Health care expenditures and ageing: an international comparison

This study examines national health expenditure trends for Japan, Canada, Australia, and England and Wales (combined) to assess the impact of changing demographics and changing age-specific per capita expenditure on national health expenditure. Age-specific expenditure data were obtained from each country's department of health. We calculated changes in age-specific per capita expenditure, population demographics and the share of expenditures used by the different age groups over time. We then determined the extent to which isolated changes in population growth, demographic shifts and changes in age-specific per capita expenditure could predict observed increases in health expenditure. For Japan, Canada and Australia per capita health expenditure increased fastest among those aged 65 and over, at up to twice the increase of those aged 45-64. In England and Wales, on the other hand, those aged 65 and over experienced one-third of the cost increase of those aged 45-64. Hence, the proportion of national health expenditures used by the population aged 65 and over decreased from 40% to 35% in England and Wales, while increasing in the other countries by up to 10 percentage points. Demographic shifts and population growth predicted only 18% of the observed increases in health care expenditures in England and Wales, compared to 68%, 44% and 34% for Japan, Canada and Australia respectively. These differential changes in costs for older age groups over time invite future research into the driving forces behind these costs.     

Health care use and expenditures of Medicare HMO disenrollees

We examine the impact of the first wave of Medicare health maintenance organization HMO withdrawals. With data from CMS and United Health Group, we estimate use and expenditure changes between 1998 and 1999 for HMO enrollees who were involuntarily dropped from their plan and returned to fee-for-service (FFS) Medicare using a difference-in-difference model. Compared to those who voluntarily left an HMO, involuntarily disenrolled beneficiaries had higher out-of-pocket expenditures, an 80 percent decrease in physician visits, 38 percent higher emergency room (ER) use and a higher probability of dying. The results suggest beneficiaries face significant costs and reduced health outcomes from unstable Medicare managed care markets.     

Health care expenditures in a rural Indian community

Financing health services is an increasing concern that looms as one of the major obstacles to achieving an equitable distribution of primary health care in developing communities. An important step in solving this problem is the assessment of current levels of health care expenditures in these communities in order to determine the extent to which local resources are being used for these purposes. Ways to maximize the effectiveness of these resources can then be sought. Village level studies carried out between 1968 and 1974 in Punjab, India, revealed that at least 80% of all health care expenditures in this rural area were for services of traditional practitioners or private 'modern' doctors. This paper explores various aspects of these expenditures including the source of services and the effect of individual characteristics such as caste on the amount spent on health care. Out-of-pocket expenditures are contrasted to expenditures in the government system. Assessment of the impact of 'free' village level primary care services in this setting revealed that the poor reduced their expenditures on health care more than the wealthy, but both groups took almost equal advantage of the 'free' services. The results raise the possibility of mobilizing some of the savings accruing to the community to help support the 'free' services as well as the potential of encouraging private traditional and modern practitioners to cooperate in achieving primary health care goals.     

Health care expenditures and gross domestic product: the Turkish case

Our study examines the long-term relationship among per capita gross domestic product (GDP), per capita health expenditures and population growth rate in Turkey during the period 1984–2006, employing the Johansen multivariate cointegration technique. Related previous studies on OECD countries have mostly excluded Turkey—itself an OECD country. The only study on Turkey examines the period 1984–1998. However, after 1998, major events and policy changes that had a substantial impact on income and health expenditures took place in Turkey, including a series of reforms to restructure the health and social security system. In contrast to earlier findings in the literature, we find that the income elasticity of total health expenditures is less than one, which indicates that health care is a necessity in Turkey during the period of analysis. According to our results, a 10% increase in per capita GDP is associated with an 8.7% increase in total per capita health expenditures, controlling for population growth. We find that the income elasticity of public health expenditures is less than one. But, in the case of private health care expenditures, the elasticity is greater than one, meaning that private health care is a luxury good in Turkey.     

人口老龄化进程中的医疗卫生支出:WHO成员国的经验分析

基于世界卫生组织(WHO)成员国的经验,本文探讨了人口老龄化进程中医疗卫生支出的基本特征和一般规律。研究表明:世界各国医疗卫生水平存在极大的不平衡。随着人口老龄化的加深,医疗卫生支出中政府支出比例趋于上升,而私人卫生支出比例趋于下降。医疗卫生支出占GDP的比例逐步提高,而政府卫生支出占政府总支出比例也趋于提高,人口老龄化进程中政府在医疗卫生支出中将承担更重要的责任。而且,在政府卫生支出中,医疗保障支出比例趋于提高,并将成为政府卫生支出越来越重要的部分。当一国进入老龄化社会后,医疗卫生支出速度将会递增,经济发展和政府财政将承受越来越重的医疗支出负担。"未富先老"的中国面临着医疗卫生支出急剧增长的严峻挑战,这应该成为医疗卫生体制改革关注的议题。     

Health care expenditures for the elderly and reforms in the health care system in Japan

In recent times, significant reforms have been instituted in Japan's health care system, such as the introduction of hospital categorization and the clarification of hospital roles, together with the establishment of geriatric health care facilities, and the reform of the pharmaceutical distribution and pricing system. These reforms are expected to improve the efficiency and quality of the health care system in Japan and to provide better care for the aging society. The changes will also eventually affect health care costs and patterns of services. This paper describes Japan's health care system, including the recent reforms, and then examines the costs and patterns of health care services for the elderly in the light of the recent changes in the system. While more resource allocation is necessary for training of workers for nursing, rehabilitation and care-giving, drugs should be more cost-effective and fit for use at home and in non-medically oriented institutions. Health care providers, health care industries and the government need further to properly respond to the changes in demography, patterns of diseases and disabilities and patients' wishes for better quality of life.     

Health care transitions and the aging population: a framework for measuring the value of rapid rehabilitation

A study was undertaken to establish a framework to measure the value of rapid rehabilitation and identify indicators to quantify effective outcomes and efficient processes as health care services are delivered to the aging population across providers, services, and settings. The rapid rehabilitation protocol serving as intervention in this research provides patients (≥65 years old) the option to transition from the acute-care hospital, early in the continuum of care, to an outpatient, skilled nursing facility operated by a division of the hospital organization. A quasi-experimental, cross-sectional, retrospective study is designed to identify and quantify the relationships present in processes and outcomes inherent in health care transitions. Statistical analysis yields unexpected relationships with limited explanatory power for the selected indicators: length of stay, cost of care, discharge delays, 30-day readmissions, falls, and patient satisfaction. However, this research finds 4 imperatives for hospital and clinical leadership: (1) increase collaboration across providers, settings, and stakeholders; (2) educate workforce to optimize risk assessment of aging population; (3) standardize critical to quality measures as scientific foundation for management of services; (4) invest in technologies to ensure the integrity, validity, and reliability of information used to draw inferences about services, risk, and performance.     

Health care expenditures and GDP: panel data unit root test results

This short paper presents unit root test results for time series on per capita national health care expenditures and gross domestic product in the OECD. Unlike the country-by-country test used by [Hansen, P., King, A., 1996. The determinants of health care expenditure: A cointegration approach. J. Health Econ, 15, 127-137], the test we employ exploits the panel nature of the OECD data. Using this approach, we are able to reject the null hypothesis that these series contain unit roots. No single test is likely to be definitive in this rapidly-evolving area of econometric research; however, our results help to mitigate concern that panel data analyses of national health care expenditures are misspecified.     

Health and the allocation of public expenditures

In a cross-country study we use a multiple regression in order to estimate the contribution of several factors to life expectancy. We find schooling as the main variable. Medicine also has a significant contribution. Calorie supply has a positive contribution only in the less developed countries.