State health expenditure accounts: building blocks for state health spending analysis

The dynamics of financing health care among various levels of government and the private sector are rapidly changing; structural relationships among health care providers are also being altered. These changes are placing increased importance on State-level expenditure estimates that will be instrumental in measuring the differential impact of Federal policies and State-specific initiatives on individual States. This article presents personal health care expenditures (PHCE) for 1980-93. Statistics show wide variation in level and rate of growth of regional spending per person. These statistics also quantify differences in both the percent of health care costs in each State borne by Medicare and Medicaid and in the proportion of each State's economy devoted to the provision of health care.     

Is there a bias in patient choices for hospital care? Evidence from three Italian regional health systems

Patients choice is at the core of competition in hospital care. In spite of a flourishing literature, little is known about the true process leading patients to choose a specific provider. Most models in this literature assume - without testing - that hospitals are perceived to be homogeneous providers. In this article we take a different direction. We assume that patients have a bias towards some types of hospitals, we test this hypothesis and show which attributes determine this bias. We exploit the characteristic of Italian health care organization, where devolution has allowed regional systems to choose the level of competition and the private-public hospitals mix. We estimate conditional logit models for hip replacement admissions in three regions (Lombardy, Veneto, and Emilia-Romagna) over the period 2014- 2016. We show that, depending on the competition framework (peculiar to each region) patients are aware that some hospitals are best performers in their area and are willing to travel more to be admitted there. This is particularly true for regional health care systems where competition between public and private providers is well developed. Our model provides interesting policy implications: a) the idea that hospitals are different in patients perception should be kept in mind in the architecture of the market for hospital care; b) clinical quality as a driver to patients choice seems to work better in a less regulated competition settings     

Geographic variation in inpatient costs for Acute Myocardial Infarction care: Insights from Italy

Geographic variations in healthcare expenditures have been widely reported within and between countries. Nevertheless, empirical evidence on the role of organizational factors and care systems in explaining these variations is still needed. This paper aims at assessing the regional differences in hospital spending for patients hospitalized for Acute Myocardial Infarction (AMI) in Tuscany and Lombardy regions (Italy), which rank high in terms of care quality and that have been, at least until 2016, characterized by quite different governance systems. Generalized linear models are performed to estimate index, 30-day and one-year hospitalization spending adjusted for baseline covariates. A two-part model is used to estimate 31–365 day expenditure. Adjusted hospital spending for AMI patients were significantly higher in Lombardy compared with Tuscany. In Lombardy, patients experienced higher re-hospitalizations in the 31–365 days and longer length of stays than in Tuscany. On the other hand, no significant regional differences in adjusted mortality rates at both acute and longer phases were found.Comparing two regional healthcare systems which mainly differ in both the reimbursement systems and the level of integration between hospital and community services provides insights into factors potentially contributing to regional variations in spending and, therefore, in areas for efficiency improvement.     

The determinants of the public-private mix in Canadian health care expenditures: 1975-1996

The health care policy issue regarding the balance between public and private health spending is examined. An empirical model of the determinants of the public-private mix in Canadian health care expenditures over the period 1975-1996 is estimated for total health care expenditures as well as separate expenditure categories such as hospitals, physicians and drugs. The results find that the key determinants of the split are per capita income, government transfer variables and the share of individual income held by the top quintile of the income distribution. Much of the public-private split is determined by long term economic forces. However, the importance of the federal health transfer variables and the variables representing shifts in fiscal transfer regimes suggest the increase in the private share of health spending since 1975 is also partly the result of the policy choice to reduce federal health transfers.     

Private health expenditure in Ireland: Assessing the affordability of private financing of health care

This paper investigates the affordability of private health expenditure among Irish households and the services contributing towards financial hardship. We use data from the Irish Household Budget Survey, a representative survey of household spending in Ireland, covering 2009-10 and 2015-16. Private health expenditure comprises out-of-pocket payments for health and social care services and private health insurance (PHI) premiums. The poverty threshold is 60% of median total equivalised consumption and households with consumption below this level were defined as poor. Households were classified as having unaffordable health expenditure if: 1) they were poor and reported any spending; 2) they were pushed below poverty threshold by health spending; or 3) their spending on health exceeded 40% of capacity to pay. Despite signs of economic recovery, the incidence of unaffordable private health spending increased over the years—from 15% in 2009-10 to 18.8% in 2015-16. People on low incomes were disproportionately affected. The largest component of unaffordable spending for poorer households is PHI and not user charges, which have actually fallen as a cause of hardship. Our findings indicate that reliance on private health expenditure as a funding mechanism undermines the fundamental goals of equity and appropriate access within the health care system.     

