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PubMed1998

Patterns of use, expenditures, and perceived efficacy of complementary and alternative therapies in HIV-infected patients.

BACKGROUND: Complementary and alternative medicine (CAM) use is common in the general population, accounting for substantial expenditures. Among patients with human immunodeficiency virus (HIV) infection, few data are available on the prevalence, costs, and patterns of alternative therapy use. METHODS: We carried out detailed telephone surveys and medical chart reviews for 289 active patients with HIV in a general medicine practice at a university-based teaching hospital in Boston, Mass. Data were collected on prevalence and patterns of CAM use, out-of-pocket expenditures, associated outcomes, and correlates of CAM use. RESULTS: Of 180 patients who agreed to be interviewed, 122 (67.8%) used herbs, vitamins, or dietary supplements, 81 (45.0%) visited a CAM provider, and 43 (23.9%) reported using marijuana for medicinal purposes in the previous year. Patients who saw CAM providers made a median of 12 visits per year to these providers compared with 7 visits per year to their primary care physician and nurse practitioner. Mean yearly out-of-pocket expenditures for CAM users totaled $938 for all therapies. For the main reason CAM was used, respondents found therapies "extremely" or "quite a bit" helpful in 81 (81.0%) of 100 reports of supplement use, in 76 (65.5%) of 116 reports of CAM provider use, and in 27 (87%) of 31 reports of marijuana use. In multivariable models, college education (odds ratio [OR]=3.7, 95% confidence interval [CI]=1.9-7.1) and fatigue (OR=2.7, 95% CI=1.4-5.2) were associated with CAM provider use; memory loss (OR=2.3, 95% CI=1.1-4.8) and fatigue (OR=0.4, 95% CI=0.2-0.9) were associated with supplement use; and weight loss (OR=2.6, 95% CI=1.2-5.6) was associated with marijuana use. CONCLUSIONS: Patients with HIV infection use CAM, including marijuana, at a high rate; make frequent visits to CAM providers; incur substantial expenditures; and report considerable improvement with these treatments. Clinical trials of frequently used CAMs are needed to inform physicians and patients about therapies that may have measurable benefit or measurable risk.

Boston↗
PubMed1998

The black box of health care expenditure growth determinants.

In this paper, the determinants of growth of aggregate health expenditures are investigated. The study departs from previous literature in that it looks at differences across countries in growth (and not levels) of health care expenditures. Estimation is made for 24 OECD countries. Health system characteristics usually believed to influence health expenditures growth, like population ageing, the type of health system (public reimbursement, public contract or integrate) and existence of gatekeepers, are found to be non-significant. Nevertheless, there is evidence that health expenditures experienced a clear slower growth in the last decade. The explanation for this slowdown could not be found in the proposed model and should stimulate further research.

Aged↗
PubMedDate not supplied

Bucking the trend? Health care expenditures in low-income countries 1990-1995.

Health care expenditures in low-income countries are analysed for the years 1990 and 1995 using four key indicators. Key findings include a substantial reduction in public spending per capita across low-income countries between 1990-95; a significant shift towards private expenditures, which appears increasingly to be substituting rather than supplementing public expenditures; a fall in total and public health spending in many countries despite growth in national income, contradicting the relationship found in other studies. Two possible explanations are put forward. First that the patterns found are a direct result of the structural adjustment policies adopted by many low-income countries, which aim to control and often cut public financing, whilst promoting private health expenditures. Secondly, that following the wave of privatization of state industries, many governments are finding problems adapting to their new role as a tax collector, and are thus not benefiting from economic growth to the extent that might be expected.

Data Collection↗
PubMed2005

Assessing household health expenditure with Box-Cox censoring models.

In order to assess the combined presence of zero expenditures and a heavily skewed distribution of positive expenditures, the Box-Cox transformation with location parameter is used to define a set of models generalising the standard Tobit, Heckman selection and double-hurdle models. Extended flexibility with respect to previous specifications is introduced, notably regarding negative transformation parameters, which may prove necessary for medical expenditures, and corner-solution outcomes. An illustration is provided by the analysis of household health expenditure in Switzerland.

