Income and expenditure in public health nursing, 1950 trends in nonofficial agencies and combination services.
Explore the source record for details and available documents.
Health Expenditures↗
SEARCH · Search PubMed
Results for “Health Expenditures”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
[Ambulatory surgery: preoperative assessment].
Over the past 20 years public health expenditure has progressively increased for various reasons. With the aim of reducing public health expenditure and hospital stays, alternative models of public health care have been more widely adopted over the past two decades: Day Hospital, day surgery and ambulatory surgery. What is meant by ambulatory surgery is the clinical, organisational and administrative possibility of performing surgical operations and/or invasive and semi-invasive diagnostic procedures without hospitalisation of patients, in doctors' surgeries, outpatient departments or protected outpatient facilities. For both the patients and the centres providing the service to be able to exploit all the advantages stemming from this kind of health care provision, careful patient selection is mandatory, including assessment of the impact of any potential concomitant pathologies. Starting from their own personal experience and existing reports in the international literature, the authors analyse the impact that concomitant pathologies may have on patient selection for ambulatory surgery. The authors conclude that thorough preoperative evaluation of all the possible variables involved is the only way of ensuring the success of ambulatory surgery.
Ambulatory Surgical Procedures↗
The role of the World Health Organization on pharmaceuticals in Europe.
The World Health Organization (WHO) is the specialized agency of the UN on public health. It gives worldwide guidance in the field of health, sets global standards for health, cooperates with governments to strengthen national health care programs, and develops and transfers appropriate health technology, information, and standards. Within the WHO European region, health status and health expenditures vary greatly. In this paper, disparities between health status, health services, and health care expenditures between countries of the WHO European region are presented. The objectives, performance, and dilemmas facing health care systems are discussed, including the recent performance ranking published by the WHO. The paper focuses particularly on access to medicines, their appropriate use, and rising drug expenditures. Strategies used by European countries to improve drug use and contain health care expenditures are outlined. Finally, the future of pharmaceuticals and public health is explored.
Delivery of Health Care↗
Hefty health lobbying expenditures reported.
Explore the source record for details and available documents.
Data Collection↗
Optimal social health insurance with supplementary private insurance.
This paper investigates the structure of a National Health Service in which there is compulsory social insurance covering a package of essentials, a given part of individuals' health expenditure, and supplementary private policy topping up the remaining services. The latter insurance contract provides for a co-payment by patients, limiting the so-called "third-party payer" effect. Thus, an individual's health expenditure is divided into three parts: the first covered by social insurance, the second by a private policy and the third out-of-pocket. Such mixed system design has received increasing attention in recent years and has been adopted by several industrialized countries. The conditions for optimal rates of social insurance coverage and of private coinsurance are analysed and discussed. The optimality requirements refer to efficiency as well as equity concerns.
Health Expenditures↗
How well do ambulatory care groups predict expenditures on mental health and substance abuse patients?
This paper evaluates the ability of Ambulatory Care Groups (ACGs) to prospectively predict mental health and substance abuse expenditures and total health care expenditures of persons enrolled in the New Hampshire Medicaid Program during fiscal years 1993 and 1994. A series of multi-part models is estimated separately for adults and children and a synthetic R-squared and the mean absolute predictive error are calculated. The results show that with the exception of predicting total expenditures for children, ACGs do not perform as well as simple models containing various demographic and prior mental health/substance abuse utilization measures.
Adolescent↗
High and rising health care costs. Part 1: seeking an explanation.
The United States has the most expensive health care system in the world, with per capita health expenditures far above those of any other nation. For many years, U.S. health care expenditures have been growing above the overall rate of inflation in the economy. A few experts have argued that high and rising costs are not such a serious problem. Most observers disagree with this view, pointing to the negative impact of employee health care costs on employers, the government budgetary problems caused by rising health care expenditures, and an association between high health care costs and reduced access for individuals needing health services. Several explanations have been offered for high and rising health care costs. These include the perspectives that high and rising costs are created by forces external to the health system, by the weakness of a competitive free market within the health system, by the rapid diffusion of new technologies, by excessive costs of administering the health system, by the absence of strong cost-containment measures, and by undue market power of health care providers. This article, the first in a 4-part series, discusses 3 perspectives on health care: 1) Are high and rising health care costs a serious problem? 2) Are rising costs explained by factors outside the health care system? 3) Does the absence of a free market in health care explain why costs are high and rising? The remaining 3 articles in this series address other perspectives on health care costs.
Cost Sharing↗
Tracking our investments in public health: what have we learned?
