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PubMed1999

Medical care expenditures for selected circulatory diseases: opportunities for reducing national health expenditures.

OBJECTIVES: Circulatory system diseases are a significant burden in terms of morbidity, mortality, and use of health care services. This article presents total, per capita, and per condition US medical care expenditures in 1995 for circulatory diseases according to sex, age, and type of health service. METHODS: Total personal health care expenditures estimated by the Health Care Financing Administration for each type of health care service are separated into components to estimate patient expenditures by age, sex, primary medical diagnosis, and health care service for all diseases of the circulatory system, heart disease, coronary heart disease, congestive heart failure, hypertensive disease, and cerebrovascular disease. RESULTS: Expenditures for circulatory diseases totaled $127.8 billion in 1995 (17% of all personal health care expenditures), $486 per capita, and $1,636 per condition. Approximately one half of expenditures was for hospital care and 20% was for nursing home care. Heart disease accounted for 60% of circulatory expenditures. Expenditures increased with age and reached 35% of expenditures among persons aged 85 years and older, which was almost $7,000 per capita. These relationships vary somewhat according to the specific circulatory disease, type of health care, and age. CONCLUSIONS: Expenditures increase with age and circulatory diseases can be expected to command an increasing share of national health expenditures as the number and proportion of the population that is elderly grows. The alteration of lifestyles and medical interventions provide many opportunities to prevent circulatory diseases and to reduce national health expenditures.

Age Distribution↗
PubMed2003

Persistence in health expenditures in the short run: prevalence and consequences.

BACKGROUND: Knowing whether persons in the top percentiles of the health expenditure distribution exhibit persistently high expenditure is fundamental to developing health plan payment policies, containing costs, and understanding the consequences of costly illnesses. OBJECTIVES: To determine the extent of high expenditure persistence over a 2-year period. To identify the correlates and consequences of expenditure persistence. SUBJECTS: A national sample of the population from a longitudinal panel of the Medical Expenditure Panel Survey (MEPS). METHODS: Changes in a person's position in the expenditure distribution were examined. chi2 tests were used to identify differences in characteristics between high and low spenders. Logistic regression was used to predict the likelihood of expenditure persistence. Changes in income, employment, out-of-pocket expenditure burden, and health insurance were compared for high and low spenders. RESULTS: Of the top 5% of spenders in 1996, 30% retain this position in 1997 and 45% are in the top decile of 1997 spenders. High expenditures begin to regress to the mean over the study period. Cancer, mental disorders, diabetes, and infectious diseases and being in the top decile of 1996 spenders increase the probability of expenditure persistence (P < 0.05 for all). This probability also has a strong random component. An increased proportion of persons in the top expenditure decile for both years had out-of-pocket health spending greater than 20% of income in 1997 (P < 0.10). Persons with persistently high expenditures were less likely than low spenders to lose employment-based coverage (5.4% vs. 8.8%, P < 0.05) but no changes in income or employment status were detected. CONCLUSIONS: A sizable minority of persons exhibits persistently high expenditures, creating incentives for favorable risk selection. Few consequences of short-run expenditures persistence are observed.

Adult↗
PubMed1997

Mental health expenditures for services for people with severe mental illnesses.

OBJECTIVE: To provide comprehensive information on expenditures for mental health and substance abuse services for a large number of people with severe mental illnesses, this study examined use of major types of clinical-medical mental health and psychiatric rehabilitation services over a one-year period. METHODS: Data were obtained for 1,890 clients in ten public county-based nonmetropolitan mental health systems in Wisconsin. Expenditures were for services provided with public funding, including local sources of funding, Medicaid, and Medicare. Data about services and expenditures were obtained from county records and unduplicated Medicaid claims for 12 months in 1989 and 1990. RESULTS: Expenditures per client averaged $10,995 for one year ($13,992 in 1994 dollars), with a maximum of $95,093. Expenditures for community-based outpatient services, including residential care and vocational services, represented 53.5 percent of all expenditures; residential care accounted for 12.4 percent and vocational services for 5.7 percent. Overall, 46.5 percent was spent for institutional care, with inpatient hospital care accounting for 12.6 percent. Approximately 40.6 percent of total expenditures were for services not typically covered under managed care plans. CONCLUSIONS: Expenditures for community-based care accounted for more than half of total expenditures. Expenditure patterns revealed the important role of social and rehabilitation services, a role that must be continued in managed care arrangements if they are to provide adequate services for people with severe mental illnesses.

