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PubMed1990

Health expenditures in major industrialized countries, 1960-87.

In this article, levels and changes in health care expenditures for Canada, France, the Federal Republic of Germany, Italy, Japan, the United Kingdom, and the United States are analyzed. First, the levels and changes in the share of gross domestic product (GDP) devoted to health are reviewed in terms of the health-to-GDP ratio, nominal health expenditure and GDP growth, and changes in population and prices. Second, absolute levels of health spending denominated in U.S. dollars are compared over time. Finally, some concluding observations are made.

Canada↗
PubMed2005

Exploring the spatial pattern of mental health expenditure.

BACKGROUND: Recent years have witnessed growing interest in cross-sectional variations in municipality mental health expenditure. However, empirical work to date has not examined the links between such variability and demand and supply factors, particularly in the spatial domain. AIMS OF THE STUDY: The aim is to examine whether a local authority's spending decisions in the mental health field respond to neighbouring expenditure decisions. We explore a number of reasons why there might be interdependence between local authorities' decisions, labelling them the demonstrative, market leader, contextual, directive, shared resource and inducement effects. METHODS: Exploratory techniques from spatial data analysis are used to test for the existence of spatial structure. Drawing hypotheses from these initial exploratory analyses, we then adopt a reduced form demand and supply model, extended to incorporate possible policy interaction. The analysis of expenditure and cost variations has traditionally been based on regression models under the classical assumption that the observations are independent. But omitting the recognition that observations are interdependent might lead to erroneous statistical conclusions. Hence, we use spatial econometric techniques that explicitly take into account the potential interdependence of data in order to study the sources of spending variation between municipalities. RESULTS: The exploratory data analyses reveal the presence of positive significant spatial correlation. Per capita mental health spending distributes in clusters, with the highest concentrations in metropolitan areas such as Greater London, Greater Manchester and Birmingham. The estimated spatial regression models indicate that spatial autocorrelation characterises local expenditure decisions, consistent with some degree of policy interdependence between neighbouring municipalities. Comparing the results from our spatial model with those from a classical ('non-spatial') model suggests that the differences in the regression coefficients could be explained by the evident spatial pattern of the phenomenon, since the omission of the lagged dependent variable induces bias in the OLS estimates. IMPLICATIONS FOR HEALTH POLICIES: These results help central and local decision makers understand the factors that influence local spending levels, including variations between municipalities in their achievement of expenditure-related and perhaps other performance targets. The actual patterns of spatial interaction may well be more complex than simple contiguity (the structure assumed here), but there seems little doubt that positive interdependence is an important feature of decision making. IMPLICATIONS FOR FURTHER RESEARCH: Statistical interrogation of a panel dataset would allow exploration of both time-series and cross-municipality variation in mental health expenditure. Subsequent analysis would also benefit from more disaggregated data (e.g. at a census ward level) and the accompanying use of spatial multilevel techniques.

Adolescent↗
PubMed1981

National health expenditures, 1980.

The United States spent an estimated $247 billion for health care in 1980 (Figure 1), an amount equal to 9.4 percent of the Gross National Product (GNP). Highlights of the figures that underlie this estimate include the following: Health care expenditures in 1980 accelerated at a time when the economy as a whole exhibited sluggish growth. The 9.4 percent share of the GNP was a dramatic increase from the 8.9 percent share in 1979. Health care expenditures amounted to $1,067 per person in 1980 (Table 1). Of that amount, $450, or 42.2 percent, came from public funds. Expenditures for health care included $64.9 billion in premiums to private health insurance, $70.9 billion in Federal payments, and $33.3 billion in State and local government funds (Table 2). Hospital care accounted for 40.3 percent of total health care spending in 1980 (Table 3). These expenditures increased 16.2 percent between 1979 and 1980, to a level of $99.6 billion. Spending for the services of physicians increased 14.5 percent to $46.6 billion, 18.9 percent of all health care spending. All third parties combined--private health insurers, governments, philanthropists, and industry--financed 67.6 percent of the $217.9 billion spent for personal health care in 1980 (Table 4), ranging from 90.9 percent of hospital care services to 62.7 percent of physicians' services and 38.5 percent of the remainder (Table 5). Direct payments by consumers reached $70.6 billion in 1980 (Table 6). This accounted for 32.4 percent of all personal health care expenses. Outlays for health care benefits by the Medicare and Medicaid programs totaled $60.6 billion, including $35.8 billion for hospital care. The two programs combined to pay for 27.8 percent of all personal health care in the nation (Table 7).

