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PubMed1994

The role of the sickness funds in the Belgian health care market.

This article reviews some of the salient features of the Belgian health care finance and delivery system. Special attention is paid to the role played by the third-party payers, i.e. the Health Insurance Associations (HIAs) in administering the compulsory national health insurance program. It is shown how, despite extensive government regulation, the markets for GP, specialist and hospital services exhibit fierce competition of the non-price variety. Next, the paper considers the three problems perceived to be the most pressing ones at present: (i) the problem of raising sufficient revenues to cover the public share of health expenditures; (ii) the (related) cost containment problem; and (iii) the problem of ensuring efficiency through appropriate incentive mechanisms. Finally, two recently proposed options for reform are discussed and complemented with a third proposal based on the ideas of regulated competition. It is concluded that strengthening the role of the third-party payers remains crucial in any attempt to reshape the system to make it efficient and affordable while keeping it equitable.

Belgium↗
PubMed1998

Future financial impact of the current health financing system.

Major political parties remain publicly committed to Medicare and community-rated voluntary health insurance. It is important to understand the future financial consequences of this policy in order to assist community debate about whether such a commitment is appropriate or some other policy should be developed. This paper describes development of, and results from, the APHA health financing model. It suggests that health expenditure would represent 12.9% of gross domestic product by 2021, compared to 8.5% in 1995. Increasing per capita expenditure is the major contributor to the growth, with demographic changes responsible for only 14.3%.

Australia↗
PubMed2002

An evaluation of universal health insurance in the elderly: burden of disease, utilization, and costs in the Republic of Korea.

OBJECTIVE: This article evaluates Korea's national health insurance system for the elderly by simultaneously examining disease patterns, demand for care, utilization, costs of care, and facility type. METHODS: Claim records (N = 8,306,976) for 1995 to 1997 were obtained from the Youndeoung-Po district for four insurance categories. Utilization is examined using a probit model; a linear regression model is used to compare costs. FINDINGS: Insurees averaged 10.6 medical visits per year, most commonly for acute respiratory diseases. The elderly were more likely to seek care for circulatory problems, use more inpatient services, and rely on hospitals for outpatient care. Insurance costs for the elderly poor were markedly higher, and overall care for the elderly was higher per visit. DISCUSSION: By simultaneously analyzing utilization rates, disease patterns, and relative costs of care, policymakers may be able to avert a financing crisis. Stronger pricing strategies and better disease targeting would adjust utilization and increase efficiency of health expenditures.

Age Distribution↗
PubMed1977

Age differences in health care spending, fiscal year 1976.

Of the $120.4 billion spent by the Nation for personal health care in fiscal year 1976, 29% was spent for those aged 65 or older, 15% for those under age 19, and the remaining 56% for those aged 19-64. The average health bill reached $1,521 for the aged, $547 for the intermediate age group, and $249 for the young. Public funds financed 68% of the health expenses of the aged with Medicare and Medicaid together accounting for 59%. Private sources paid 74% of the health expenses of the young and 70% of the expenses of those aged 19-64. Third-party payments met 65% of the health expenditures of all those under age 65.

Adolescent↗
PubMed1997

The hospital financing system in Germany.

In common with other western coutries, German health expenditure had been increasing at a rapid rate in recent years, especially in the hospital sector. This paper describes the reaction of the German legislator and summarises what has happened over the last few years following the introduction of the extensive Legal Reform Act. The paper puts the main emphasis on a new differentiated benefit system for hospitals, which is a requirement from 1996 onwards, after a transitional period. It shows the single components and the modalities of the new system and the possibilities of combining the new types of payment.

Cost Control↗
PubMedDate not supplied

State estimates of total medical expenditures attributable to cigarette smoking, 1993.

