Health care expenditure inertia in the OECD countries: A heterogeneous analysis

Health care expenditure studies of the Organization for Economic Cooperation and Development (OECD) countries remain important because their findings often suggest cost containment and other policy initiatives. This paper focuses on the compatibility of OECD health data with the “expenditure inertia” (or lagged adjustments) hypothesis, by modeling individual country time‐series data of 21 nations for the 1960–1993 period. Maximum likelihood estimates of the Box–Cox transformation regression models reveal that: (a) the hypothesized impact of health “expenditure inertia” is both pervasive and strong, averaging 0.64 across the countries; (b) the real GDP elasticities of health care expenditures vary widely among the countries and average 0.34 in the short run – implying that health care is a necessity; (c) the long run GDP elasticities are less than 1 in 8 countries, unitary elastic in 8 countries and elastic in 5 countries – suggesting that health care is not universally a necessity or a luxury commodity for the OECD countries; (d) physician‐inducement effects (dis‐inducement in a few countries) are weak, with a mean elasticity estimate of 0.17; and (e) no unique functional form approximation model is globally compatible with the data across the countries. Health care cost containment policy implications of these findings are explored. This revised version was published online in July 2006 with corrections to the Cover Date.     

Health policies and Health For All strategies in the Nordic countries

In the 1980s all five Nordic countries expressed, at the highest political level, their commitment to WHO's program Health for All (HFA) by the Year 2000. This program aims at improving the prerequisites for a healthier and longer life by changing lifestyles, decreasing environmental hazards and by shifting the emphasis in health care from specialized services towards primary health care. Following their policy statements all the Nordic countries formulated national HFA strategies during the latter half of the 1980s. This paper looks at the background and the formulation and implementation of these strategies, covering the period up until the end of the 1980s. The implementation of national strategies seems to be a slow and difficult process. The monitoring of progress toward accepted healthy policy goals is not easy, because measurable objectives or targets are mostly missing.     

Health care in the CIS countries

The study analyses the technical efficiency of community hospitals in Ukraine during 1997–2001. Hospital cost amount to two-thirds of Ukrainian spending on health care. Data are available on the number of beds, physicians and nurses employed, surgical procedures performed, and admissions and patient days. We employ data envelopment analysis to calculate the efficiency of hospitals and to assess productivity changes over time. The scores calculated with an output-oriented model assuming constant returns to scale range from 150% to 110%. Average relative inefficiency of the hospitals is initially above 30% and later drops to 15% or below. The average productivity change is positive but below 1%; a Malmquist index decomposition reveals that negative technological progress is overcompensated by positive catching-up.     

Health care expenditure and income in Europe

In this work we have tried to analyse the variations in health care expenditure in all the countries of the European Community except Greece and Portugal. We have wanted to provide additional evidence on the empirical relationship between expenditure on health care and income. Our analysis, starting from the approach of Fuchs and Baumol, has been an extension of the traditional studies on health care international comparisons, in at least three directions: we have not imposed any restrictions on the price effects, we have analysed dynamic models instead of the cross-sectional analysis and we have used proper deflators. We have deflated health care expenditure in each country by means of its sectoral price index and by the purchasing parity power of its currency, to allow international comparisons. In the former case we express health care in terms of ‘expenditure’, in the latter we express health care in terms of ‘weighted quantity’. Income elasticities, in the short and in the long-run, have been estimated using econometric methods that allow us to obtain simultaneously equilibrium long-run relationships, if any, and adjustment processes in the short-run. We have found cointegrating relationships and we have estimated consistent estimators of the elasticities. The estimated income elasticities are greater than one in all the models analysed.     

Health care expenditure in Sweden--an international comparison

This paper analyses health care expenditure in Sweden and compares this with the corresponding expenditure in OECD countries. The definition and measurement problems of health care expenditure are discussed, new figures for the development of health care expenditure are presented and different measures of health care expenditure are provided. We found that health care expenditure has increased by about 20% in constant prices for Sweden between 1980 and 1988, but that health care expenditure as a share of the GDP has dropped during the same period in current prices. Health care expenditure disaggregated on different age groups show for Sweden that in the age group 15-64 years, health care expenditure has not increased in constant prices between 1976 and 1985, but in the oldest age group, health care expenditure has increased considerable during this period. Health care expenditure in Sweden is as high as would be expected, taking into account the degree of economic development and the growth of expenditure during the 80s, and has followed that in comparable OECD countries. However, the relative price is lower, which means that the input of real resources are greater than in other countries.     

