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Park S, Dieleman JL, Weaver MR, Bae G, Eggleston K. Health Care Spending Increases and Value in South Korea. JAMA HEALTH FORUM 2025; 6:e245145. [PMID: 39854002 PMCID: PMC11762226 DOI: 10.1001/jamahealthforum.2024.5145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Accepted: 11/25/2024] [Indexed: 01/26/2025] Open
Abstract
Importance Health care spending in South Korea (hereafter Korea) nearly doubled from 2010 to 2019. However, little is known about the drivers and effectiveness of these spending increases in terms of changes in disability-adjusted life-years (DALYs). Objectives To evaluate the factors contributing to changes in health care spending and DALYs and estimate the value of health care spending from 2010 to 2019 in Korea. Design, Setting, and Participants This cross-sectional study of the population of Korea used 2010 and 2019 data from the National Health Insurance Service for health care spending, and from the Global Burden of Disease 2019 for DALYs. Changes from 2010 to 2019 were decomposed into changes in several factors, including population size, aging, and per-person measures of spending or DALYs. Data analyses were performed from April 2023 to June 2024. Main Outcomes and Measures Health care spending was calculated as the total expenditure on medical and long-term care, and health gains were measured as DALYs averted. The value of health care spending was estimated as the ratio of changes in spending per person to changes in DALYs per person. Results Total health care spending in Korea increased from $55.0 billion in 2010 to $92.0 billion in 2019. Increases in spending per person accounted for 52.9% of the increase, followed by population aging and population size (35.6% and 11.4%). Total DALYs increased from 11.4 million to 12.2 million. Population aging accounted for 269.4% of the increase, followed by population growth (64.0%). However, DALYs per person decreased (-233.4%), reflecting a lower per capita health burden given the country's age structure. Assuming 50% and 80% of these health improvements could be attributed to health care spending, the estimated spending per DALY averted was $20 678 and $12 924, respectively. The estimate was slightly larger when excluding DALYs not directly impacted by medical care ($23 687). Korea's spending per DALY averted is at the lower range of estimates and comparable to that of other high-income countries. Conclusions and Relevance This cross-sectional study indicates that increased spending per person, which accounted for half of the total health care spending increase, was associated with improved overall health, evidenced by substantially fewer DALYs. These findings contribute to understanding and evaluating the value of health care spending in Korea.
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Affiliation(s)
- Sungchul Park
- Department of Health Management and Policy, Korea University, Seoul, South Korea
| | - Joseph L. Dieleman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Marcia R. Weaver
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
| | - Giryeon Bae
- Department of Health Management and Policy, Korea University, Seoul, South Korea
| | - Karen Eggleston
- Shorenstein Asia-Pacific Research Center, Stanford University, Stanford, California
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McFarland S, Miller J. The inefficient effects of non-clinical factors on health care costs. HEALTH ECONOMICS, POLICY, AND LAW 2024; 19:459-473. [PMID: 39315529 DOI: 10.1017/s174413312400015x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
We use Benford's law to examine the non-random elements of health care costs. We find that as health care expenditures increase, the conformity to the expected distribution of naturally occurring numbers worsens, indicating a tendency towards inefficient treatment. Government insurers follow Benford's law better than private insurers indicating more efficient treatment. Surprisingly, self-insured patients suffer the most from non-clinical cost factors. We suggest that cost saving efforts to reduce non-clinical expenses should be focused on more severe, costly encounters. Doing so focuses cost reduction efforts on less than 10% of encounters that constitute over 70% of dollars spent on health care treatment.
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Affiliation(s)
- Shawn McFarland
- Department of Finance, Insurance and Real Estate, University of Memphis, Memphis, TN, USA
| | - Jonathan Miller
- Department of Finance, Insurance and Real Estate, University of Memphis, Memphis, TN, USA
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Maynou L, McGuire A, Serra-Sastre V. Efficiency and productivity gains of robotic surgery: The case of the English National Health Service. HEALTH ECONOMICS 2024; 33:1831-1856. [PMID: 38733282 DOI: 10.1002/hec.4838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 03/10/2024] [Accepted: 04/08/2024] [Indexed: 05/13/2024]
Abstract
This paper examines the effect of new medical technology (robotic surgery) on efficiency gains and productivity changes for surgical treatment in patients with prostate cancer from the perspective of a public health sector organization. In particular, we consider three interrelated surgical technologies within the English National Health System: robotic, laparoscopic and open radical prostatectomy. Robotic and laparoscopic techniques are minimally invasive procedures with similar clinical benefits. While the clinical benefits in adopting robotic surgery over laparoscopic intervention are unproven, it requires a high initial investment cost and carries high on-going maintenance costs. Using data from Hospital Episode Statistics for the period 2000-2018, we observe growing volumes of prostatectomies over time, mostly driven by an increase in robotic-assisted surgeries, and further analyze whether hospital providers that adopted a robot see improved measures of throughput. We then quantify changes in total factor and labor productivity arising from the use of this technology. We examine the impact of robotic adoption on efficiency gains employing a staggered difference-in-difference estimator and find evidence of a 50% reduction in length of stay (LoS), 49% decrease in post-LoS and 44% and 46% decrease in postoperative visits after 1 year and 2 years, respectively. Productivity analysis shows the growth in radical prostatectomy volume is sustained with a relatively stable number of urology surgeons. The robotic technique increases total production at the hospital level between 21% and 26%, coupled with a 29% improvement in labor productivity. These benefits lend some, but not overwhelming support for the large-scale hospital investments in such costly technology.
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Affiliation(s)
- Laia Maynou
- Department of Econometrics, Statistics and Applied Economics, Universitat de Barcelona, Barcelona, Spain
- Department of Health Policy, London School of Economics and Political Science, London, UK
- Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Barcelona, Spain
| | - Alistair McGuire
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Victoria Serra-Sastre
- Department of Health Policy, London School of Economics and Political Science, London, UK
- Department of Economics, City, University of London, London, UK
- Office of Health Economics, London, UK
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Maynou L, McGuire A, Serra-Sastre V. What happens when the tasks dry up? Exploring the impact of medical technology on workforce planning. Soc Sci Med 2024; 352:117014. [PMID: 38906087 DOI: 10.1016/j.socscimed.2024.117014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 05/08/2024] [Accepted: 05/20/2024] [Indexed: 06/23/2024]
Abstract
Increasing evidence suggests that new technologies tend to substitute for low skilled labour and complement highly skilled labour. This paper considers the manner in which new technology impacts on two distinct groups of highly skilled health care labour, cardiologists and cardiac surgeons. We consider the diffusion impact of PCI as it replaces CABG in the treatment of cardiovascular disease in the English NHS, and explicitly estimate the degree to which the cardiac surgical workforce reacts to this newer technology. Using administrative data we trace the complementarity between CABG and PCI during the mature phase of technology adoption, mapped against an increasing employment of cardiologists as they replace cardiothoracic surgeons. Our findings show evidence of growing employment of cardiologists, as PCI is increasingly expanded to older and sicker patients. While in cardiothoracic surgery, surgeons compensate falling CABG rates in a manner consistent with undertaking replacement activity and redeployment. While for cardiologists this reflects the general findings in the literature, that new technology enhances rather than substitutes for skilled labour, for the surgeons the new technology leads to redeployment rather than a downsizing of their labour.