National health expenditures, 1987.

The 1987 national health expenditure estimates are examined from different perspectives in the following two articles. In the first article, revised expenditure estimates for 1984-87 are presented. A breakdown of the type of services and products purchased is included, as well as the source of funds used to finance health care. In the second article, health care expenditure estimates are used to explore marginal analysis as a policy tool for understanding health spending in relation to our Nation's ability to finance that spending. The concept of marginal analysis is also used to examine selected periods that were relevant to health policy and the timing of public and private changes in health policy in the past.     

Financial health and customer satisfaction in private health care providers in Brazil

This paper analyzes the relationship between the financial health and organizational form of private health care providers in Brazil. It also examines the major determinants of customer satisfaction associated with the provider's organizational form. An adjusted Altman's z-score is used as an indicator of financial health. A proxy variable based on customer complaints filed at the Brazilian National Agency for Supplementary Health is used as an indicator for customer satisfaction. The study uses a sample of 270 private health care providers and their operations over the period 2003-2005. Panel data analysis includes control variables related to market, operations, and management. Principal results indicate that: (1) private health care providers benefit from economies of scale; (2) self-funded health plans have better financial health; (3) spending on marketing does not have a significant impact on customer satisfaction in Brazil; (4) weak empirical evidence exists showing that good financial performance enhances customer's satisfaction.     

Public expenditures and health care in Africa.

Unfavorable economic conditions in most of Africa (in this paper Africa refers to Sub-Saharan Africa only) have meant public austerity and a deceleration in government health spending. Given the dominant role of government in providing health services in Africa there is a need to investigate the links between public spending and the provision of health care. Analyzing information from five Sub-Saharan African countries, namely Botswana, Burkina Faso, Cameroon, Ethiopia and Senegal, we investigate the impacts of shifting expenditure patterns and levels on the process of providing health services as well as on delivery of health care. The country analyses indicate that in addition to the level of public spending, the expenditure mix (i.e. salaries, drugs, supplies etc.), the composition of the health infrastructure (hospitals, clinics, health posts etc.), community efforts, and the availability of private health care all influence health care delivery. Consequently, per capita public expenditure (the most important indicator in a number of related studies) alone as a measure of the availability of health care and especially for cross-country comparisons is inadequate. Reductions in government resources for health care often result in less efficient mixing of resources and hence less health care delivery, in quality and quantity terms. With the recent trends in health care spending in Africa there should be greater effort to increase the efficient use of these increasingly scarce resources, yet the trend in resource mix has been in the opposite direction. Given the input to public health care of local communities, as well as the provision of private health care, it would seem that government spending on health care should be counter-cyclical, i.e. government health spending should accelerate during periods of economic down turns. Such counter-cyclical spending would tend to offset the difficulties facing local communities and the declining ability of individuals to pay for private health care. Recommending counter-cyclical health spending may seem wishful, but it points up the necessity of understanding what is likely to happen to health care in African countries in the face of economic difficulties, and particularly in the face of fiscal austerity.     

National health expenditures: a global analysis.

As part of the background research to the World development report 1993: investing in health, an effort was made to estimate public, private and total expenditures on health for all countries of the world. Estimates could be found for public spending for most countries, but for private expenditure in many fewer countries. Regressions were used to predict the missing values of regional and global estimates. These econometric exercises were also used to relate expenditure to measures of health status. In 1990 the world spent an estimated US$ 1.7 trillion (1.7 x 10(12) on health, or $1.9 trillion (1.9 x 10(12)) in dollars adjusted for higher purchasing power in poorer countries. This amount was about 60% public and 40% private in origin. However, as incomes rise, public health expenditure tends to displace private spending and to account for the increasing share of incomes devoted to health.     