OBJECTIVE: To estimate state-by-state totals of medical expenditures attributable to cigarette smoking for calendar year 1993. METHODS: The smoking-attributable fractions (SAFs) of total state medical expenditures, by type of expenditure, were estimated using a national model that describes the relationship between smoking and medical expenditures, controlling for a variety of sociodemographic, economic, and behavioral factors. Employing data from the Behavioral Risk Factor Surveillance System, the authors used the national model to estimate SAFs for the 50 states and the District of Columbia, then applied these SAFs to published state medical expenditures, by type of expenditures, to estimate total 1993 state medical expenditures attributable to smoking. National estimates are the sums of state estimates. RESULTS: In 1993, the estimated proportion of total medical expenditures attributable to smoking for the U.S. as a whole was 11.8%, with a range across states from 6.6% to 14.1%. By type of expenditure, SAFs ranged from a low of 8.0% for home health expenditures to a high of 15.9% for nursing home expenditures for the nation as a whole. Total U.S. medical expenditures attributable to smoking amounted to an estimated $72.7 billion in 1993 (95% interval estimate $48.0-$97.4 billion). Estimates of total smoking-attributable state medical expenditures (SAEs) ranged from $79.6 million to $8.72 billion. CONCLUSIONS: Cigarette smoking accounted for a substantial portion of state and national medical expenditures in 1993, with considerable variation among states. The range across states was due to differences in smoking prevalence, health status, other socioeconomic variables used in the model, and the magnitude and patterns of state medical expenditures.

Adult↗
PubMed2003

Projecting future drug expenditures--2003.

Drug expenditure projections for 2003 and factors likely to influence drug costs are discussed. The United States continues to face the challenge of increased growth in health expenditures, and drug expenditures are continuing to increase faster than the growth in total health care expenditures. These increases can be largely attributed to an increase in the average age of the U.S. population and technological advancement. On the basis of price inflation and non-price inflationary factors, including increases in volume, shifts in patient and therapeutic intensity, and expected approval of new drugs, a 10-12% increase in drug expenditures in 2003 for the inpatient setting and a 13.5-15.5% increase for ambulatory care settings are forecasted. While few new drugs are expected to greatly influence expenditures in 2003, the continued diffusion of recently approved drugs such as drotrecogin alfa and nesiritide will have a dramatic impact on total drug expenditures and must be carefully considered in the budgeting process. An agent likely to have a significant impact on HIV treatment is enfuvirtide, the first in a new class of antiretrovirals (fusion inhibitors), but its high cost ($10,000-$15,000 per year) may limit patients' access to this medication. An expanded user's guide is provided to assist the reader in appropriate application of this information in the drug budgeting process. Technological, demographic, and market-based changes and changes in public policy will continue to influence pharmaceutical expenditures in the coming year. An understanding of the overall drivers of medication expenditures and vigilance in monitoring pharmaceutical innovation are critical in the effective management of these resources.

Drug Approval↗
PubMed2000

World Health Report 2000: the position of Slovak Republic.

The World Health Organization (WHO) published the analysis of the health systems in 191 member states of WHO with important data (mostly for the year 1999) on probability of dying under age 5 years and between ages 15 and 59 years, life expectancy at birth, disability-adjusted life expectancy--DALE which is defined as the expectation of life lived in equivalent full health, responsiveness of health system, fairness of financial contribution and overall health system attainment. The last parameter was based on five weighted components: overall level of population health, health inequalities within the population, level of health system responsiveness, distribution of responsiveness between population and the distribution of health system financial burden within the population. Between 149 countries with more than 1 million inhabitants the rank for Slovakia (30th) is not bad and is close to Croatia and Poland. The estimates of overall health system performance (i.e. how efficiently health systems translate financial expenditure into health) belong to the problematic part of the report:. In this parameter the health system of USA ranks much lower than Turkey or Tunisia and Slovakia ranks lower than Albania. The authors did not take into consideration, that the health of population depends not only on health care and health expenditure but on many other factors, such as life style, nutrition, pollution, etc., which are not influenced by expenditure into health system. (Tab. 2, Fig. 6, Ref. 15.)

Adolescent↗
PubMedDate not supplied

[Economic costs of childhood epilepsy in Spain].

INTRODUCTION: Health expenditure increases continuously in all developed countries. Common disorders, including epilepsy are responsible for most of the health budget. OBJECTIVE: To quantify the economic effect of childhood epilepsy in Spain by analyzing its major components. PATIENTS AND METHODS: We asked a number of neuropediatricians to complete to questionnaire including data from which to calculate, from a social aspect, the direct and indirect costs (medical and non-medical) of the last 12 months follow-up of children under 14 years old with controlled and uncontrolled epilepsy. RESULTS: During 1998, the average annual cost of children with controlled epilepsy was 308,352 pesetas and of children with uncontrolled epilepsy 823,635 pesetas, or 2.7 times more. The cost of the prevalence of epilepsy in Spain during 1998 was nearly 11,300 million pesetas with direct costs making up most of the total cost. CONCLUSIONS: The size of the economic aspect increases the impact of the disease on the child and his family. The different cost distribution in children and in adults with epilepsy makes early treatment necessary so as to permit lower indirect costs of the disease when the patient becomes adult. Pharmaco-economic assessment is also necessary to justify the use of newer anti-epileptic drugs which are considerably more expensive than the classical anti-epileptic drugs.