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Affiliation(s)
- L Maynou
- Department of Econometrics, Statistics and Applied Economics, Universitat de Barcelona, Spain; Department of Health Policy, London School of Economics and Political Science, UK; Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Spain
| | - A McGuire
- Department of Health Policy, London School of Economics and Political Science, UK
| | - V Serra-Sastre
- Department of Health Policy, London School of Economics and Political Science, UK; Department of Economics, City University of London, UK; Office of Health Economics, London, UK.
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5
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Best R, Tuncay B. Understanding household healthcare expenditure can promote health policy reform. HEALTH ECONOMICS, POLICY, AND LAW 2024; 19:192-215. [PMID: 37589091 DOI: 10.1017/s1744133123000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Studies of health care expenditure often exclude explanatory variables measuring wealth, despite the intuitive importance and policy relevance. We use the Household, Income and Labour Dynamics in Australia Survey to assess impacts of income and wealth on health expenditure. We investigate four different dependent variables related to health expenditure and use three main methodological approaches. These approaches include a first difference model and introduction of a lagged dependent variable into a cross-sectional context. The key findings include that wealth tends to be more important than income in identifying variation in health expenditure. This applies for health variables which are not directly linked to means testing, such as spending on health practitioners and for being unable to afford required medical treatment. In contrast, the paper includes no evidence of different impacts of income and wealth on spending on medicines, prescriptions or pharmaceuticals. The results motivate two novel policy innovations. One is the introduction of an asset test for determining rebate eligibility for private health insurance. The second is greater focus on asset testing, rather than income tests, for a wide range of general welfare payments that can be used for health expenditure. Australia's world-leading use of means testing can provide a test case for many countries.
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Affiliation(s)
- Rohan Best
- Department of Economics, Macquarie University, Macquarie Business School, Sydney, Australia
| | - Berna Tuncay
- Department of Economics, Ozyegin University, Istanbul, Turkey
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Ngepah N, Mouteyica AEN. Factors influencing inequality in government health expenditures within African regional economic communities. BMC Health Serv Res 2024; 24:311. [PMID: 38454438 PMCID: PMC10921763 DOI: 10.1186/s12913-024-10783-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The unequal distribution of government health spending within African regional economic groupings is a significant barrier to achieving Universal Health Coverage and reaching health-related Sustainable Development targets. It also hampers the progress toward achieving the African Union's vision of an integrated and prosperous Africa, free of its heavy disease burden. Based on panel data from 36 countries nested into eight Regional Economic Communities (RECs), this study probes the effects of countries' macro-level factors on government health expenditure disparities within eight regional economic communities from 2000 to 2019. METHOD We use the multilevel linear mixed-effect method to show whether countries' trade gains, life expectancy at birth, poverty, urbanization, information and communication technology, and population aging worsen or reduce the differences for two government health expenditure indicators. RESULTS The insignificant effect of GDP per capita suggests that in most regional economic groupings, the health sector is still not considered a high-priority sector regarding overall government expenditures. Countries' poverty levels and urbanization increase the domestic general government health expenditure disparities as a percentage of general government expenditure within the regional groupings. However, trade gains and ICT diffusion reduce these disparities. Furthermore, the results reveal that external health expenditure per capita and life expectancy at birth positively impact within-regional inequalities in the domestic general government health expenditure per capita. In contrast, GDP per capita and trade gains tend to reduce them. CONCLUSIONS This study enriches the research on the determinants of government health expenditure inequality in Africa. Policies that can spur growth in trade and ICT access should be encouraged. Countries should also make more efforts to reduce poverty. Governments should also develop policies promoting economic growth and planned urbanization.
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Affiliation(s)
- Nicholas Ngepah
- School of Economics, College of Business and Economics, University of Johannesburg, Johannesburg, South Africa
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Dauda RS, Balogun FA. Drivers of healthcare expenditure growth in West Africa: A panel data investigation. Int J Health Plann Manage 2024; 39:461-476. [PMID: 37996969 DOI: 10.1002/hpm.3735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023] Open
Abstract
Per capita health expenditure in West African countries appears to have assumed a growing trend over the years. This may not be unconnected with the critical role played by health in economic growth, sustainable development and human capital formation. This study analysed drivers of healthcare expenditure in West Africa, using panel data analysis. Random Effects estimating technique was preferred to pooled Ordinary Least Squares and Fixed Effects techniques based on Hausman and Breusch-Pagan Lagrangian multiplier tests. Data employed were sourced from World Bank's world development indicators. The findings indicated that number of people using at least basic sanitation services, incidence of tuberculosis, malaria incidence, and per capita GDP, significantly increased healthcare expenditure in West Africa within the study period. Infant and under-five mortality (UFM) rates raised healthcare expenditure but insignificantly in the sub-region. The study recommends the need to reduce malaria and tuberculosis incidences as well as UFM rate in West Africa through appropriate policy enactment. Such policies should include adequate investment in education, increased per capita income, development of malaria vaccines, maintenance of hygienic environment and free treatment of tuberculosis patients.
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Ammi M, Arpin E, Dedewanou FA, Allin S. Do expenditures on public health reduce preventable mortality in the long run? Evidence from the Canadian provinces. Soc Sci Med 2024; 345:116696. [PMID: 38377835 DOI: 10.1016/j.socscimed.2024.116696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 01/19/2024] [Accepted: 02/13/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Investments in public health - prevention of illnesses, and promotion, surveillance, and protection of population health - may improve population health, however, effects may only be observed over a long period of time. OBJECTIVE To investigate the potential long-run relationship between expenditures on public health and avoidable mortality from preventable causes. METHODS We focused on the country spending the most on public health in the OECD, Canada. We constructed a longitudinal dataset on mortality, health care expenditures and socio-demographic information covering years 1979-2017 for the ten Canadian provinces. We estimated error correction models for panel data to disentangle short-from long-run relationships between expenditures on public health and avoidable mortality from preventable causes. We further explored some specific causes of mortality to understand potential drivers. For comparison, we also estimated the short-run relationship between curative expenditures and avoidable mortality from treatable causes. RESULTS We find evidence of a long-run relationship between expenditures on public health and preventable mortality, and no consistent short-run associations between these two variables. Findings suggest that a 1% increase in expenditures on public health could lead to 0.22% decrease in preventable mortality. Reductions in preventable mortality are greater for males (-0.29%) compared to females (-0.09%). These results are robust to different specifications. Reductions in some cancer and cardiovascular deaths are among the probable drivers of this overall decrease. By contrast, we do not find evidence of a consistent short-run relationship between curative expenditures and treatable mortality, except for males. CONCLUSION This study supports the argument that expenditures on public health reap health benefits primarily in the long run, which, in this case, represents a reduction in avoidable mortality from preventable causes. Reducing public health expenditures on the premise that they have no immediate measurable benefits might thus harm population health outcomes in the long run.