Health care expenditure patterns for adolescents

Health care expenditure patterns are described using a sample of 2,767 adolescents aged 10 to 18 years from the National Medical Care Utilization and Expenditure Survey. Average total per capita health care expenditures were $525. Average out-of-pocket expenses were $151 in 1988 dollars. The burden of out-of-pocket expenses was distributed unevenly among the families of adolescents. The 10% of adolescents with the highest expenses accounted for 65% of ail out-of-pocket expenses. The presence of health insurance coverage greatly reduced the risk of incurring burdensome out-of-pocket expenses. Health policy interventions to improve health insurance coverage of adolescents are discussed.     

Health expenditure trends in OECD countries, 1990-2001

This article presents data on health care spending for 30 OECD countries from OECD Health Data 2003, the latest edition of OECD's annual data collection on health systems across industrialized countries. OECD data show health care expenditures as a proportion of gross domestic product at an all-time high, due to both increased expenditures and overall economic slow-down. The article discusses similarities and differences across countries in how health care expenditures are funded and how the health care dollar is spent among types of services.     

Health care expenditure in the last months of life

In OECD countries, a considerable share of health care expenditure (HCE) is spent for the care of the terminally ill. This paper derives the demand for HCE in the last 2 years of life from a model that accounts for age, mortality risk and wealth. The empirical tests are based on data of deceased members of a major Swiss sick fund. The empirical evidence confirms most of the hypotheses derived from the model, i.e., (i) HCE increases with closeness to death, (ii) for retired individuals, HCE decreases with age, and (iii) low-income individuals, as compared to high-income individuals, incur lower HCE in the last months of life.     

Health expenditure trends in OECD countries, 1970-1997

This article provides an overview of current trends in health expenditures in 29 OECD countries and recent revisions of OECD health accounts. U.S. health expenditures are compared with those of other OECD countries. The interactions of cost-containment measures with changes in the public-private mix of financing and in the composition of health care spending are discussed.     

Health for all by the year 2000: alcohol and the Nordic countries

One of the European targets in the "Health for all by the year 2000" programme is to reduce alcohol consumption significantly by the turn of the century. This article describes how this target, and especially the 25% goal included in it, has been adopted in the Nordic countries. With the exception of Denmark, alcohol has for a long time been regarded as a serious public health problem, and the reduction of total consumption of alcohol has been held as one of the most important ways of combating alcohol problems. In the 1980s Sweden and Norway have accepted the European 25% goal with the least reservations. In Finland the target has been regarded as unrealistic. Yet Finland, like Iceland, has accepted the goal of reducing total alcohol consumption but left the amount unspecified. In Denmark, controlling total alcohol consumption has been consistently held to be an irrelevant way to reduce alcohol problems. The alcohol policy measures suggested to reach the targets are the classical ones: price increases, restrictions in alcohol availability, and more efficient information and education. One cannot, however, avoid the observation that very few concrete measures have been taken so far and that many forces work against a reduction in alcohol consumption. The European alcohol target has affected alcohol policy in the Nordic countries in terms of target setting and programme design. It remains to be seen whether the forces advocating more restrictive alcohol control policy will be strong enough to generate concrete action plans and implement the accepted targets in actual alcohol policy measures.     

中低收入国家的卫生体系

<正>过去10年来,全球卫生开始逐渐意识到卫生体系的重要性,包括制度、组织和资源(人力、物力、财力)等与卫生服务提供有关的要素,以更好的满足人群需求。而中低收入国家的卫生体系尤为重要,但这些国家缺乏足够资金改善卫生基础设施,一些特定的疾病项目主要依赖外部资金支持,尤其是药物     

Nordic cooperation--expanding to the Baltic countries

The paper describes the establishment in 1995 of the Nordic Association for Medical and Health Information, bringing together the five national associations from Denmark, Norway, Sweden, Iceland and Finland. Many forms of good and informal cooperation between these countries have always existed, but an association is needed to be able to officially act as a unified medical library community. Since the opening up of Eastern Europe to the West in the early 1990s, their need for professional updating and literature was paramount, and one of the current concerns of the Nordic Association is cooperation with the Baltic countries.     