A voluntary public health expenditures reporting system existed in the United States for over 25 years, tracking and reporting trends in health department expenditures, revenue streams, functions, and programs. Today, no such system exists and no data are available to help us understand how and where public health dollars are being spent and the trends during good and bad economic times. This article discusses the history of and lessons learned from the former public health expenditures reporting system and more recent demonstration projects that experimented with reporting by essential public health services. The article also explores how what we have learned can be used for developing and implementing a system today to meet public health and public policy needs.
Financing, Government↗
The war and public expenditure on mental health care in England and Wales--the postponement effect.
Explore the source record for details and available documents.
Attitude↗
[Diabetic foot from the social medicine viewpoint].
Despite continuously rising health expenditures since 1989 (Declaration of St. Vincent) no demonstrable improvements in health were achieved for diabetic patients. In poorly treated patients quality of life and life expectance are impaired by complications. In addition, these patients account for a huge burden of health expenditures. Education is the key both to preventing diabetes and successfully treating patients with diabetes. Integrated activities of purchasers, their medical review boards and of all medical healthcare providers could improve the quality of therapy and reduce the costs.
Cost Control↗
Cost containment--another view.
There is an emerging public consensus that in a slowly growing economy, the continuing rise in the nation's health-care costs must be moderated. Ginzberg has suggested that we can and must do this without reducing the quality of care we provide and without major changes in the structure or governance of our health-care-delivery system. He implies that we can readily identify and eliminate substantial numbers of useless health-care services. Such an approach to cost containment is almost certain to fail. A successful cost-containment program will include some or all of the following elements: caps on public health expenditures and implicit limits on the quality and accessibility of health care to be provided at public expense, much tighter government regulation of private health-care expenditures, control of the physician supply, and modification of the fee-for-service reimbursement system for physicians and hospitals. Until our society is prepared to accept these kinds of structural changes and their adverse impact, to some degree, on the quality and accessibility of health services, effective cost containment will not occur. Are we ready for these kinds of changes? Should we be? Perhaps we ought to be less concerned about cost containment and more prepared to spend 12 or 13 per cent of the gross national product on health care by 1990. What we should not do is pretend that painless cost containment is an achievable goal.
Ambulatory Care↗
National health care spending in 1991.
The United States spent $751.8 billion on health in 1991, an increase of 11.4 percent over 1990 levels. National health expenditures consumed 13.2 percent of gross domestic product (GDP). The 11.4 percent growth rate in spending is four times the rate of growth in the general economy. Medicaid contributed substantially to overall spending in 1991. Consumers' out-of-pocket payments grew only 5.7 percent to a total of $144.3 billion, accounting for 19.2 percent of national health expenditures (the lowest share ever reported). Economywide price inflation accounted for 36 percent of health spending growth in 1991; increases in use and intensity of health services accounted for 30 percent of total spending growth; excess medical price inflation accounted for 25 percent, an amount that is consistent with its share throughout the 1980s.
Data Collection↗
Assessing the effect of the 2001-06 Mexican health reform: an interim report card.
Since 2001, Mexico has been designing, legislating, and implementing a major health-system reform. A key component was the creation of Seguro Popular, which is intended to expand insurance coverage over 7 years to uninsured people, nearly half the total population at the start of 2001. The reform included five actions: legislation of entitlement per family affiliated which, with full implementation, will increase public spending on health by 0.8-1.0% of gross domestic product; creation of explicit benefits packages; allocation of monies to decentralised state ministries of health in proportion to number of families affiliated; division of federal resources flowing to states into separate funds for personal and non-personal health services; and creation of a fund to protect families against catastrophic health expenditures. Using the WHO health-systems framework, we used a wide range of datasets to assess the effect of this reform on different dimensions of the health system. Key findings include: affiliation is preferentially reaching the poor and the marginalised communities; federal non-social security expenditure in real per-head terms increased by 38% from 2000 to 2005; equity of public-health expenditure across states improved; Seguro Popular affiliates used more inpatient and outpatient services than uninsured people; effective coverage of 11 interventions has improved between 2000 and 2005-06; inequalities in effective coverage across states and wealth deciles has decreased over this period; catastrophic expenditures for Seguro Popular affiliates are lower than for uninsured people even though use of services has increased. We present some lessons for Mexico based on this interim evaluation and explore implications for other countries considering health reforms.
Delivery of Health Care↗
Persons with chronic conditions. Their prevalence and costs.