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Affiliation(s)
- Mehdi Ammi
- School of Public Policy and Administration, Carleton University, Richcraft Hall, 1125 Colonel By Dr, Ottawa, ON, K1S 5B6, Canada; Centre for the Business and Economics of Health, University of Queensland, Sir Llew Edwards Building, St Lucia, QLD, 4072, Australia.
| | - Emmanuelle Arpin
- Institute of Health Policy Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - F Antoine Dedewanou
- School of Public Policy and Administration, Carleton University, Richcraft Hall, 1125 Colonel By Dr, Ottawa, ON, K1S 5B6, Canada
| | - Sara Allin
- Institute of Health Policy Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
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Rodrigues PHDA, Mattos ALC, Monteiro NSDS, Silva RDFDC, Baldo VSS. [State and capital accumulation in Brazilian health from the perspective of the Marxist Dependency Theory]. CAD SAUDE PUBLICA 2024; 39:e00082923. [PMID: 38198364 PMCID: PMC10775961 DOI: 10.1590/0102-311xpt082923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 01/12/2024] Open
Abstract
The health sector is one of the major fields of economic, social, scientific, and technological development in Brazil, and has been the arena of dispute between capitalist interests that regard health as a commodity and advocates of universal access who regard health as an essential good. The Brazilian Federal Constitution of 1988 determined that health is a fundamental right and the State's responsibility, and since then the country has made progress with public policy, but has suffered setbacks and blockages due to its status as a peripheric country, historically subordinated to the interests of core countries, which see Brazil as a broad consumer market. These external interests associated with the internal bourgeoisie have been taking advantage of the Brazilian State since the 1960s, when the foundation of business groups expanded, dominating various health segments, especially since the neoliberal policies of the 1990s. These aspects are much explored in publications in Public Health, but this text seeks a new approach, using the Marxist Theory of Dependency as a reference to analyze, albeit in a preliminary way, the situation of political, economic, and technological dependence that has distanced health policy from the ideals of a public and universal system, defended in the Brazilian Health Reform.
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Affiliation(s)
| | - Arthur Lobo Costa Mattos
- Instituto de Medicina Social Hésio Cordeiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
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Navarro‐García C, Sarria‐Santamera A. The effect of older population on public health spending: Evidence from Spain. HEALTH CARE SCIENCE 2023; 2:306-316. [PMID: 38938585 PMCID: PMC11080808 DOI: 10.1002/hcs2.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/29/2023] [Accepted: 09/13/2023] [Indexed: 06/29/2024]
Abstract
Background The gradual ageing of the population, and its effect on public spending, constitutes an urgent challenge for advanced economies. Through this study, we analyse the effect of older people, and their health and individual characteristics, on public health spending. Methods Using logistic regression methods, we have analysed the use of different health services and health technologies by older people in Spain, controlled for several health, socioeconomic, and other individual factors. Results The main factors that explain the consumption of both health services and health technology, above age, are related to the so-called need factors: self-reported health status, presence of chronic diseases, and disability. Conclusion Knowing the main factors that imply greater public health spending is a topic of special interest for designing efficient health policies, in a context of growth in public health spending. In this way, preventive attention on the so-called need factors may be an important driver to improve the effectiveness of spending.
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Remler DK, Korenman S. On the Importance and Intrinsic Difficulties of Incorporating Health Insurance Benefits in Absolute Poverty Trends. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2023; 48:761-798. [PMID: 36995345 DOI: 10.1215/03616878-10637735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
CONTEXT US government poverty measures do not include health insurance in the threshold or health insurance benefits in resources. Yet the 2019 Economic Report of the President presented long-term trends using the full-income poverty measure (FPM), which includes health insurance benefits as resources. A 2021 technical advisory report recommended statistical agencies produce absolute poverty trends with and without health insurance. METHODS The authors analyzed the conceptual validity and relevance of long-term absolute poverty trends incorporating health insurance benefits. They estimated the extent to which the FPM credits health insurance benefits with meeting nonhealth needs. FINDINGS In FPM estimates, health insurance benefits alone remove many households from poverty. Long-term absolute poverty trends incorporating health insurance benefits have intrinsic difficulties, because health insurance benefits are in-kind, mostly nonfungible, and large, and because health care undergoes substantial technological change-features that interact to undermine validity. Valid poverty measures with health insurance benefits require resources and thresholds consistent at each point in time, while absolute poverty measures require thresholds constant in real terms over time. These goals conflict. CONCLUSIONS Statistical agencies should not produce absolute poverty trends incorporating health insurance benefits. Instead, they should focus on less-absolute poverty measures with health insurance benefits.
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Chen L, Xu X. Relationships between the Physical Activity Intensity and the Medical Expenditure of Middle-Aged and Elderly People: Parsing from the CHARLS Database. Behav Sci (Basel) 2023; 13:566. [PMID: 37504013 PMCID: PMC10376150 DOI: 10.3390/bs13070566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/24/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023] Open
Abstract
There are many studies on the impact of physical activity on health but few studies on the relationship between physical activity and medical expenditure among the elderly. Based on the China Health and Retirement Longitudinal Survey (CHARLS) database and selected 4456 valid samples, this paper used a two-part model to analyze the effects of high, moderate, and low physical activity intensity on medical expenditure. It is found that the intensity of physical activity was negatively correlated with medical expenditure, and the medical expenditure of the high physical activity intensity group was significantly lower than that of the low physical activity intensity group. For example, compared to people with no physical activity, the total medical expenditure decreased by 22.4%, 40.4%, and 62.5% per week in those with low, moderate, and high physical activity intensity. Thus, the government should provide more places for the elderly to exercise, planning special exercise areas for the elderly in community playgrounds, such as a dancing square, which will also help the elderly to increase their amount of exercise per week and develop a daily exercise habit.
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Affiliation(s)
- Linhong Chen
- School of Marxism, Chongqing Technology and Business University, Chongqing 400067, China
| | - Xiaocang Xu
- School of Economics and Management, Huzhou University, Huzhou 313000, China
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Yu ZQ, Chen LP, Qu JQ, Wu WZ, Zeng Y. A study on the sustainability assessment of China's basic medical insurance fund under the background of population aging-evidence from Shanghai. Front Public Health 2023; 11:1170782. [PMID: 37333524 PMCID: PMC10273205 DOI: 10.3389/fpubh.2023.1170782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
Objective As China's population aging process accelerates, the expenditure of China's basic medical insurance fund for employees may increase significantly, which may threaten the sustainability of China's basic medical insurance fund for employees. This paper aims to forecast the future development of China's basic medical insurance fund for employees in the context of the increasingly severe aging of the population. Methods This paper taking an empirical study from Shanghai as an example, constructs an actuarial model to analyze the impact of changes in the growth rate of per capita medical expenses due to non-demographic factors and in the population structure on the sustainability of the basic medical insurance fund for employees. Results Shanghai basic medical insurance fund for employees can achieve the goal of sustainable operation in 2021-2035, with a cumulative balance of 402.150-817.751 billion yuan in 2035. The lower the growth rate of per capita medical expenses brought about by non-demographic factors, the better the sustainable operation of the fund. Conclusion Shanghai basic medical insurance fund for employees can operate sustainably in the next 15 years, which can further reduce the contribution burden of enterprises, which lays the foundation for improving the basic medical insurance treatment for employees.
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Affiliation(s)
- Zhi-Qing Yu
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Li-Peng Chen
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Jun-Qiao Qu
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Wan-Zong Wu
- Business School, Yangzhou University, Yangzhou, China
| | - Yi Zeng
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
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Hofbauer-Milan V, Fetzer S, Hagist C. How to Predict Drug Expenditure: A Markov Model Approach with Risk Classes. PHARMACOECONOMICS 2023; 41:561-572. [PMID: 36840748 PMCID: PMC10085961 DOI: 10.1007/s40273-023-01240-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Although pharmaceutical expenditures have been rising for decades, the question of their drivers remains unclear, and long-term projections of pharmaceutical spending are still scarce. We use a Markov approach considering different cost-risk groups to show the possible range of future drug spending in Germany and illustrate the influence of various determinants on pharmaceutical expenditure. METHODS We compute different medium and long-term projections of pharmaceutical expenditure in Germany up to 2060 and compare extrapolations with constant shares, time-to-death scenarios, and Markov modeling based on transition probabilities. Our modeling is based on data from a large statutory sickness fund covering around four million insureds. We divide the population into six risk groups according to their share of total pharmaceutical expenditures, determine their cost growth rates, survival and transition probabilities, and compute different scenarios related to changes in life expectancy or spending trends in different cost-risk groups. RESULTS If the spending trends in the high-cost groups continue, per-capita expenditure will increase by over 40% until 2040. By 2060, pharmaceutical expenditures could more than double, even if these groups would not benefit from rising life expectancy. By contrast, the isolated effect of demographic change would "only" lead to a long-term increase of around 15%. CONCLUSION The long-term development of pharmaceutical spending in Germany will depend mainly on future expenditure and life expectancy trends of particularly high-cost patients. Thus, appropriate pricing of new expensive pharmaceuticals is essential for the sustainability of the German healthcare system.