National Health Accounts development: lessons from Thailand

National Health Accounts (NHA) are an important tool to demonstrate how a country's health resources are spent, on what services, and who pays for them. NHA are used by policy-makers for monitoring health expenditure patterns; policy instruments to re-orientate the pattern can then be further introduced. The National Economic and Social Development Board (NESDB) of Thailand produces aggregate health expenditure data but its estimation methods have several limitations. This has led to the research and development of an NHA prototype in 1994, through an agreed definition of health expenditure and methodology, in consultation with peer and other stakeholders. This is an initiative by local researchers without external support, with an emphasis on putting the system into place. It involves two steps: firstly, the flow of funds from ultimate sources of finance to financing agencies; and secondly, the use of funds by financing agencies. Five ultimate sources and 12 financing agencies (seven public and five private) were identified. Use of consumption expenditures was listed under four main categories and 32 sub-categories. Using 1994 figures, we estimated a total health expenditure of 128,305.11 million Baht; 84.07% consumption and 15.93% capital formation. Of total consumption expenditure, 36.14% was spent on purchasing care from public providers, with 32.35% on private providers, 5.93% on administration and 9.65% on all other public health programmes. Public sources of finance were responsible for 48.79% and private 51.21% of the total 1994 health expenditure. Total health expenditure accounted for 3.56% of GDP (consumption expenditure at 3.00% of GDP and capital formation at 0.57% of GDP). The NESDB consumption expenditure estimate in 1994 was 180,516 million Baht or 5.01% of GDP, of which private sources were dominant (82.17%) and public sources played a minor role (17.83%). The discrepancy of consumption expenditure between the two estimates is 2.01% of GDP. There is also a large difference in the public and private proportion of consumption expenses, at 46:54 in NHA and 18:82 in NESDB. Future NHA sustainable development is proposed. Firstly, we need more accurate aggregate and disaggregated data, especially from households, who take the lion's share of total expenditure, based on amended questionnaires in the National Statistical Office Household Socio-Economic Survey. Secondly, partnership building with NESDB and other financing agencies is needed in the further development of the financial information system to suit the biennial NHA report. Thirdly, expenditures need breaking down into ambulatory and inpatient care for monitoring and the proper introduction of policy instruments. We also suggest that in a pluralistic health care system, the breakdown of spending on public and private providers is important. Finally, a sustainable NHA development and utilization of NHA for planning and policy development is the prime objective. International comparisons through collaborative efforts in standardizing definition and methodology will be a useful by-product when developing countries are able to sustain their NHA reports.     

Technology as a 'major driver' of health care costs: a cointegration analysis of the Newhouse conjecture

Per capita real income on the demand-side and technological change, proxied by total R&D and health R&D spending, on the supply-side are hypothesized as major drivers of per capita real health care expenditure in the US during the 1960-1997 period. The findings are robust to a battery of unit root and cointegration tests. They support the Newhouse [Journal of Economic Perspectives 6 (1992) 3] conjecture that technological change is a major escalator of health care expenditure and confirm a significant and stable long-run relationship among per capita real health care expenditure, per capita real income and broad-based R&D expenditures. Policy implications are noted.     

Private health care expenditure and quality in Beveridge systems: Cross-regional differences in the Italian NHS

Private health care expenditure ranges from 15% to 30% of total healthcare spending in OECD countries. The literature suggests that there should be an inverse correlation between quality of public services and private expenditures. The main objective of this study is to explore the association between quality of public healthcare and private expenditures in the Italian Regional Healthcare Systems (RHSs). The institutional framework offered by the Italian NHS allows to investigate on the differences among the regions while controlling for institutional factors. The study uses micro-data from the ISTAT Household Consumption Survey (HCS) and a rich set of regional quality indicators. The results indicate that there is a positive and significant correlation between quality and private spending per capita across regions. The study also points out the strong association between the distribution of private consumption and income. In order to account for the influence of income, the study segmented data in three socio-economic classes and computed cross-regional correlations of RHSs quality and household healthcare expenditure per capita, within each class. No correlation was found between the two variables. These findings are quite surprising and call into question the theory that better quality of public services crowds out private spending, or, at the very least, it undermines the simplistic notions that higher levels of private spending are a direct consequence of poor quality in the public sector. This suggests that policies should avoid to simplistically link private spending with judgements or assessments about the functioning or efficacy of the public system and its organizations.     

Recession contributes to slowest annual rate of increase in health spending in five decades

In 2009, US health care spending grew 4.0 percent--a historically low rate of annual increase--to $2.5 trillion, or $8,086 per person. Despite the slower growth, the share of the gross domestic product devoted to health spending increased to 17.6 percent in 2009 from 16.6 percent in 2008. The growth rate of health spending continued to outpace the growth of the overall economy, which experienced its largest drop since 1938. The recession contributed to slower growth in private health insurance spending and out-of-pocket spending by consumers, as well as a reduction in capital investments by health care providers. The recession also placed increased burdens on households, businesses, and governments, which meant that fewer financial resources were available to pay for health care. Declining federal revenues and strong growth in federal health spending increased the health spending share of total federal revenue from 37.6 percent in 2008 to 54.2 percent in 2009.     