Adult↗
PubMed1979

Health expenditure under multiple-priority pressures. A case study of Israel.

Since Israel's inception, it has faced many problems that have a high priority in the national consciousness. Problems of defense and national security are outstanding among these, and problems such as absorption of immigrants, education, land reclamation and water supply are next. This creates heavy pressure on scarce resources, and is reflected in the share of specific items in Government and national expenditures. An analysis of developments since the early 1950s shows how health expenditure has been given a high priority in the evaluation of the nation's needs on one hand, and has been influenced by defense needs and other pressing requests on the other hand. It may be concluded that health receives a fair share of the nation's resources, but, in view of the strained economic situation in the country, careful planning for future health services in coordination, cooperation and integration with other welfare services is essential.

Budgets↗
PubMed1992

National health expenditures projections through 2030.

If current laws and practices continue, health expenditures in the United States will reach $1.7 trillion by the year 2000, an amount equal to 18.1 percent of the Nation's gross domestic product (GDP). By the year 2030, as America's baby boomers enter their seventies and eighties, health spending will top $16 trillion, or 32 percent of GDP. The projections presented here incorporate the assumptions and conclusions of the Medicare trustees in their 1992 report to Congress on the status of Medicare, and the 1992 President's budget estimates of Medicaid outlays.

Actuarial Analysis↗
PubMed1988

[Evaluation of health expenditures in the first 6 months after the diagnosis of cancer using a population register].

It is currently estimated in France, that the cost of cancer is rising to 25 billion francs, which represents approximately 6% of all health expenditure with an annual growth of 5-10%. The data from the Register of Tumors in the Doubs region have enabled us to make an evaluation of health expenditure, reimbursed by the social security system, and its distribution in relationship with the different posts (assessment, type of treatment, supervision, transport) according to the cancer site. The average cost per patient within the first 6 months of the illness has been evaluated at 26,000 F (1984). The results show major differences for the cancer sites, care facilities and posts which are budgeted for.

Cancer Care Facilities↗
PubMed2004

Private finance and sustainable growth of national health expenditures.

This analysis explores the role of the private sector relative to all health spending among Organization for Economic Cooperation and Development (OECD) countries. Bi-variate regression was employed for 31 countries using current data. It was found that the share of GDP allocated to health varies among countries, ranging from 5 percent in Turkey to 14 percent in the United States. Variation in per capita income explains much of this difference but other factors are important too. One appears to be the role of the private sector in financing health expenditures. Our analysis concludes that concern about rising health sector costs should be placed in a larger context: rising health care costs may be justified if benefits are large enough and cover the opportunity costs of alternative uses of resources.

Data Collection↗
PubMed1994

National health expenditures, 1993.

This article presents data on health care spending for the United States, covering expenditures for various types of medical services and products and their sources of funding from 1960 to 1993. Although these statistics show a slowing in the growth of health care expenditures over the past few years, spending continues to increase faster than the overall economy. The share of the Nation's health care bill funded by the Federal Government through the Medicaid and Medicare programs steadily increased from 1991 to 1993. This significant change in the share of health expenditures funded by the public sector has caused Federal health expenditures as a share of all Federal spending to increase dramatically.

Cost Allocation↗
PubMedDate not supplied

The relationship between health expenditures and the age structure of the population in OECD countries.

The purpose of this study was to analyse national health expenditures of OECD countries relative to their age structures. Using econometric techniques designed to analyse cross-sectional time series data, the ageing of the population was found to affect health spending in several countries while having no effect in others. In addition, the effect of income on health spending was lower than that generally reported in the literature. These findings suggest that unobserved country-specific factors play a major role in determining the amount of resources allocated to health services in a country. Such factors also determine if the ageing of the population with increased health spending.

Age Factors↗
PubMed2004

A flexible approach for estimating the effects of covariates on health expenditures.