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Affiliation(s)
- Valeska Hofbauer-Milan
- AOK Baden-Württemberg, Stuttgart, Germany.
- Chair of Economic and Social Policy, WHU Otto Beisheim School of Management, Burgplatz 2, 56179, Vallendar, Germany.
| | - Stefan Fetzer
- Hochschule Aalen - Technik und Wirtschaft, Aalen, Germany
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15
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Cadeddu C, Regazzi L, Di Brino E, Basile M, Cascini F, Paladini A, Rumi F, Cicchetti A, Ricciardi W. The added value of applying a disinvestment approach to the process of health technology assessment in Italy. Int J Technol Assess Health Care 2023; 39:e17. [PMID: 36861658 PMCID: PMC11570134 DOI: 10.1017/s0266462323000107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 12/05/2022] [Accepted: 02/05/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVES The objective of the present policy analysis was to understand how a disinvestment approach to the process of health technology assessment (HTA), applied to the field of medical devices, might help Italian policymakers to properly spend the resources in healthcare. METHODS Previous international and national experiences in disinvestment for medical devices were reviewed. Precious insights for the rational expenditure of the resources were derived by assessing the evidence available. RESULTS The disinvestment of ineffective or inappropriate technologies or interventions with an inadequate value-for-money ratio has become a growing priority for National Health Systems. Different international disinvestment experiences of medical devices were identified and described through a rapid review. Although most of them have a strong theoretical framework, their practical application remains difficult. In Italy, there are no examples of large and complex HTA-based disinvestment practices, but their importance is becoming increasingly acknowledged, especially given the need to prioritize the funds provided by Recovery and Resilience Plan. CONCLUSIONS Anchoring decisions on health technologies without reassessing the current technological landscape through a robust HTA model might expose to the risk of not ensuring the best employment of the resources available. Thus, it is necessary to develop a strong HTA ecosystem in Italy through adequate consultation with stakeholders to enable a data-driven and evidence-based prioritization of resources toward choices characterized by high value for both patients and society as a whole.
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Affiliation(s)
- Chiara Cadeddu
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Regazzi
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eugenio Di Brino
- Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michele Basile
- Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fidelia Cascini
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Paladini
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Rumi
- Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Americo Cicchetti
- Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Walter Ricciardi
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
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16
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Frankovic I, Kuhn M. Health insurance, endogenous medical progress, health expenditure growth, and welfare. JOURNAL OF HEALTH ECONOMICS 2023; 87:102717. [PMID: 36638641 DOI: 10.1016/j.jhealeco.2022.102717] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/23/2022] [Accepted: 12/08/2022] [Indexed: 06/17/2023]
Abstract
We study the impact of health insurance expansion on medical spending, longevity and welfare in an OLG economy in which individuals purchase health care to lower mortality and medical progress is profit-driven. Three sectors are considered: final goods production; a health care sector, selling medical services to individuals; and an R&D sector, selling increasingly effective medical technology to the health care sector. We calibrate the model to the development of the US economy/health care system from 1965 to 2005 and study numerically the impact of the insurance expansion. We find that more extensive health insurance accounts for a large share of the rise in US health spending but also boosts the rate of medical progress. A welfare analysis shows that while the subsidization of health care through health insurance creates excessive health care spending, the gains in life expectancy brought about by induced medical progress more than compensate for this.
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Affiliation(s)
| | - Michael Kuhn
- International Institute for Applied Systems Analysis (IIASA), Austria; Wittgenstein Centre (IIASA, OeAW, University of Vienna), Austria.
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17
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Ma G, Xu K. Value-Based Health Care: Long-Term Care Insurance for Out-of-Pocket Medical Expenses and Self-Rated Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:192. [PMID: 36612515 PMCID: PMC9819384 DOI: 10.3390/ijerph20010192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/08/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Long-term care insurance (LTCI) is a significant approach in the effort to actively manage aging and the currently unmet need for aged care in China. Based on data from the 2011, 2013, 2015, and 2018 phases of the China Health and Retirement Longitudinal Study, we used the propensity score matching-difference in difference (PSM-DID) approach to explore the impact of LTCI on out-of-pocket medical expenses and self-rated health. Results showed that LTCI can significantly reduce out-of-pocket medical expenses by 37.16% (p < 0.01) per year and improve self-rated health by 5.73% (p < 0.01), which conforms to the spirit of “value-based health care”. The results were found to be stable in the robustness tests conducted. Currently, China is at the intersection of “low-value-based health care” and “value-based health care”. Improving the health level of aged individuals while keeping medical costs under reasonable control is crucial for formulating and implementing a new round of healthcare reform in China.
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Affiliation(s)
| | - Kun Xu
- Correspondence: ; Tel.: +86-198-1075-0586
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18
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Breyer F, Lorenz N, Pruckner GJ, Schober T. Looking into the black box of "Medical Innovation": rising health expenditures by illness type. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1601-1612. [PMID: 35298739 PMCID: PMC9666302 DOI: 10.1007/s10198-022-01447-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 02/11/2022] [Indexed: 05/25/2023]
Abstract
There is agreement among health economists that on the whole medical innovation causes health care expenditures (HCE) to rise. This paper analyzes for which diagnoses HCE per patient have grown significantly faster than average HCE. We distinguish decedents (patients in their last 4 years of life) from survivors and use a unique dataset comprising detailed HCE of all members of a regional health insurance fund in Upper Austria for the period 2005-2018. Our results indicate that among decedents in particular, the expenditures for treatment of neoplasms have exceeded the general trend in HCE. This confirms that medical innovation for this group of diseases has been particularly strong over the last 15 years. For survivors, we find a noticeable growth in cases and cost per case for pregnancies and childbirth, and also for treatment of mental and behavioral disorders. We discuss whether these findings contradict the widespread interpretation of cost-increasing innovations as "medical progress" and offer some policy recommendations.