Family Characteristics↗
PubMed2007

Public health expenditure and spatial interactions in a decentralized national health system.

One of the limitations of cross-country health expenditure analysis refers to the fact that the financing, the internal organization and political restraints of health care decision-making are country-specific and heterogeneous. Yet, a way through is to examine the influence of such effects in those countries that have undertaken decentralization processes. In such a setting, it is possible to examine potential expenditure spillovers across the geography of a country as well as the influence of the political ideology of regional incumbents and institutional factors on public health expenditure. This paper examines the determinants of public health expenditure within Spanish region-states (Autonomous Communities, ACs), most of them subject to similar financing structures although exhibiting significant heterogeneity as a result of the increasing decentralization, region-specific political factors along with different use of health care inputs, economic dimension and spatial interactions.

Health Expenditures↗
PubMed1993

Health care expenditure and income in Europe.

In this work we have tried to analyse the variations in health care expenditure in all the countries of the European Community except Greece and Portugal. We have wanted to provide additional evidence on the empirical relationship between expenditure on health care and income. Our analysis, starting from the approach of Fuchs and Baumol, has been an extension of the traditional studies on health care international comparisons, in at least three directions: we have not imposed any restrictions on the price effects, we have analysed dynamic models instead of the cross-sectional analysis and we have used proper deflators. We have deflated health care expenditure in each country by means of its sectoral price index and by the purchasing parity power of its currency, to allow international comparisons. In the former case we express health care in terms of 'expenditure', in the latter we express health care in terms of 'weighted quantity'. Income elasticities, in the short and in the long-run, have been estimated using econometric methods that allow us to obtain simultaneously equilibrium long-run relationships, if any, and adjustment processes in the short-run. We have found cointegrating relationships and we have estimated consistent estimators of the elasticities. The estimated income elasticities are greater than one in all the models analysed.

Bias↗
PubMedDate not supplied

Shared 'features' in prices: income and price elasticities for health care expenditures.

The evidence found in most studies suggests a strong positive relationship between health care expenditure and gross domestic product. However, this evidence weakens with respect to the actual value of the income elasticity. There are two possible sources of these discrepancies, the use of arbitrary deflators and specification errors. We find that health PPP cannot be taken as a 'universal' price index. The problem is that its components do not move together. Nevertheless, we derive a 'universal' health price index from a dynamic system in which its components share both short and long run co-movements. The omission of relevant explanatory variables seems to be the main cause of the discrepancies. We confirm that there exists a strong positive relationship between per capita health care expenditure and per capita GDP. However we estimate a long run income elasticity at or around unity, although it is greater than unity for the countries with lower per capita income (Spain and Ireland). The results for income elasticity are the same regardless of whether health care expenditure is converted using the GDP PPP or the 'universal' health price index. The importance of non-income variables is also confirmed, in particular the relative price of health care. We find that relative price has a strong rationing effect on the quantity of health demanded and has no effect on the expenditures.

Data Interpretation, Statistical↗
PubMedDate not supplied

Determinants of expenditure variation in health care and care of the elderly among Finnish municipalities.

In Finland, municipal health care expenditure varies from FIM 3 800 per capita to FIM 7 800 per capita. The objective of this study was to estimate the impact of different economic, structural and demographic factors on the per capita costs of health services and care of the elderly. Using regression analysis we attempted to explain observed differences in expenditure by determining separately the effects of allocative and productive inefficiency and the effects of factors influencing the demand for services. We found income level of local population, generosity of central government matching grant, allocative efficiency (the mix of care between institutional and non-institutional care), productive efficiency of service providers, and factors associated with the need of services (age structure, morbidity) to be the most important determinants of health care expenditure. Our results reveal that municipalities have the means at their disposal (by shifting resources to outpatient care and increasing productivity) to significantly reduce expenditure on health services and care of the elderly.

Aged↗
PubMed2003

The determinants of health care expenditure: testing pooling restrictions in small samples.

