Modelling health and output at business cycle horizons for the USA

In this paper we employ a theoretical framework – a simple macro model augmented with health – that draws guidance from the Keynesian view of business cycles to examine the relative importance of permanent and transitory shocks in explaining variations in health expenditure and output at business cycle horizons for the USA. The variance decomposition analysis of shocks reveals that at business cycle horizons permanent shocks explain the bulk of the variations in output, while transitory shocks explain the bulk of the variations in health expenditures. We undertake a shock decomposition analysis for private health expenditures versus public health expenditures and interestingly find that while transitory shocks are more important for private sector expenditures, permanent shocks dominate public health expenditures. Copyright © 2009 John Wiley & Sons, Ltd.     

An income-weighted international average for comparative analysis of health expenditures

Data from 17 countries across 28 years are used to estimate an international health expenditure function based on real per capita GNP. Actual and expected spending levels are compared for 24 countries. Between 1960 and 1987, it has been rare for health expenditure in any country to be more than +/- 20 per cent from the projected value. The norm is for spending to rise at 1.5 times the growth rate of GDP. Two countries appear to display significant anomalies. Spending in the United Kingdom is consistently 15-25 per cent below normal for all years, and Danish expenditure has declined from 7 to 6 per cent of GDP since 1975.     

The role of education in psychological response to adverse health shocks

The prevalence of common mental disorders is on the rise: in the last decade mental disorders have become one of the major contributors to the global burden of disease and the leading cause of disability worldwide. While the association between depressive symptoms and physical health has been the subject of many studies, little is known about the potential pathways through which physical health affects mental health and how this relationship varies across different socioeconomic groups. This study aims at investigating on the role that a higher educational level may have not only in protecting people from depressive and anxiety symptoms but also on its role in mediating the relationship between mental and physical health shocks. For the scope of our analysis, we relied on hospital administrative records collected from Liguria, a north-western Italian region. We evaluate the impact of education in protecting individuals from mental disorders when they experienced an adverse health event, such as severe hospitalization or an onset of a chronic condition. Our results suggest that among those who suffer from severe physical health issues, highly educated individuals are less likely to experience depressive and anxiety symptoms compared to those with a lower level of education, even though, in presence of an adverse health shock, the protecting role of education slightly decreases.     

Ageing and healthcare expenditures: Exploring the role of individual health status

In 1999, Zweifel, Felder, and Meiers questioned conventional wisdom on ageing and healthcare expenditure (HCE). According to these authors, the positive association between age and HCE is due to an increasing age‐specific mortality and the high cost of dying. After a weighty academic debate, a new consensus was reached on the importance of proximity to death when analysing HCE. Nevertheless, the influence of individual health status remains unknown. The objective of our study is to analyse the influence individual health status has on HCE, when compared to proximity to death and demographic effects and considering a comprehensive view of healthcare services and costs. We examined data concerning different HCE components of N = 61,473 persons aged 30 to 95 years old. Using 2‐part models, we analysed the probability of use and positive HCE. Regardless of the specific group of healthcare services, HCE at the end of life depends mainly on the individual health status. Proximity to death approximates individual morbidity when it is excluded from the model. The inclusion of morbidity generally improves the goodness of fit. These results provide implications for the analysis of ageing population and its impact on HCE that should be taken into account.     

Public health expenditures,taxation, and growth

This note studies the empirical link between public health expenditures and growth using a dynamic panel data model and U.S. state‐level data over the period 1963–2015. We find a positive relationship between public health expenditures and growth, even after controlling for the offsetting impacts of the requisite taxation and the government budget constraint.     

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.     

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 is associated with increased health spending.     

政府卫生支出健康效率测算及分析

目的：测算和分析中国1990年、2000年和2010年政府卫生支出的健康效率及其影响因素。方法：运用DEA和Tobit测算政府卫生支出的健康效率,评估效率值的影响因素。结果：政府卫生支出的健康生产效率在波动中有所提高,不同年度处于前沿面的省份基本一致,远离前沿面的省份存在较大差别;该效率在各区域间的差异较显著,东部地区政府卫生支出的健康生产效率高于中、西部地区;财政分权与政府卫生支出健康效率存在显著负相关关系。结论：财政分权制度的改革与完善是提高政府卫生支出健康效率的重要途径。     