Public health care funding modifies the effect of out-of-pocket spending on maternal,infant, and child mortality

Increased out-of-pocket (OOP) health care spending has been associated with increased maternal, infant, and child mortality, but the effect of public health care spending on mortality has not been studied. I identified a statistically significant interaction between public health care expenditure and OOP health care spending for maternal, infant, and child mortality. Generally, increases in public expenditure coincide with decreased rates of mortality, regardless of OOP spending levels. Specifically, higher levels of public expenditure with moderate levels of OOP spending may result in the lowest mortality rates. Increased public health care spending may improve health outcomes better than efforts to reduce OOP expenditure alone.     

Regional regulators in health care service under quality competition: A game theoretical model

In several countries, health care services are provided by public and/or private subjects, and they are reimbursed by the government, on the basis of regulated prices (in most countries, diagnosis‐related group). Providers take prices as given and compete on quality to attract patients. In some countries, regulated prices differ across regions. This paper focuses on the interdependence between regional regulators within a country: It studies how price setters of different regions interact, in a simple but realistic framework. Specifically, we model a circular city as divided in two administrative regions. Each region has two providers and one regulator, who sets the local price. Patients are mobile and make their choice on the basis of provider location and service quality. Interregional mobility occurs in the presence of asymmetries in providers' cost efficiency, regulated prices, and service quality. We show that the optimal regulated price is higher in the region with the more efficient providers; we also show that decentralisation of price regulation implies higher expenditure but higher patients' welfare.     

Family health care spending in Latin America

Household budget data from surveys in six Latin American countries, 1966-75, are used to estimate income elasticities of private health care spending. For ten cities in five countries the elasticity is constant at 1.5; for metropolitan, other urban, and rural areas of Brazil it is constant at 1.17. The Brazilian data also show 30 percent higher spending in small than in large cities, and 50 percent higher in the countryside. These results are consistent with supposing that private care is a luxury compared to public care, and that more is spent on the former when the latter is not available. Geographic differences may be exaggerated by differences in payment mechanisms, since reported out-of-pocket expenditure is not net of public reimbursement. Different components of spending such as drugs and hospitalization show very different behavior from the total.     

Trends in U.S. health care spending, 2001

U.S. health care spending grew 8.7 percent to $5,035 per capita in 2001. Total public funding continued to accelerate, increasing 9.4 percent and exceeding private funding growth by 1.2 percentage points. This acceleration was due in part to increased Medicaid spending in the midst of a recession and payment increases for Medicare providers. Prompted by sluggish economic growth and by faster-paced health spending, health spending's share of GDP spiked 0.8 percentage points in 2001 to 14.1 percent.     

A global budget pilot project among provider partners and blue shield of california led to savings in first two years

Health care plans and providers in the private sector are developing alternative payment and delivery models to reduce spending and improve health care quality. To respond to intense competition from other organizations, Blue Shield of California created a partnership with health care providers to use an annual global budget for total expected spending and to share risk and savings among partners for providing health care. The patient population consisted of certain members of the California Public Employees' Retirement System in Northern California. Launched in 2010, the pilot accountable care organization in Sacramento provided a framework for operations and established goals and financial risk arrangements. The model shows early promise for its ease of implementation and effectiveness in controlling costs. During the two-year period, the total compound annual growth rate for per member per month cost was approximately 3?percent, or less than half the rate at which premiums rose over the past decade. Some of the savings stemmed from declines in inpatient lengths-of-stay and thirty-day readmission rates. Results suggest that the approach can achieve considerable financial savings in as little as one year and can gain wide acceptance from reform-minded providers.     

Rural Indian women's care-seeking behavior and choice of provider for gynecological symptoms

This study uses data from the India National Family and Health Survey-2 conducted in 1998-99 to investigate the level and correlates of care-seeking and choice of provider for gynecological symptoms among currently married women in rural India. Of the symptomatic women surveyed, 31 percent sought care, overwhelmingly from private providers (70 percent). Only 8 percent of women consulted frontline paramedical health workers. Care-seeking behavior and type of providers consulted varied significantly across different Indian states. Significant differentials in care-seeking by age, caste, religion, education, household wealth, and women's autonomy suggest the existence of multiple cultural, economic, and demand-side barriers to care-seeking. Although socially disadvantaged women were less likely than better-off women to consult private providers, the majority of even the poorest, uneducated, and lower-caste women consulted private providers. Geographical access to public health facilities had no significant association with choice of provider, whereas access to private providers had only a moderately significant association with that choice. The predominance of use of private services for self-perceived gynecological morbidity warrants the inclusion of private providers in the national reproductive health strategy to enhance its effectiveness.     

Gender role and child health care utilization in Nepal

OBJECTIVE: To study the gender role in child health care utilization in Nepal. METHODS: We analysed 8112 individual observations of age 相似文献