Adolescent↗
PubMed1987

Hospital and community health service costs: England and Scotland compared.

In publications which have compared the health expenditure in the component parts of the United Kingdom by applying the Resource Allocation Working Party (RAWP) formula to the health budget of England, Scotland, Wales, and Northern Ireland it has been previously concluded that Scotland's hospital and community health services expenditure is more than 19% above what would be a fair distribution. It has also been implied that Scotland's allocation should be cut substantially to improve services in England. On the assumption that the purpose of examining the distribution of the health and community health service budget is to ensure "equal opportunity of access to health care for people at equal risk" it is concluded that simple RAWPing of the United Kingdom budget is flawed and a conclusion based on this is therefore untenable.

Community Health Services↗
PubMed1999

Out-of-pocket payments for health care in Croatia: implications for equity.

AIM: To assess the distribution of out-of-pocket payments for health care in Croatia by income groups. METHODS: The study is based on data from 1994 out-of-pocket health expenditure survey carried out through interviews of randomly selected adults in two major cities of Croatia, Zagreb and Split. We analyzed co-payments for public health care services and other payments related to private practice, non-prescription medicaments, or informal payments to health care providers. Spending of each income group was analyzed as a share of its income and as proportion of total payments. RESULTS: We found an inequitable pattern of out-of-pocket health care payments. Burden of out-of-pocket expenditure was not equally distributed among income groups, with persons from the low income group paying about six times larger share of their income than the high income group. When we compared the proportions of income received by different groups with the proportions of their payments, the results indicated (again) that the low income persons payed proportionally more than those with high income. CONCLUSION: Distribution of out-of-pocket payments in Croatia is regressive, with a greater burden falling on lower income persons. Possible introduction of the mix of health care financing would need reconsideration of the policy measures to balance equity and efficiency.

Cost Sharing↗
PubMedDate not supplied

Primary health care is viable.

'Selective primary health care' and other recent vertical health strategies have been justified on the grounds that the broad primary health care (PHC) approach cannot be afforded by developing countries in the present constrained economic circumstances. This judgement is too sweeping. A simulated case example is presented, starting with baseline health expenditure data that are representative of the situation in many developing countries. It is assumed that real economic growth occurs and that government funding of health care is allowed to grow in parallel. Two annual growth rates are considered: 2 and 5 per cent. Two restrictive conditions are applied: none of the main health services is subjected to absolute cuts; and, additional funds from existing or new sources of finance are not considered. It is shown that, even with slow growth rates, substantial increases in the funding of priority (rural and PHC) services can be achieved if the growth in expenditures of lower-priority services is curtailed. Also, savings from improved health service efficiency can be channelled to priority services. The message is that the PHC approach is viable even with slow economic growth. What is required is the technical capacity to identify and plan resource flows in the health sector, and the political will to effect resource allocations according to PHC priorities. A strategic policy like PHC should not be 'adjusted' out of effective existence because of reversible economic problems. Rather, actions should be taken to reverse the adverse economic environment. International health-related agencies should continue to support countries to develop national health systems based on PHC, and should campaign for reforms in the world economy to create at least the minimum economic conditions necessary for PHC implementation.

Data Collection↗
PubMed1997

Reform follows failure: I. Unregulated private care in Lebanon.

This first of two papers on the health sector in Lebanon describes how unregulated development of private care quickly led to a crisis situation. Following the civil war the health care sector in Lebanon is characterized by (i) ambulatory care provided by private practitioners working as individual entrepreneurs, and, to a small extent, by NGO health centres; and (ii) by a fast increase in hi-tech private hospitals. The latter is fuelled by unregulated purchase of hospital care by the Ministry of Health and public insurance schemes. Health expenditure and financing patterns are described. The position of the public sector in this context is analyzed. In Lebanon unregulated private care has resulted in major inefficiencies, distortion of the health care system, the creation of a culture that is oriented to secondary care and technology, and a non-sustainable cost explosion. Between 1991 and 1995 this led to a financing and organizational crisis that is the background for growing pressure for reform.