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Affiliation(s)
- Friedrich Breyer
- Department of Economics, University of Konstanz, P.O. Box 135, 78457, Konstanz, Germany.
| | | | - Gerald J Pruckner
- Johannes Kepler University of Linz, Linz, Austria
- Christian Doppler Laboratory for Aging, Health, and the Labor Market, Linz, Austria
| | - Thomas Schober
- Johannes Kepler University of Linz, Linz, Austria
- Christian Doppler Laboratory for Aging, Health, and the Labor Market, Linz, Austria
- Auckland University of Technology, Auckland, New Zealand
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19
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Zhang Z, Ge P, Yan M, Niu Y, Liu D, Xiong P, Li Q, Zhang J, Yu W, Sun X, Liu Z, Wu Y. Self-Medication Behaviors of Chinese Residents and Consideration Related to Drug Prices and Medical Insurance Reimbursement When Self-Medicating: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13754. [PMID: 36360638 PMCID: PMC9656509 DOI: 10.3390/ijerph192113754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/16/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Self-medication has become a common phenomenon. Economic factors are important factors that affect the self-medication of residents. This study aimed to investigate the current status of self-medication behaviors in China and explored the related factors affecting considerations associated with medical insurance reimbursement or drug price in self-medication. METHODS A national cross-sectional investigation was conducted among Chinese people over 18 years old under a multi-stage sampling method through a questionnaire, which includes demographic sociological characteristics, self-medication behaviors and scales. The Chi-square test was used to analyze whether the respondents consider medical insurance reimbursement or drug price as an important factor when purchasing over-the-counter (OTC) drugs. Logistic regression was used to examine the associated factors of considering medical insurance reimbursement or drug price. RESULTS In total, 9256 respondents were included in this study; 37.52% of the respondents regarded drug prices as an important consideration, and 28.53% of the respondents attached great importance to medical insurance reimbursement. Elderly respondents who lived in the central region, had medical insurance, and had lower levels of health literacy were more likely to consider the medical insurance reimbursement, while respondents with high monthly family income as well as students were less likely to consider the same issue (p < 0.05). Respondents settled in the central and western regions, students, those without fixed occupations, those who suffered from chronic diseases, or those with lower health literacy were more likely to consider drug prices, while the respondents with bachelor degrees, urban population and high per capita monthly income were less likely to consider the drug prices (p < 0.05). CONCLUSION Self-medication behaviors with OTC drugs were prevalent in China, and consideration factors of medical insurance reimbursement or drug prices were related to socio-demographic characteristics and health literacy. There is a need to take measures to reduce the economic burden of self-medication, improve the health literacy of residents and strengthen public health education.
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Affiliation(s)
- Ziwei Zhang
- School of Public Health, Peking University, Beijing 100191, China
| | - Pu Ge
- Institute of Chinese Medical Sciences, University of Macau, Macao 999078, China
| | - Mengyao Yan
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100006, China
| | - Yuyao Niu
- Faculty of Arts and Humanities, University of Macau, Macao 999078, China
| | - Diyue Liu
- International School of Public Health and One Health, Hainan Medical University, Haikou 571199, China
| | - Ping Xiong
- Institute of Chinese Medical Sciences, University of Macau, Macao 999078, China
| | - Qiyu Li
- School of Humanities and Management, Jinzhou Medical University, Jinzhou 121001, China
| | - Jinzi Zhang
- School of Humanities and Social Sciences, Harbin Medical University, Harbin 150076, China
| | - Wenli Yu
- School of Foreign Languages, Weifang University of Science and Technology, Weifang 262700, China
| | - Xinying Sun
- School of Public Health, Peking University, Beijing 100191, China
| | - Zhizhong Liu
- School of Finance and Trade, Liaoning University, Shenyang 110036, China
| | - Yibo Wu
- School of Public Health, Peking University, Beijing 100191, China
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20
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Lucarelli C, Nicholson S, Tilipman N. Price Indices and the Value of Innovation with Heterogenous Patients. JOURNAL OF HEALTH ECONOMICS 2022; 84:102625. [PMID: 35561551 DOI: 10.1016/j.jhealeco.2022.102625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/31/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
Many countries use uniform cost-effectiveness criteria to determine whether to adopt a new medical technology for the entire population. This approach assumes homogeneous preferences for expected health benefits and side effects. We examine whether new prescription drugs generate welfare gains when accounting for heterogeneous preferences by constructing quality-adjusted price indices in the market for colorectal cancer drug treatments. We find that while the efficacy gains from newer drugs do not justify high prices for the population as a whole, innovation improves the welfare of sicker, late-stage cancer patients. A uniform evaluation criterion would not permit these innovations despite welfare gains to a subpopulation.
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Affiliation(s)
- Claudio Lucarelli
- Department of Health Care Management, The Wharton School, University of Pennsylvania.
| | - Sean Nicholson
- Department of Policy Analysis & Management, Cornell University.
| | - Nicholas Tilipman
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago.
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21
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Xia L, Chai L, Zhang H, Sun Z. Mapping the Global Landscape of Long-Term Care Insurance Research: A Scientometric Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7425. [PMID: 35742674 PMCID: PMC9223750 DOI: 10.3390/ijerph19127425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 12/04/2022]
Abstract
With the aging population increasing dramatically and the high cost of long-term care (LTC), long-term care insurance (LTCI) has expanded rapidly across the world. This review aims to summarize the status quo, evolution trends, and new frontiers of global LTCI research between 1984 and 2021 through a comprehensive retrospective analysis. A total of 1568 articles retrieved from the Web of Science Core Collection database were systematically analyzed using CiteSpace visualization software (CiteSpace 5.8. R2, developed by Dr. Chaomei Chen at Drexel University (Philadelphia, PA, USA)). The overall characteristics analysis showed that LTCI is an emerging research field in a rapid development stage-nearly 50% of articles were published in the past five years. The most productive LTCI research institutions and authors are located primarily in Japan and the USA. A rigorous analysis based on a dual perspective of references and keywords was applied to reveal that common LTCI hot topics include disability in the elderly, LTC financing, demand for and supply of LTCI, and LTCI systems. In addition, LTCI research trends have shifted from the supply side to the demand side, and from basic studies to practical applications. The new research frontiers are frailty in the elderly, demand for LTCI, and LTCI systems. These findings can provide help and reference for public health practitioners and researchers, as well as help with the sustainable development of LTCI research.
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Affiliation(s)
| | | | | | - Zhaohui Sun
- Department of Law and Political Science, North China Electric Power University, Baoding 071003, China; (L.X.); (L.C.); (H.Z.)
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22
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Brewer B, Conway KS, Ozabaci D, Woodward RS. US Health Care Expenditures, GDP and Health Policy Reforms: Evidence from End-of-Sample Structural Break Tests. EASTERN ECONOMIC JOURNAL 2022; 48:451-487. [PMID: 35729891 PMCID: PMC9188657 DOI: 10.1057/s41302-022-00218-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This research investigates the over-time stability of the aggregate US healthcare expenditure (HCE)-GDP relationship, focusing on periods of healthcare reforms. The most consequential reforms-Medicaid/Medicare and the Affordable Care Act (ACA)-are challenging to study because they occur near the ends of the available data. Using annual national- and state-level data and a battery of structural break tests, we find the HCE-GDP relationship to be overwhelmingly stable. An ancillary analysis around the 2006 Massachusetts healthcare reform, which avoids the confounding effects of the Great Recession and the staggered rollout of the ACA, likewise finds no change.
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Affiliation(s)
- Ben Brewer
- University of Hartford, West Hartford, CT USA
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23
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Barajas Galindo DE, Martínez Pillado M, Ballesteros Pomar MD, Said Criado I, Ramos Bachiller B, Regueiro Martínez A, Cano Rodríguez I. [Validation of a questionnaire for the analysis of digital competence in patients with type 1 diabetes mellitus]. J Healthc Qual Res 2022; 37:374-381. [PMID: 35660328 DOI: 10.1016/j.jhqr.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/02/2022] [Accepted: 04/18/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Validation of a questionnaire designed to stratify the level of digital competence in chronic patients. METHOD Cross-sectional study, carried out in the Endocrinology and Nutrition Section of the Complejo Asistencial Universitario de León (CAULE). We selected the digital competencies section of the Cambados questionnaire, designed for the identification of digital chronic patient, with a maximum score of 20 points. The questionnaire was completed for validation by patients for whom were prescribed a digital tool for glycemic control. Reliability was assessed by assessing the correct use of the prescribed tool and internal consistency. RESULTS The questionnaire was completely filled in by 171 patients, with a mean age of 44.36 (SD 17.36). The mean score obtained in the questionnaire was 11.04 (SD 4.74) and a score over 12 was the most appropriate cut-off point to discriminate between patients according to their level of digital competence. 48.54% of the patients made adequate use of the tool. The scale showed good internal consistency with a Cronbach's alpha of 0.77. CONCLUSIONS The results reached in the present study allow us to affirm that the responses obtained from the patients in the digital competency definition questionnaire are a good indicator of the use of digital tools.