Health Expenditures↗
PubMed2004

Determinants of health expenditure growth of the OECD countries: jackknife resampling plan estimates.

Due to the lack of internal consistency across unit root and cointegration test methods for short time-series data, past research findings conflict on whether the OECD health expenditure data are stationary. Stationarity reasonably guarantees that the estimated OLS relationship is nonspurious. This paper departs from past investigations that applied asymptotic statistical tests of unit root to insufficient time-series lengths. Instead, data were calibrated in annual growth rates, in 5-year (1968-72, ..., 1993-97) partitions, for maximum likelihood estimation using flexible Box-Cox transformations model and bias-reducing jackknife resampling plan for data expansion. The drivers of OECD health care spending growth are economic and institutional. Findings from the growth convergence theory affirm that health care expenditure growth accords with conditional beta convergence. Statistical significance and optimal functional form models are not unique across the growth period models. Our findings exemplify the benefits of jackknife resampling plan for short data series, and caution researchers against imposing faulty functional forms and applying asymptotic statistical methods to short time-series regressions. Policy implications are discussed.

Analysis of Variance↗
PubMed1977

Health expenditure.

Explore the source record for details and available documents.

Health Expenditures↗
PubMedDate not supplied

[The physician/population ratio in Switzerland: the impact of its regional variation on mortality, health expenditures and user's satisfaction].

An opinion survey conducted in 1997 in the various Swiss "cantons" produced the following findings: 1. The satisfaction of the population concerning the provision of ambulatory care does not increase when the physician/population ratio increases. It is not clear whether a decrease of "oversupply" gives raise, at least in the short term, to a feeling of dissatisfaction. 2. The perception of signs of shortened supply does not increase when the physician/population ratio decreases. 3. When the cantons are grouped by level of physician/population ratio, the different groups show nearly the same health performance as measured by the rate of avoidable mortality. 4. The number of consultations per capita increases clearly in the "cantons" having high physician/population ratios. Increased ratios have clearly an impact on health expenditures.

Computer Graphics↗
PubMed1989

Overview of international comparisons of health care expenditures.

Health care expenditure and utilization trends in the 24 Organization for Economic Cooperation and Development countries are provided and analyzed in terms of trends in price, population, and volume-intensity. The United States spends more on health than other countries, both in absolute dollar terms and relative to gross domestic product. Moreover, the gap appears to have grown in recent years. Although international comparisons are difficult for a number of reasons outlined in the article, they can be useful in focusing efforts to understand what the United States is getting for its one-half trillion dollar expenditure on health services.

Cross-Cultural Comparison↗
PubMed1992

The determinants and effects of health expenditure in developed countries.

Previous studies of international differences in health spending have been restricted to the use of relatively small samples of cross-sectional data. Our objective here is to re-examine the results of previous work using a sample of 560 pooled time-series and cross-section observations. Results confirm the importance of GDP as a determinant of health spending, with an estimated income elasticity at or around unity, but also suggest that OECD countries should not be regarded as a single, homogeneous group. The importance of some non-income variables is also confirmed, although the direct effect of these factors appears to be small.

Australia↗
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↗
PubMed1999

Canadian health expenditures: where do we really stand internationally?

There are different ways to measure how much Canada spends on health care and the quality of these measurements may vary. This paper examines Organization for Economic Cooperation and Development data for 3 common standards of measure: health expenditures as a proportion of gross domestic product (GDP), nominal spending per capita (US dollars) and spending per capita in purchasing power parities (PPP) equivalents. In 1994, the most recent year for which there were firm data. Canada spent 9.9% of its GDP on health care (rank 3 of 29), and $1999 PPPs per capita (rank 3). However, actual spending was only US$1824 per capita (rank 14). In the same year Japan spent 7% of GDP on health care (rank 22), $1478 in PPPs per capita (rank 16), but actually spent US$2614 per capita (rank 3). Although each measure is suitable for some policy purposes, Canadian spending remains modest by international standards.

Canada↗