Ambulatory Care↗
PubMed1983

Health care financing: recent experience in Africa.

The economic realities of health sector development in Africa has been analyzed in this paper. Both the global and national macroeconomic context has been defined. Given the available data, it is clear that most African countries face increasingly serious economic realities, such as slow or even declining economic growth (per capita), a depressed food production situation, severe balance of payments crises, and increasing dependence on external financial assistance. Given the limited but increasingly available 1981 and 1982 data, the economic situation in many countries is more constrained than those indicated by the data contained in this paper. In this context, the potential competitive situation facing governmental health care systems was reviewed. In addition, the diversity in the sources of health expenditures between countries in Africa was highlighted. These data provide clear evidence that governments clearly do not finance the entire health care system and that individual payment for service in many countries represent an important source of revenue for many care providers in various health care systems operating in any given country. The potential for governments to finance either an expansion of or improvements to the government component of their health care systems is then reviewed. The highlights of this analysis include the following points. First, the tax structure in many African countries is highly dependent on export and import duties, which in turn creates dependency on sustained foreign demand for exports.(ABSTRACT TRUNCATED AT 250 WORDS)

Africa↗
PubMed1991

International healthcare expenditures: spending totals and public satisfaction among the OECD nations.

As an introduction to this Hospital Topics theme issue on international healthcare systems, our guest editor and one of our authors present aggregate health expenditures and public-satisfaction data from member nations of the Organization for Economic Cooperation and Development. Although healthcare funding is not the explicit focus of this issue, it underlies most of the points raised, and however the health systems examined here may vary in structure or impact, financing remains a shared challenge and one of our best base lines for comparison.

Attitude to Health↗
PubMedDate not supplied

Merging managed care with the German model.

Since public officials in the United States may lack the courage and political will to significantly raise payroll taxes or the contain Social Security, Medicare and Medicaid benefits, Americans can anticipate that; (a) future generations increasingly will pay for these entitlements; (b) additional cutbacks to providers in Medicare, Medicaid and health maintenance organization reimbursement will hasten the current thrust of hospitals, physicians and insurers in forming huge health networks with their powerful managed care plans; and, (c) many of these new alliances will function as virtual monopolies--eventually resulting in the public proposing that state health services commissions be established. This article then suggests that future modifications in how the United States health delivery system be organized and financed preferably should be along the lines of the German multi-player, multi-tier, self-governing, decentralized, quasi-private, quasi-public model; and, also patterned after experiences of the State of Arizona's Medicaid program. It concludes that what America needs most is a hybrid of the European global budgetary targets to constrain total health expenditures, and the competitive managed care concept to curtail use patterns and to enhance quality.

Delivery of Health Care, Integrated↗
PubMed2002

Prevalence, expenditures, utilization, and payment for persons with MS in insured populations.

OBJECTIVE: To determine the prevalence, expenditures, and utilization of enrollees with MS relative to all enrollees in privately insured, Medicare, and Medicaid populations. METHODS: The authors used insurer administrative billing data to identify persons with MS, their insured medical expenditures and utilization, and benchmark general insured population expenditures and utilization. Three samples of insurer billing data were analyzed: nationally representative samples for the privately insured (1994 through 1995) and Medicare (1996 though 1997) populations, and Medicaid data for disabled (1991 through 1996) populations from six states. RESULTS: Using 2 years of diagnoses on claims, the prevalence of MS in the privately insured population was 24 per 10,000, 36 per 10,000 in the Medicare population, and 71 per 10,000 in the Medicaid disabled population. Annual insured expenditures were $7,677 per privately insured enrollee with MS vs $2,394 for all privately insured enrollees, $13,048 per Medicare beneficiary with MS compared with $6,006 for all Medicare beneficiaries, and $7,352 per Medicaid disabled recipient with MS vs $4,088 per disabled recipient without MS. Home health expenditures were very high for Medicare beneficiaries with MS and nursing facility expenditures were very high for Medicaid disabled recipients with MS. A small proportion of enrollees with MS accounted for most expenditures. CONCLUSIONS: Insured enrollees with MS are two to three times more expensive than average insured enrollees. If the premiums that employers or governments pay health insurers and the capitation amounts that insurers pay health care providers do not account for these higher costs, a disincentive is created for the enrollment and care of persons with MS.

Adolescent↗