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Affiliation(s)
- D E Barajas Galindo
- Sección de Endocrinología y Nutrición, Complejo Asistencial Universitario de León, León, España.
| | - M Martínez Pillado
- Unidad de Calidad, Complexo Hospitalario de Pontevedra, Pontevedra, España
| | - M D Ballesteros Pomar
- Sección de Endocrinología y Nutrición, Complejo Asistencial Universitario de León, León, España
| | - I Said Criado
- Servicio de Medicina Interna, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - B Ramos Bachiller
- Sección de Endocrinología y Nutrición, Complejo Asistencial Universitario de León, León, España
| | - A Regueiro Martínez
- Centro de Salud de Vilanova de Arousa, Área Sanitaria de Pontevedra, Pontevedra, España
| | - I Cano Rodríguez
- Sección de Endocrinología y Nutrición, Complejo Asistencial Universitario de León, León, España
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24
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Laudicella M, Li Donni P, Olsen KR, Gyrd‐Hansen D. Age, morbidity, or something else? A residual approach using microdata to measure the impact of technological progress on health care expenditure. HEALTH ECONOMICS 2022; 31:1184-1201. [PMID: 35362244 PMCID: PMC9314678 DOI: 10.1002/hec.4500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 02/09/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
This study measures the increment of health care expenditure (HCE) that can be attributed to technological progress and change in medical practice by using a residual approach and microdata. We examine repeated cross-sections of individuals experiencing an initial health shock at different point in time over a 10-year window and capture the impact of unobservable technology and medical practice to which they are exposed after allowing for differences in health and socioeconomic characteristics. We decompose the residual increment in the part that is due to the effect of delaying time to death, that is, individuals surviving longer after a health shock and thus contributing longer to the demand of care, and the part that is due to increasing intensity of resource use, that is, the basket of services becoming more expensive to allow for the cost of innovation. We use data from the Danish National Health System that offers universal coverage and is free of charge at the point of access. We find that technological progress and change in medical practice can explain about 60% of the increment of HCE, in line with macroeconomic studies that traditionally investigate this subject.
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Affiliation(s)
- Mauro Laudicella
- Danish Centre for Health Economics ‐ DaCHEUniversity of Southern DenmarkOdenseDenmark
| | | | - Kim Rose Olsen
- Danish Centre for Health Economics ‐ DaCHEUniversity of Southern DenmarkOdenseDenmark
| | - Dorte Gyrd‐Hansen
- Danish Centre for Health Economics ‐ DaCHEUniversity of Southern DenmarkOdenseDenmark
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25
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Xu X, Wang Q, Li C. The Impact of Dependency Burden on Urban Household Health Expenditure and Its Regional Heterogeneity in China: Based on Quantile Regression Method. Front Public Health 2022; 10:876088. [PMID: 35602138 PMCID: PMC9116474 DOI: 10.3389/fpubh.2022.876088] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/05/2022] [Indexed: 11/28/2022] Open
Abstract
Background The aging population has led to a growing health expenditure burden. According to the National Bureau of Statistics of China, the old-age dependency ratio rose from 10.7% in 2003 to 17.8% in 2019, and health expenditure increased from 658.410 billion yuan in 2003 to 5812.191 billion yuan in 2019 in China. Methods This paper utilizes the quantile regression method to discuss the influencing factors of health expenditure in urban China based on the China Household Finance Survey (CHFS), especially dependency burden. Moreover, its regional heterogeneity is also compared. Results The old-age dependency ratio, age, family size, self-rated health status, and income significantly impact the health expenditure of urban families in the quantile regression of the national sample. Dependency burden and other variables on urban household health expenditure have great regional heterogeneity. The relationship between urban health expenditure and residential areas in western China is more stable than that in eastern and central China. Discussion Government should improve the healthcare system suitable for the older adult population as soon as possible. The government of western China should pay more attention to the introduction of professional medical talents and the configuration of precision medical equipment to improve the health system in western China.
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Affiliation(s)
- Xiaocang Xu
- School of Economics and Management, Huzhou University, Huzhou, China.,Research Center for Economy of Upper Reaches of the Yangtse River/School of Economics, Chongqing Technology and Business University, Chongqing, China
| | - Qingqing Wang
- Business School, Zhengzhou University, Zhengzhou, China
| | - Chang Li
- School of Economics and Management, Hebei University of Science and Technology, Shijiazhuang, China
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26
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ASSESSING THE VALUE OF HEALTHCARE INNOVATIONS: A PROPOSAL FOR AN INTEGRATED HTA-RIH APPROACH IN THE 'NEW NORMAL'. Int J Technol Assess Health Care 2022; 38:e47. [PMID: 35549786 DOI: 10.1017/s0266462322000319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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27
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Shah MH, Salem S, Ahmed B, Ullah I, Rehman A, Zeeshan M, Fareed Z. Nexus Between Foreign Direct Investment Inflow, Renewable Energy Consumption, Ambient Air Pollution, and Human Mortality: A Public Health Perspective From Non-linear ARDL Approach. Front Public Health 2022; 9:814208. [PMID: 35096757 PMCID: PMC8793008 DOI: 10.3389/fpubh.2021.814208] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/09/2021] [Indexed: 11/26/2022] Open
Abstract
A huge foreign direct investment (FDI) inflow has been witnessed in China, though on the one hand, it brings a significant contribution to economic growth. On the other hand, it adversely affects the ambient air pollution that may affect human mortality in the country. Renewable energy (RE) usage meets the country's energy needs with no adverse effect on the environment. Therefore, this study is trying to empirically analyze the effect of FDI inflow on human morality and RE consumption in China. We used time-series data for 1998–2020 and applied a non-linear ARDL approach for the estimations. The empirical outcomes suggest that FDI inflow positively affects mortality and RE. There is also unidirectional causality running from RE and pollution to mortality. In addition, the relationship among the variable verifies the existence of a non-linear relationship. The government needs policy guidelines to further boost FDI inflow due to its positive aspects. However, to reduce the negative effect on the environment and human morality, the extensive usage of RE should be adopted. Indeed, proper legislation for foreign firms might be a good step toward quality environmental and longevity of human health in society.