Government health expenditures and health outcomes

This paper provides econometric evidence linking a country's per capita government health expenditures and per capita income to two health outcomes: under-five mortality and maternal mortality. Using instrumental variables techniques (GMM-H2SL), we estimate the elasticity of these outcomes with respect to government health expenditures and income while treating both variables as endogenous. Consequently, our elasticity estimates are larger in magnitude than those reported in literature, which may be biased up. The elasticity of under-five mortality with respect to government expenditures ranges from -0.25 to -0.42 with a mean value of -0.33. For maternal mortality the elasticity ranges from -0.42 to -0.52 with a mean value of -0.50. For developing countries, our results imply that while economic growth is certainly an important contributor to health outcomes, government spending on health is just as important a factor.     

Modifiable health risk factors and medical expenditures - The case of Taiwan

To contain escalating healthcare spending has become a great challenge for many countries around the world. Among all factors influencing medical costs, extensive studies have shown that adoption of healthy lifestyles such as not smoking, moderate drinking, eating healthy food, and exercising regularly can contribute to good health and lower the odds of having diseases that result in higher medical spending. The goal of this paper is to explore the relationship between modifiable risk factors and healthcare costs in Taiwan. A two-part model is employed to estimate the association between modifiable risk factors and medical expenditures. A logit model is used in the first stage of estimation and a generalized linear model is used in the second stage of estimation. Linking the 2001 National Health Interview Survey (NHIS) and the claims data in the National Health Insurance Research Database (NHIRD) in Taiwan, I find some significant associations between several lifestyle variables and medical expenditures. Former smokers are found to have higher probability of using medical care and incur higher medical expenses. People with exercise habits are less likely to use inpatient care services, and they incur lower inpatient expenses. Therefore, healthcare policies promoting non-smoking and physical activities should be used in Taiwan to curb rising expenditures and to achieve better care for people with chronic diseases.     

The effect of wealth status on care seeking and health expenditures in Afghanistan

This paper analyses the effect of wealth status on care-seekingpatterns and health expenditures in Afghanistan, based on anational household survey conducted within public health facilitycatchment areas. We found high rates of reported care-seeking,with more than 90% of those ill seeking care. Sick individualsfrom all wealth quintiles had high rates of care-seeking, althoughthose in the wealthiest quintile were more likely to seek carethan those from the poorest (odds ratio 2.2; 95% CI 1.6, 3.0).The nearest clinic providing the government's Basic Packageof Health Services (BPHS) was the most commonly sought firstprovider (53% overall), especially for relatively poor households(62% in poorest vs. 42% in least poor quintile, P < 0.0001).Sick individuals from wealthier quintiles used hospitals andfor-profit private providers more than those in poorer quintiles.Multivariate analysis showed that wealth quintile was the strongestpredictor of seeking care, and of going first to private providers.More than 90% of those seeking care paid money out-of-pocket.Mean (median) expenditures among those paying for care in theprevious month were 873 Afghanis (200 Afghanis), equivalentto US$17.5 (US$4). Expenditures were lowest at BPHS clinicsand highest at private providers. Financing care through borrowingmoney or selling assets/land (‘any distress’ financing)was reported in nearly 30% of cases and was almost twice ashigh among households in the poorest versus the least poor quintile(P < 0.0001). Financing care through selling assets/land(‘severe distress’ financing) was less common (10%overall) and did not differ by wealth status. These findingsindicate that BPHS facilities are being used by the poor wholive close to them, but further research is needed to assessutilization among populations in more remote areas. The highout-of-pocket health expenditures, particularly for privatesector services, highlight the need to develop financial protectionmechanisms in Afghanistan.     

A methodological note on combining health and social care expenditures into a single statistic for policy-making purposes

Current national expenditure series in the health sector focus predominantly on spending for medical services. However, as the percentage of elderly individuals grows, national policy makers will increasingly require an expenditure series which includes combined expenditure for social care as well as medical expenditures. In one country, Sweden, national policy makers have begun to relate policy decisions to a 12.0% (1996) figure for combined health and social care expenditures. Calculating such a combined figure presents a number of methodological issues, such as which social care services to include and how to reflect donated care from relatives and friends. An international comparison of this new health and social care figure would enable national decision makers to judge better the efficiency and effectiveness of current policy.     