Health inequalities by education and age in four Nordic countries, 1986 and 1994

STUDY OBJECTIVE: To compare the age pattern of educational health inequalities in four Nordic countries in the mid-1980s and the mid-1990s. DESIGN: Cross sectional interview surveys at two points of time. SETTING: Data on self reported limiting longstanding illness, and perceived health were collected from Denmark, Finland, Norway, and Sweden in 1986/87 and in 1994/95. PARTICIPANTS: Representative samples of the non-institutionalised population at 15 years or older. Analyses were restricted to respondents aged between 25 and 75 (n= 23 325 men and 24 184 women). Response rates varied from 73% to 87%. MAIN RESULTS: The age adjusted prevalence of limiting longstanding illness in Finland was 10% higher in men and 6% higher in women than in other Nordic countries in 1986/87 but the gap narrowed by 1994/95. Educational health inequalities were largest in Norway. In 1986/87 the odds ratio (OR) for limiting longstanding illness was 11.25 (95% CI 8.66 to 14.62) among men and 8.23 (95% CI 6.60 to 10.27) among women in the oldest age group (65-74 years old) in Finland when the youngest age group (25-34 years old) was used as the reference category (OR=1.00). The age pattern in Finland was steeper than in Sweden (OR=5.02, 95% CI 3.97 to 6.34 in men and 5.29, 95% CI 4.18 to 6.71 in women) or Norway (OR=6.32, 95% CI 4.06 to 9.84 and 5.45, 95% CI 3.81 to 7.82, respectively). In 1994/95 relative health improved in the oldest age group in Finland (OR=5.80, 95% CI 4.33 to 7.78 in men and 5.94, 95% CI 4.52 to 7.79 in women) and in Norway (OR=4.55, 95% CI 3.01 to 6.88 and 3.96, 95% CI 2.70 to 5.81, respectively) but remained stable in Sweden. The study compared health differences by age in different educational categories and found that in Finland in 1986/87 the health in the oldest age group was poorer for secondary (OR=10.59, 95% CI 5.96 to 18.82) or basic educated (OR=9.76, 95% CI 6.66 to 14.30) men than for men with higher education (OR=5.15, 95% CI 2.59 to 10.22). The difference was not found among women or in other Nordic countries and it diminished among men in Finland in 1994/95. The results of perceived health were broadly similar to the above results of limiting longstanding illness. CONCLUSION: The results suggest that compared with other Nordic countries the comparatively poorer health in Finland is partly attributable to a cohort effect. This may be associated with the lower standard of living in Finland that lasted until the mid-1950s. The cohort effect is also likely to contribute to educational health inequalities among older Finnish men. The results suggest that not only current social policies but also past economic circumstances are likely to affect the overall health status as well as health inequalities.     

Health care reform in six Central European countries

This study gives an overview of the health care reform in six Central European countries after the transition from a central planning system to a regulated market economy. We focused on cost containment policies for drugs, especially the requirements for submitting health economic data in the pricing and/or reimbursement processes. The literature review was supplemented with a survey with decision makers at national health authorities in each country. The study covered Croatia, Czech Republic, Hungary, Poland, Slovakia, and Slovenia. All countries had in common that health economic information was used in reimbursement rather than in pricing processes. Differences between the six countries were mainly variations in the relative importance of health economic data and the presence of explicit requirements and guidelines. Published health economic guidelines exist in two countries and one of the six countries applies a mandatory submission system for a selected range of new drugs. In most of the Central European countries it is more typical that authorities issue a brief list of required data for reimbursement submissions that include health economic information among other data. There is a generally widespread expectation towards more systematic and formalized requirements for health economic and outcomes research data appearing within the next 3–5 years in the region.     

Health care expenditure decisions in the presence of devolution and equalisation grants

In a model where health care provision, its regional distribution and the equalisation grant are the result of a utilitarian bargaining between a (relatively) rich region and a poor one, a First Best solution can be reached only if the two Regions have the same bargaining power. From a policy point of view, our model may explain the observed cross-national differences in the redistributive power of health care expenditure and it suggests that to equalise resources across Regions an income based equalisation grant may be preferred because it causes less distortions than an expenditure based one.     

Health care expenditure and mortality from amenable conditions in the European Community

This paper addresses the question whether within the European Community a higher national level of health care expenditure is associated with a larger degree of success in eliminating mortality from preventable and curable conditions. An aggregate measure of mortality from 12 amenable conditions was derived, incorporating an adjustment for the level of socio-economic development. In 1980-84, between country variation in this measure was almost 2-fold and showed surprising patterns. Rates are relatively low in Greece, The Netherlands and Denmark, and relatively high in Portugal, Italy and Germany. There was no association at all between this measure and the level of health care expenditure. These disturbing findings, which suggest substantial variation in the cost-effectiveness of different health service systems, warrant further investigation.