Health care expenditure has increased substantially in all Western industrialized countries in the last decades. The necessity to contain the increase in health care expenditure has motivated the analysis of its determinants to explain differences across countries and health systems. However, recent studies have questioned the use of cross section data arguing that health systems are too different to allow for such comparisons. In this paper we investigate whether this criticism is really justified. We analyze the variations of health care expenditure in OECD countries relative to income, population aging and technological change. Our analysis is based on pooled cross section data and time series. Firstly, formulating error correction models for individual countries we demonstrate that in almost all cases the investigated variables are cointegrated. Secondly, we use a bootstrap framework for inference and examine whether the influence of explanatory variables is unique across countries. Applying recursive estimation procedures we find evidence for cross country homogeneity during the period 1961-1979. In the last two decades health care dynamics become more and more country specific thus indicating divergence of health systems and the growing importance of country-specific effects in the explanation of differences in health care expenditure.

Analysis of Variance↗
PubMedDate not supplied

Regulation of pharmaceutical markets in Germany: improving efficiency and controlling expenditures?

Rising pharmaceutical expenditure has become a major concern for policy makers in Germany over recent years. Therefore, the pharmaceutical market has been increasingly targeted by different kinds of regulation, focussing on both the supply and the demand side, using price, volume and spending controls. Specific regulations include price reductions, reference pricing, pharmacy rebates for sickness funds, increasing co-payments, an 'autidem' substitution, parallel imports, a negative list, directives, and finally, spending caps for pharmaceutical expenditure per physicians' association. Although it is difficult to attribute certain effects to single measures, some measures like reference pricing and physician spending caps are more effective and long-lasting than others. In spite of being opposed by physicians, the spending caps applied between 1993 and 2001 have limited pharmaceutical expenditure for an entire decade. However, while some measures do effectively control expenditures, their effect on allocative efficiency may be detrimental.

Cost Control↗
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↗
PubMed2001

National estimates of mental health utilization and expenditures for children in 1998.

No recent national data on expenditures and utilization are available to provide a benchmark for reform of mental health systems for children and adolescents. The most recent estimates, from 1986, predate the dramatic growth of managed care. This study provides updated national estimates. Treatment expenditures are estimated to be $11.68 billion ($172 per child). Adolescents have the highest expenditures at $293 per child followed by $163 per child aged 6 to 11 and $35 per preschool-aged child. Outpatient services account for 57%, inpatient for 33%, and psychotropic medications for 9% of the total. Unlike earlier reports, outpatient care now accounts for the majority of expenditures. This finding replicates the differences between recent managed care data and earlier actuarial databases for privately insured adults and confirms the trend from inpatient toward outpatient care.

Adolescent↗
PubMed2006

Threatened and endangered species: at what cost? The corps of engineers looks at expenditures and priorities.

Current political conditions, primarily budgetary uncertainty, and the related reluctance to make funding commitments for future generations, have raised questions about the costs of conservation and environmental protection that have not previously been asked. As Federal investments are scrutinized and budgets become ever more constrained, the costs associated with environmental requirements could begin to be of greater importance and to influence decisions on Federal projects. In response to concerns about the U.S. Army Corps of Engineers (Corps) spending under the Endangered Species Act (P.L. 93-205) (ESA), a limited investigation was performed to determine the accuracy of reported Corps expenditures. The investigation showed that, for particular groups of species, actual conservation costs for threatened and endangered species may be twice the amounts previously reported in the annual ESA expenditure reporting to the U.S. Fish and Wildlife Service. In light of this finding, the Corps has sought a means to provide more accurate and consistent reporting of expenditures for addressing threatened and endangered species. A Species Costs Template (template) has been developed to identify the types and magnitude of costs related to the ESA and to counteract the impediments (legal, institutional, and practical) to underreporting costs. The template will be used by the Corps for reporting ESA costs beginning with Fiscal Year 2005 (FY05) (reported in January 2006). Five broad categories of expenditures (effects determination costs, ESA protection and conservation costs, equipment costs, opportunity costs, and other species costs) are identified by the template.