Tobacco expenditures and child health and nutritional outcomes in rural Bangladesh

This study examined the relationship between tobacco prices and child health outcomes so as to assess the potential of improved child health outcomes resulting from less tobacco expenditure. In part, this paper was motivated by a study by. Efroymson et al. [(2001). Hungry for tobacco: An analysis of the economic impact of tobacco consumption on the poor in Bangladesh. Tobacco Control, 10, 212-217] suggesting that for the poorest households in Bangladesh, amongst whom malnutrition is widespread, shifting tobacco expenditures to expenditures on food would significantly improve the nutritional status of the household. We used data from a survey of 956 households conducted in rural Bangladesh between June 1996 and September 1997. The households were surveyed four times at approximately 4-month intervals during the 16-month period. We restricted our sample to households with children aged 2-10, and 600 households satisfied this criterion. The primary dependent variables for this study are three anthropometric indicators of child health and nutritional status: a standardized measure of height for age, a standardized measure of weight for height, and a standardized measure of weight for age. We also used measures of self-reported morbidity, including the incidence and duration of respiratory illness. We used regression methods on data averaged across survey rounds to estimate the relationship between tobacco prices and the outcome variables. Tobacco prices were found to be a significant determinant of height for age and weight for height for both boys and girls. Furthermore, the price of tobacco products is a significant predictor of weight for age for girls and the pooled sample. Our results suggest that higher tobacco prices would, for the most part, improve child health.     

实施社区卫生服务收支两条线管理的财政可行性分析

目的了解社区卫生服务收支两条线管理的财政可行性。方法预测试点地区全区域实施社区卫生服务收支两条线改革所需投入水平，以及所预测的投入水平占财政支出和卫生事业支出的比例。结果预测全区域进行社区卫生服务收支两条线改革需要政府投入的水平与目前政府实际投入水平相差不大。结论在东部地区和部分中西部地区，政府已经具备财政能力在全区域实行社区卫生服务收支两条线改革；改革的难点不是财政实力问题，而是相应的监管问题。     

A note on cointegration of health expenditures and income

Utilizing a panel data set of 50 US states, this note investigates nonstationarity and cointegration of health care expenditures and gross state products (GSP). Both the individual state-based method and the recent panel data method are applied. Allowing for structural breaks in the test, we find that health care expenditures and GSP are both nonstationary. The evidence also suggests that the two series form a cointegrating relationship. The income elasticities of health spending vary over states and became smaller in the 1990s.     

中国农村贫困地区卫生总费用时间序列系统分析

本文运用宏观卫生经济核算的方法，按照卫生总费用分配流向，整理测算了1978－1993年中国农村贫困地区卫生总费用时间序列的数据并对测算结果进行了政策分析。测算结果发现，贫困的农村地区卫生发展迟缓，与全国平均水平比较，差距在明显扩大；贫困地区在人均国内生产总值水平只有全国平均水平的30％的情况下，投了4．6％的国内生产总值发展卫生保健服务。即使如此，贫困地区居民医疗消费的实际支付能力与当地医疗机构的收费额度相比较，差距日益扩大。在现有支付能力下，贫困农民根本不可能从医疗机构得到基本的卫生保健服务。一方面，是贫困农民医疗需求不足；另一方面，贫困地区医疗机构供给相对有余，效率低下人浮于事。在我国贫困地区卫生费用对农民人均纯收入的多少竟然缺乏弹性，说明贫困地区温饱问题尚未解决。因此，很难指望贫困农民在温饱与健康的选择中，放弃温饱而选择健康。作者认为，农村居民基本卫生服务的实现程度，农村居民大病住院医疗的保障程度，是农村贫困地区卫生行政的主要责任。     

The determinants of Chinese provincial government health expenditures: evidence from 2002-2006 data

There is great divergence in provincial government health expenditures in China. Real per capita provincial government health expenditures (GHE) over the period 2002-2006 are examined using panel regression analysis. Key determinants of real per capita provincial GHE are real provincial per capita general budget revenue, real provincial per capita transfers from the central government, the proportion of provincial population under age 15, urban employee basic health insurance coverage, and proportion of urban population. Roughly equal and relatively low elasticities of budget revenue and transfers imply that the GHE is a necessity rather than a luxury good, and transfers have yet to become efficient instruments for the fair allocation of health resources by policy makers. Moreover, severe acute respiratory syndrome outbreak has increased the GHE, but we find no statistical evidence that provincial GHE have fluctuated according to the public health status.