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Affiliation(s)
| | - Sultan Salem
- Department of Economics, Birmingham Business School, College of Social Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Bilal Ahmed
- School of Management, Zhejiang University of Technology, Hangzhou, China
| | - Irfan Ullah
- Reading Academy, Nanjing University of Information Science and Technology, Nanjing, China
| | - Alam Rehman
- Faculty of Management Sciences, National University of Modern Languages, Islamabad, Pakistan
| | - Muhammad Zeeshan
- College of Business Administration, Liaoning Technical University, Fuxin, China
| | - Zeeshan Fareed
- School of Economics and Management, Huzhou University, Huzhou, China
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28
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ÇELİK EU, OMAY T, TUZLUKAYA Ş. Testing Health Expenditure Convergence In 21 OECD Countries By Using Nonlinear Unit Root Tests. KONURALP TIP DERGISI 2022. [DOI: 10.18521/ktd.1056926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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29
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Kamanda E, Lanpin Y, Sesay B. Causal nexus between health expenditure, health outcome and economic growth: Empirical evidence from Sub-Saharan Africa countries. Int J Health Plann Manage 2022; 37:2284-2302. [PMID: 35393680 DOI: 10.1002/hpm.3469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/11/2022] [Accepted: 03/21/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION The relationships among health expenditure, health outcome, and economic growth have been given significant consideration in the current literature. Nevertheless, there are potential gaps in the nature of health-growth nexus that current empirical studies have not thoroughly considered. METHODOLOGY This study explores Granger causality and cointegration relationships in a trivariate framework among, health expenditure, health outcome, and economic growth. We used three health outcome measures and a panel vector autoregressive model to study 45 countries in Sub-Saharan Africa between 1990 and 2018. Our innovative panel data evaluation technique allows to ascertain significant causal relationships among the studied variables in the short and long run. RESULTS Findings from the study include (1) health expenditure and health outcome Granger-cause economic growth in the long run; (2) economic growth Granger-cause health expenditure in the short run; (3) no causal relationship was found running from health expenditure and health outcome to economic growth in the short-run. The former result (1) may not be surprising, given that the countries considered in this study are relatively less developed countries from Sub-Saharan Africa. Hence, further health improvement may play a statistically significant role in spurring further economic growth. CONCLUSION Based on the results, the study presents interesting and possible effective policy perspectives for health improvement in the studied countries. Policies that stimulate health spending are needed to create a better and more industrious society that can support SSA's economic progress. This is because a healthy person may be more productive than someone who is sick, allowing them to produce greater output.
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Affiliation(s)
- Edmond Kamanda
- School of Economics, Wuhan University of Technology, Wuhan, China
| | - Yang Lanpin
- School of Economics, Wuhan University of Technology, Wuhan, China
| | - Brima Sesay
- School of International Education, Wuhan University of Technology, Wuhan, China
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30
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Maynou L. The diffusion of robotic surgery: examining technology use in the English NHS. Health Policy 2022; 126:325-336. [DOI: 10.1016/j.healthpol.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 01/03/2023]
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Liu H, Hu T. Evaluating the long-term care insurance policy from medical expenses and health security equity perspective: evidence from China. Arch Public Health 2022; 80:3. [PMID: 34983634 PMCID: PMC8725500 DOI: 10.1186/s13690-021-00761-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Since the national long-term care (LTCI) policy pilot in 2016 of China, the LTCI policy has had significant impact on the residents in the pilot area. Methods From the perspective of medical expenses and health security equity, this study selects tracking survey data from the CHARLS database in 2013, 2015, and 2018 and empirically investigates the effect of LTCI policy pilot by using differences-in-differences method (DID). Moreover, this study measures the economic distribution and health equity of the treated and untreated groups using the concentration and Theil indices. Results The results showed that group heterogeneity of medical expenses and health level of elderly in the treatment group were narrowing. Moreover, the policy results showed that the LTCI policy pilot significantly affects the outpatient, hospital expenses, and length of stay of elders. Residence registration, income level, and basic medical insurance play a significant regulatory role. Additionally, LTCI policy pilot significantly improved the overall health of the elderly. Conclusions The measurement results of inequality show that the policy increases the income of low-income people, lowers the inequality level of outpatient and inpatient reimbursement, and reduces the concentration index of ADL disability and serious diseases. However, the inequality of serious diseases is becoming higher. Based on this, this paper provides several suggestions on optimizing the pilot policy of LTCI.
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Affiliation(s)
- Huan Liu
- Zhejiang University of Finance & Economics, Hang Zhou, China.
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Dranove D, Garthwaite C, Heard C, Wu B. The economics of medical procedure innovation. JOURNAL OF HEALTH ECONOMICS 2022; 81:102549. [PMID: 34979301 DOI: 10.1016/j.jhealeco.2021.102549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 10/21/2021] [Accepted: 10/23/2021] [Indexed: 06/14/2023]
Abstract
This paper explores the economic incentives for medical procedure innovation. Using a proprietary dataset on billing code applications for emerging medical procedures, we highlight two mechanisms that could hinder innovation. First, the administrative hurdle of securing permanent, reimbursable billing codes substantially delays innovation diffusion. We find that Medicare utilization of innovative procedures increases nearly nine-fold after the billing codes are promoted to permanent (reimbursable) from provisional (non-reimbursable). However, only 29 percent of the provisional codes are promoted within the five-year probation period. Second, medical procedures lack intellectual property rights, especially those without patented devices. When appropriability is limited, specialty medical societies lead the applications for billing codes. We indicate that the ad hoc process for securing billing codes for procedure innovations creates uncertainty about both the development process and the allocation and enforceability of property rights. This stands in stark contrast to the more deliberate regulatory oversight for pharmaceutical innovations.
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Affiliation(s)
- David Dranove
- Kellogg School of Management, Northwestern University, 2211 Campus Drive, Evanston, IL 60208, USA.
| | - Craig Garthwaite
- Kellogg School of Management, Northwestern University, 2211 Campus Drive, Evanston, IL 60208, USA.
| | - Christopher Heard
- Department of Economics, Northwestern University, 2211 Campus Drive, Evanston, IL 60208, USA.
| | - Bingxiao Wu
- Department of Economics, Rutgers University, 75 Hamilton St, New Brunswick, NJ 08901, USA.
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Maynou L, Mehtsun WT, Serra‐Sastre V, Papanicolas I. Patterns of adoption of robotic radical prostatectomy in the United States and England. Health Serv Res 2021; 56 Suppl 3:1441-1461. [PMID: 34350592 PMCID: PMC8579206 DOI: 10.1111/1475-6773.13706] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/15/2021] [Accepted: 06/27/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To compare patterns of technological adoption of minimally invasive surgery for radical prostatectomy across the United States and England. DATA SOURCES We examine radical prostatectomy in the United States and England between 2005 and 2017, using de-identified administrative claims data from the OptumLabs Data Warehouse in the United States and the Hospital Episodes Statistics in England. STUDY DESIGN We conducted a longitudinal analysis of robotic, laparoscopic, and open surgery for radical prostatectomy. We compared the trends of adoption over time within and across countries. Next, we explored whether differential adoption patterns in the two health systems are associated with differences in volumes and patient characteristics. Finally, we explored the relationship between these adoption patterns and length of stay, 30-day readmission, and urology follow-up visits. DATA COLLECTION Open, laparoscopic, and robotic radical prostatectomies are identified using Office of Population Censuses and Surveys Classification of Interventions and Procedures (OPCS) codes in England and International Classification of Diseases ninth revision (ICD9), ICD10, and Current Procedural Terminology (CPT) codes in the United States. PRINCIPAL FINDINGS We identified 66,879 radical prostatectomies in England and 79,358 in the United States during 2005-2017. In both countries, open surgery dominates until 2009, where it is overtaken by minimally invasive surgery. The adoption of robotic surgery is faster in the United States. The adoption rates and, as a result, the observed centralization of volume, have been different across countries. In both countries, patients undergoing radical prostatectomies are older and have more comorbidities. Minimally invasive techniques show decreased length of stay and 30-day readmissions compared to open surgery. In the United States, robotic approaches were associated with lower length of stay and readmissions when compared to laparoscopic. CONCLUSIONS Robotic surgery has become the standard approach for radical proctectomy in the United States and England, showing decreased length of stay and in 30-day readmissions compared to open surgery. Adoption rates and specialization differ across countries, likely a product of differences in cost-containment efforts.
