1975-1984.

South African health care expenditure is reported for the period 1975-1984 and analysed for the public and private sectors. Approximately 5.9% of South Africa's gross national product was devoted to health care in 1984-1985. This proportion appears to be increasing. Real per capita expenditure on health increased by 13% during the period under review. Trends of health care expenditure during the decade are discussed as well as some underlying causes of the increases in health care expenditure in South Africa. Precise expenditure data and outcome information are required in order to ensure appropriate resource allocation.

Financing, Government↗
PubMed1988

Private social welfare expenditures, 1972-85.

This article updates the private social welfare expenditures series with complete data for 1985 and information for most categories through 1986. In the United States, private sector expenditures play a substantial role in the provision of social welfare services. This article presents private social welfare expenditures in terms of the four major categories--health, education, welfare and related services, and income maintenance that includes private pensions, sickness and disability benefits, and group insurance. The private expenditures, which totaled $429.3 billion in 1985, are distributed by major category beginning in 1972 and are also related to public social welfare expenditures and gross national product.

Education↗
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↗
PubMed1993

Trends in primary medical care related services and expenditure in New Zealand 1983-93.

AIMS: To analyse recent trends in primary medical care (PMC) related expenditure, general medical services (GMS), pharmaceuticals, laboratory, Accident Compensation Corporation (ACC) and other categories, as a basis for general practitioners, other primary health care providers and regional health authorities becoming better positioned to make more effective decisions about the use of this expenditure. METHODS: Data from the Department of Health, Accident Compensation Corporation and other sources of this expenditure over the period 1983-93 were obtained and analysed. RESULTS: Primary medical care related expenditure between 1982-3 and 1990-1 increased annually at an inflation adjusted rate of 6.1% to a total of $1006.2M. In 1991-2 there was a slight inflation adjusted decrease in overall primary medical care related expenditure of 0.5% although maternity benefits increased by 20.7%. An overall increase of 2.7% occurred in 1992-3 with a 10.1% increase in laboratory benefits and 16.4% in maternity benefits. Price, volume, mix and other factors were analysed to explain these increases. The overriding determinants of the cost increases are the volume of primary medical care related services such as pharmaceuticals, laboratory and maternity services and the mix effect ie, more expensive drugs, tests, etc. CONCLUSION: Alternative strategies for control of primary medical care related service utilisation costs are discussed. It is suggested that the most effective strategy is some form of general practitioner or community based budget holding within which general practitioners and/or communities are empowered to make decisions about their priorities in achieving the best possible quality and quantity of primary health care.

Financing, Government↗
PubMed1993

Trends and determinants of prescription drug expenditures in the elderly: data from the British Columbia Pharmacare Program.

This paper uses claims data from the prescription drug program for the elderly in British Columbia to describe temporal trends in prescription drug use and the determinants of those trends. Drug expenditures under the program increased by 317% from $21.6 million in 1981-82 to $90 million in 1988-89. Of the $68.4 million-dollar increase in overall expenditures, 34% was due to new drugs, 24% to increased age-specific utilization rates of old drugs, 21% to increased prices of old drugs, and 14% to the increased size of the elderly population. The analysis indicates that 61.5% of new drug expenditures can be attributed to four specific drugs and that the relative importance of price and utilization rates in determining changes in expenditures on old drugs varies by drug category. The paper provides a framework for understanding and predicting expenditures for drug benefit plans.

Age Factors↗
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↗
PubMed1997

Medical scheme expenditure on dental care--a smaller slice of the pie.

Medical schemes play an important part in financing dental care in the private sector and provide many dental practitioners with a substantial source of income. Data on medical scheme expenditure indicates a steady decline in their proportional pay-out for dental care during the period 1985 to 1994. In 1985 more than 12 per cent of total medical scheme expenditure was spent on dental care. In 1994 this had reduced to 8.37 per cent. In the present study, the historical trend (1985-1994) of medical scheme expenditure on dental care is analysed. By using the least squares method, the annual medical scheme expenditure on dental care is computed for the next eleven years (1995-2005). If the secular trend continues, less than 4 per cent of medical scheme expenditure will be paid for dental care by the year 2005.