OBJECTIVES: To determine (1) the number and proportion of Americans living with chronic conditions, and (2) the magnitude of their costs, including direct costs (annual personal health expenditures) and indirect costs to society (lost productivity due to chronic conditions and premature death). DESIGN: Analysis of the 1987 National Medical Expenditure Survey for prevalence and direct health care costs; indirect costs based on the 1990 National Health Interview Survey and Vital Statistics of the United States. SETTING: US population. PARTICIPANTS: For the estimate of prevalence and direct costs, the National Medical Expenditure Survey sample of persons who reported health conditions associated with (1) use of health services or supplies or (2) periods of disability. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The number of persons with chronic conditions, their annual direct health care costs, and indirect costs from lost productivity and premature deaths. RESULTS: In 1987, 90 million Americans were living with chronic conditions, 39 million of whom were living with more than 1 chronic condition. Over 45% of noninstitutionalized Americans have 1 or more chronic conditions and their direct health care costs account for three fourths of US health care expenditures. Total costs projected to 1990 for people with chronic conditions amounted to $659 billion--$425 billion for direct health care costs and $234 billion in indirect costs. CONCLUSIONS: The prevalence and costs of chronic conditions as a whole have rarely been estimated. Because the number of persons with limitations due to chronic conditions is more regularly reported in the literature, the total prevalence of chronic conditions has perhaps been minimized. The majority of persons with chronic conditions are not disabled, nor are they elderly. Chronic conditions affect all ages. Because persons with chronic conditions have greater health needs at any age, their costs are disproportionately high.
Adolescent↗
Training health services managers: improving health by more health economics?
In times of rising health expenditures and imminent health problems, efficiency is a crucial element for maintaining and improving health care and, finally, health. One major support measure is the effective management of health services. This paper considers possible improvements of health care by training health services managers in health economics. It surveys the current state of health economics training, presents approaches towards the key issues of health economics, discusses the impact of health economics by two examples, and considers management aspects of health economics training.
Curriculum↗
Longitudinal study of child immunization determinants in China.
This paper exploits longitudinal data and methods to study the determinants of child immunization in 1990 s China. Many countries such as China are experiencing rapid economic transitions characterized by declining public health expenditures, privatizing health-care sectors, increased inequality and high income growth. It is still poorly understood how such changes affect utilization of preventive health care. Data from three waves of the China Health and Nutrition Survey were used to examine the immunization effects of child, household, and community health facility characteristics, as well as changes of such effects over time. Results indicate that gender and wealth differentials in immunization increased during China's transition, though these effects were small. The most important determinants were service price and maternal education. Wealth effects were minimal, indicating that the long-run effect of economic transition on immunization rates may depend crucially on the extent to which more rapid economic growth leads to increased educational investments. Methodologically, the paper finds substantial bias from standard cross-sectional models in contrast to panel data approaches, adding to the case for expanded collection of longitudinal health data in developing countries.
Child↗
Private health care.
During the last decade there has been considerable international mobilisation around shrinking the role of States in health care. The World Bank reports that, in many low and middle-income countries, private sources of finance comprise the largest share of total national health expenditures. Private sector health care is ubiquitous, reaches throughout the population, preferred by the people and is significant from both economic as well as health perspective. Resources are limited, governments are weak, and a new approach is needed. This paper provides a broad overview and raises key issues with regard to private health care. The focus is on provision of health care by private medical providers. On the background of the world's common health problems and interventions available to tackle them, the place of private health care in the overall context is first discussed. The concept of privatisation within the various forms of health care systems is then explained. The paper then describes the genesis and key elements of rapidly enhancing role of the private sector in health care and points to the paucity of literature from low and middle-income countries. Common concerns about private health care are outlined. Two illustrative examples--tuberculosis, the top infectious killer among the poor and coronary heart disease, the top non-infectious killer among the rich--are presented to understand the current and possible role of private sector in provision of health care. Highlighting the need to distinguish between health care as a public good or a market commodity, the paper leaves it to the reader to draw conclusions.
Cardiovascular Diseases↗
[Models for calculating the cost of operational expenditure for a health centre in Senegal].
The transformation of a health post into a health centre generates new services which mobilise different resources. The objective of this work is to propose a budgetary forecasting model for this specific type of case, one which is recurrent although seldom documented. As a preliminary step, the quarterly operational costs were determined, and the "complete costs method" (or the homogeneous sections method) was utilised for this purpose. In the second phase, the "pre-established costs method" was used to set the budget forecasts. The amount to be recovered by the health committee for a three month period of operation is estimated at 1,574,967 F CFA (equivalent to approximately 2,400 Euros), representing 42% of the total cost. The states assures the contribution of public funds to cover 54.2% of the cost, and the commune of Kanel furnishes 3.8% of the total cost, however only in the form of in-kind contributions or other material resources. The overall estimated budget for the year 2004 is estimated at 14,835,425 F CFA (about 22,615 Euros) of which 57.6% is expected to be received from the state.
Costs and Cost Analysis↗