Biodiversity↗
PubMed2006

Determinants of household health expenditure on western institutional health care.

We try to identify determinants of illness reporting, provider choice and resulting expenditure with different econometric models using data from a representative household panel survey of 800 households in Nouna health district, Burkina Faso, during 2000-2001. The factors "being an adult", "married", "illness occurred in rainy season" and "severe illness" significantly increased the magnitude of health expenditure. Compared to malaria, individuals spent more on other infectious diseases, injury and the other disease category. In contrast, people were less likely to spend on chronic illness. An individual who belonged to a household headed by a female, a literate household head and with a higher household expenditure had a significantly positive association with the magnitude of expenditure. Findings from this study can be used for policy implication to improve health system performance in Burkina Faso through enhancing health care utilization.

Adult↗
PubMed2005

Analysis and implications of the determinants of healthcare expenditure in African countries.

The income elasticity of health care spending in the OECD countries tends toward luxury good values. Similar studies, based on more recent data, and capable of informing macroeconomic health policies of the African countries, do not currently exist. How the health care expenditure in Africa responds to changes in the Gross Domestic Products (GDP), Official Development Assistance (ODA), and other determinants, is also relevant for health policy because health care is a necessity in the 'basic needs' theory of economic development. This paper presents econometric model findings of the determinants of per-capita health expenditure (in PPPs) for 26 African countries, using the flexible Box-Cox model regression methods and 1995 cross-sectional data (sources: WRI, UNEP, UNDP, The World Bank). The economic and other determinants, capturing 74 percent of the variations in health expenditures, include per-capita GDP (in PPPs), ODA (US dollar), Gini income inequality index, population dependency ratio, internal conflicts, and the percentage of births attended by trained medical workers. Income inequality dampens, while the ODA and population per health personnel raise health care expenditure. The GDP elasticity of about 0.6 signals the tendency for health care to behave like a technical 'necessity'. Implications for sustainable basic health development policies are discussed.

Africa↗
PubMed1986

Health status and medical expenditures: is there a link?

Until now, cross-national studies have not demonstrated a positive relationship between health care expenditures and improved health status, as measured by such indicators as age-adjusted mortality rates. It has therefore been argued that cutting expenditures will not have a negative effect upon health status. Using health and life-style data from the OECD for Germany, the United Kingdom, The Netherlands, France, Sweden and the United States, this study finds that when one holds constant those changes in life style that have an impact upon health (e.g. smoking, drinking, traffic accidents, dangers on the job) and adjusts for inflation and population size, health care expenditures do bear a positive relationship to health status. This suggests that reductions in health care expenditures may well have some cost in terms of overall health.

Aged↗
PubMed1987

Health status and medical expenditures: more evidence of a link.

The hypothesis that one must include life-style changes in order to accurately capture the true relationship between medical expenditures and health status is explored, using data from 22 countries over a 20-year period. A simultaneous model is estimated using a variety of indicators for life style as well as health status. Changes in life style, aging of the population and changes in occupational risk are modeled as influences on medical expenditures: medical expenditures and changes in life style are modeled as having direct influences on health status. The results are consistent with the existence of a positive link between medical expenditures and health status.

Female↗
PubMed2005

The macro determinants of health expenditure in the United States and Canada: assessing the impact of income, age distribution and time.

This paper examines the determinants of real per capita health expenditures in order to assess the impact of age distribution, income and time using American state-level data for the period 1980-1998 and Canadian province-level data for the period 1975-2000. Ageing population distributions and income explain a relatively small portion of health expenditures when the impact of time effects, which is a partial proxy for technological change, is controlled for. However, the impact of age is of more concern given that cost increases are concentrated in the last few years of life and there may be cohort effects as the "Baby-Boom" generation ages. There is an urgent need to better understand the exact mechanisms driving health expenditure increases given that time accounts for approximately two-thirds of health expenditure increases and that its effect is non-linear.

Age Distribution↗