Our estimation strategy uses sequences of conditional probability functions, similar to those used in discrete time hazard rate analyses, to construct a discrete approximation to the density function of an outcome of interest conditional on exogenous explanatory variables. Once the conditional density function has been constructed, we can examine expectations of arbitrary functions of the outcome of interest and evaluate how these expectations vary with observed exogenous covariates. We demonstrate the features and precision of the conditional density estimation method (and compare it to other commonly used methods) through Monte Carlo experiments and an application to health expenditures using the RAND Health Insurance Experiment data. Overall, we find that the approximate conditional density estimator provides accurate and precise estimates of derivatives of expected outcomes for a wide range of types of explanatory variables.

Adult↗
PubMed1991

Health expenditure growth in Japan and the United States.

This paper compares the effects of governmental policy changes on health care expenditures in Japan with similar effects in the United States. Our results indicate that Japanese economic expansion and inflation before 1982 generated higher health expenditure growth rates than those in the United States. But after a policy change in 1982, Japanese health expenditure growth dropped from 15 to 5.5 percent annually while expenditure growth in the United States remained high despite Medicare's Prospective Payment System (PPS).

Data Collection↗
PubMed1983

National health expenditures, 1982.

Rapid growth in the share of the nation's gross national product devoted to health expenditure has heightened concern over the survival of government entitlement programs and has led to debate of the desirability of current methods of financing health care. In this article, the authors present the data at the heart of the issue, quantifying spending for various types of health care in 1982 and discussing the sources of funds for that spending.

Health Expenditures↗
PubMed1993

Econometric analyses of national health expenditures: can positive economics help to answer normative questions?

The size of national health care expenditure is an important research and policy issue. This paper reviews theoretical and empirical analyses of an implied optimal size for a health sector. Various economic theories are explicitly or implicitly invoked, but none is fully satisfactory. Theory provides, at best, a loose justification for empirical specifications of health sector behaviour. Nevertheless, this has a large and growing empirical research industry. The complexity of the issues provides an excuse for reliance on empirical analyses using ad hoc models. The paper analyses aggregate time-series data, using the cointegration approach, on health, health care expenditures and national income. Only one national model met both statistical criteria and showed a significant relationship: between potential life years lost and health care expenditure in the UK. The case for any general relationships remains unproven. There is no objective scientific method to determine optimal health expenditure, nor should we expect one. However, positive analyses can help with normative questions. A better understanding of health expenditure determination would arise from better specification of the relationships, perhaps by analysis at a lower level of aggregation.

Bias↗
PubMed2000

Forecasting health expenditures: short, medium, and long (long) term.

As the forecasting perspective changes from short to medium to long run, the appropriate measure of health spending and the choice of which variables to hold constant and which to include changes. In the short run, current dollar spending is the best unit and the primary factors affecting spending are contracts (insurance, labor) and inflation. In the medium run, real per capita health expenditures are a better measure and prior growth of income is the primary factor. In the long run, the percentage of gross domestic product is the best measure and the structure of the health system and operation of budget constraints become the most important determinants. Accuracy of +/- 1-2 percent per year is obtainable. A major issue is whether the recent moderation in the rate of growth of spending is a pause or a turning point.

Delivery of Health Care↗
PubMed1995

Out-of-pocket health expenditures by elderly households: change over the 1980s.

This study compares out-of-pocket health expenditures of elderly and nonelderly households over the past decade, using descriptive statistics and two-stage least squares analysis of Consumer Expenditure Survey data for 1980-1981 and 1989-90. This empirical analysis provides a basis for discussion of both efficiency and equity issues in health policy. We find that increases in out-of-pocket medical care expenditures over the last decade were mainly for insurance premiums rather than medical goods and services, which indicates potential inefficiencies in health care markets. We also find that Medicare promoted equity of out-of-pocket expenditures on health care among elderly persons over the 1980s, which implies that universal national health insurance would enhance distribution equity.

Aged↗
PubMed1986

National health expenditures, 1985.

Slower price inflation in 1985 translated into slower growth of national health expenditures, but underlying growth in the use of goods and services continued along historic trends. Coupled with somewhat sluggish growth of the gross national product, this adherence to trends pushed the share of our Nation's output accounted for by health spending to 10.7 percent. Some aspects of health spending changed: falling use of hospital services was offset by rising hospital profits and increased use of other health care services. Other aspects remained the same: both the public sector and the private sector continued efforts to contain costs, efforts that have affected and will continue to affect not only the providers of care but the users of care as well.

Data Collection↗