Dental Care↗
PubMed1997

[An analysis of factors associated with the increase of in-patient medical expenditures for the elderly in Fukuoka Prefecture].

In order to evaluate factors associated with the increase in the in-patient medical expenditures for the elderly in Fukuoka prefecture during the period from 1987 to 1991, an analysis was conducted based on the data of 10 Health Care Regions. According to the results, there were two patterns in the increase. The first was the pattern observed in the southern part of the prefecture, where most of the increase in the in-patient medical expenditures for the elderly was explained by the increase of medical expenditures per capita. Furthermore, this increase per capita was due to the increase in utilization rate. This pattern is considered to be associated with the increase of general hospital beds as well as with the increase of the dependent elderly in the regions. The second pattern was observed in urban regions, such as Fukuoka and Kitakyushu, where the increase of in-patient medical expenditures for the elderly was mainly due to the increase in the number of elderly in the regions. This pattern is considered to be associated with the increase in the population categorized as the aged household. The present result suggests that in order to control the medical expenditures for the elderly, different service-mix strategies will be necessary, respecting the socio-economic characteristics of each region.

Demography↗
PubMed1998

Returns on investment in public health: effect of public health expenditures on infant health, 1983-1990.

In this study, we developed a broad conceptual framework focusing on how public health expenditures impact the nation's health. We then applied this framework to infant health outcomes and, using an eight-year state panel database, empirically analyzed how state public health expenditures, ceteris paribus, impact a state's level of teenage births and the receipt of prenatal care. Two hypotheses were tested. Hypothesis 1 states that over time, public health expenditures and public health activities, ceteris paribus, significantly decrease births to mothers less than 20 years of age. Hypothesis 2 states that over time, public health expenditures and public health activities, ceteris paribus, significantly decrease the number of infants whose mothers received late or no prenatal care. We find support for both hypotheses but observe that the way public health expenditures are measured has an impact on the findings. Other important implications of the study are noted. To our knowledge, this is the first article that has taken an aggregate state perspective over time and applied it to specific measures of infant health.

Adolescent↗
PubMed1998

Primary care physicians and specialists as personal physicians. Health care expenditures and mortality experience.

BACKGROUND: The advent of managed care has resulted in considerable debate regarding the relative effects of specialist and primary care on patient outcomes and costs. Studies on these subjects have been limited to a disease-focused orientation rather than a patient-focused orientation inherent in primary care management. We examined whether persons using a primary care physician have lower expenditures and mortality than those using a specialist as their personal physician. METHODS: Using data on a nationally representative sample of 13,270 adult respondents tot he 1987 National Medical Expenditure Survey reporting as their personal physician either a primary care physician (general practitioner, family physician, internist, or obstetrician-gynecologist) or a specialist, we examined total annual health care expenditures and 5-year mortality experience. RESULTS: Respondents with a primary care physician, rather than a specialist, as a personal physician were more likely to be women, white, live in rural areas, report fewer medical diagnoses and higher health perceptions and have lower annual healthcare expenditures (mean: $2029 vs $3100) and lower mortality (hazard ratio = 0.76, 95% confidence interval [CI], 0.64-0.90). After adjustment for demographics, health insurance status, reported diagnoses, health perceptions, and smoking status, respondents reporting using a primary care physician compared with those using a specialist had 33% lower annual adjusted health care expenditures and lower adjusted mortality (hazard ratio = 0.81; 95% CI, 0.66-0.98). CONCLUSIONS: These findings provide evidence for the cost-effective role of primary care physicians in the health care system. More research is needed on how to optimally integrate primary and specialty care.

Economics, Medical↗