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Affiliation(s)
- Laia Maynou
- Department of EconometricsStatistics and Applied Economics, Universitat de BarcelonaBarcelonaSpain
- Department of Health PolicyLondon School of Economics and Political ScienceLondonUK
- Center for Research in Health and EconomicsUniversitat Pompeu FabraBarcelonaSpain
- OptumLabsEden PrairieMinnesotaUSA
| | - Winta T. Mehtsun
- Department of Health Policy and ManagementHarvard T. H. Chan School of Public HealthBostonMassachusettsUSA
- Dana Farber Cancer InstituteBrigham and Women's Hospital, Massachusetts General HospitalBostonMassachusettsUSA
| | - Victoria Serra‐Sastre
- Department of Health PolicyLondon School of Economics and Political ScienceLondonUK
- Department of EconomicsCity, University of LondonLondonUK
- Office of Health EconomicsLondonUK
| | - Irene Papanicolas
- Department of Health PolicyLondon School of Economics and Political ScienceLondonUK
- OptumLabsEden PrairieMinnesotaUSA
- Department of Health Policy and ManagementHarvard T. H. Chan School of Public HealthBostonMassachusettsUSA
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Amin S, Yousaf R, Anwar MA, Arshed N. Assessing the impact of diversity and ageing population on health expenditure of United States. Int J Health Plann Manage 2021; 37:913-929. [PMID: 34762749 DOI: 10.1002/hpm.3383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 09/03/2021] [Accepted: 10/27/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND At the biological level, ageing results from a plodding decline in physical and mental capability, an emergent menace of malady, and eventually, fatality. Even though a few of the geriatric's health changes are hereditary, to a great extent is due to individual's physical and societal surroundings and their residence, locality, societies, gender, ethnicity or socio-economic status. The current debate is well popular by the relationship between increasing diversity and the ageing population with healthcare expenditure in the United States. Higher diversity in society and increasing ageing population have various socio-economic consequences. A good policy in this regard helpful to managed and get fruitful outcomes. OBJECTIVE This study aims to examine the direct effects of diversity and ageing population on healthcare spending. The assortment observed in geriatrics is not arbitrary. A huge portion emerges from individual's physical and social settings and the influence of these environs on their prospect and well-being demeanour. METHOD This study used the Bayesian-vector autoregressive model, impulse response analysis, and variance decomposition and data over the period 1990-2018 for empirical analysis of the United States. RESULTS The empirical findings indicate that diversity and ageing population are more persistent with health expenditure in the United States. This study concludes that an increase in diversity and ageing population will rely on the long-term healthcare facility. CONCLUSION The study suggests that cohesive society and effective health intervention might aid in curtailing expenditure pressure linked with elderly population. Furthermore, a recommendation of this study is a good opportunity for healthcare policymakers and further researches.
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Affiliation(s)
- Saqib Amin
- Oulu Business School, University of Oulu, Oulu, Finland
| | - Ruhamah Yousaf
- Department of Economics, University of Lahore, Lahore, Pakistan
| | - Muhammad Awais Anwar
- Department of Economics and Business Administration, Division of Management and Business Administrative Sciences, University of Education, Lahore, Pakistan
| | - Noman Arshed
- Department of Economics and Statistics, University of Management and Technology, Lahore, Pakistan
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Hollenbeck BK, Dunn RL, Sukul D, Modi PK, Nallamothu BK, Sen A, Bynum JP. Aortic valve replacement among patients with Alzheimer's disease and related dementias. J Am Geriatr Soc 2021; 69:3468-3475. [PMID: 34498253 DOI: 10.1111/jgs.17432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/16/2021] [Accepted: 07/31/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has made palliation from aortic stenosis more broadly available to populations previously thought to be too high risk for surgery, such as those with Alzheimer's disease and related dementias (ADRD); however, its safety and effectiveness in this context are uncertain. METHODS We performed a retrospective cohort study of national Medicare beneficiaries, aged 66 and older with Parts A and B, between 2010 and 2016. Patients undergoing AVR were identified, and follow-up was available through 2017. Multivariable regression was used to measure the independent association between having a diagnosis of ADRD at the time of AVR, stratified by TAVR and surgery, and outcomes (mortality and Medicare institutional days at 1 year after AVR). RESULTS The average rate of increase in AVR per year was 17.5 cases per 100,000 ADRD and 8.4 per 100,000 non-ADRD beneficiaries, largely driven by more rapid adoption of TAVR. Adjusted mortality following AVR declined significantly between those treated in 2010 and 2016, from 13.5% (95% CI 10.2%-17.7%) to 6.3% (95% CI 5.2%-7.6%) and from 13.7% (95% CI 12.7%-14.7%) to 6.3% (95% CI 5.8%-6.9%) in those with and without ADRD, respectively. The sharpest decline was noted for patients undergoing TAVR between 2011 and 2016, with adjusted mortality declining from 19.9% (95% CI 11.2%-32.8%) to 5.2% (95% CI 4.1%-6.5%) and from 12.2% (95% CI 9.3%-15.8%) to 5.0% (95% CI 4.4%-5.6%) in patients with and without ADRD, respectively. Similar declines were evident for Medicare institutional days in the year after AVR in both patient groups. CONCLUSIONS Rates of AVR in those with ADRD increased during the past decade largely driven by the diffusion of TAVR. The use of TAVR in this vulnerable population did not come at the expense of increasing Medicare institutional days or mortality at 1-year.
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Affiliation(s)
- Brent K Hollenbeck
- Departments of Urology, Medicine, and Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Rodney L Dunn
- Departments of Urology, Medicine, and Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Devraj Sukul
- Departments of Urology, Medicine, and Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Parth K Modi
- Departments of Urology, Medicine, and Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Brahmajee K Nallamothu
- Departments of Urology, Medicine, and Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Ananda Sen
- Departments of Urology, Medicine, and Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Julie P Bynum
- Departments of Urology, Medicine, and Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
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Elvira D, Obach M, Pontes C. Description of the use of multicriteria to support pricing and reimbursement decisions by European health technology assessment bodies. BMC Health Serv Res 2021; 21:814. [PMID: 34391431 PMCID: PMC8364048 DOI: 10.1186/s12913-021-06784-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heterogeneity in drug access throughout Europe may be influenced by differences in drug-assessment strategies. The EUnetHTA's assessment core model (EUnetHTA-core) and the EVIDEM's multicriteria framework are reference methodologies in this context, the latter including a wider compromise between non-contextual and contextual criteria. Compliance of 37 European Health Technology Assessment bodies (HTAb) with EUnetHTA-core has been reported, but the use of EVIDEM by this HTAb is still unknown. METHODS To describe the uptake and use of multicriteria approaches to evaluate drug value by European HTAb using EVIDEM as reference framework, a multicriteria framework was obtained based on EVIDEM model. The criteria used for drug appraisal by HTAb was extracted from the EUnetHTA report, and completed through search of websites, publications and HTAb reports. Use of EVIDEM assessment model in 37 European HTAb has been described semi-quantitatively and summarized using an alignment heatmap. RESULTS Aligned, medium or misaligned profiles were seen for 24,3%, 51,4% and 24,3% of HTAb when matching to EVIDEM dimensions and criteria was considered. HTAb with explicit responsibilities in providing specific advice on reimbursement showed more aligned profiles on contextual and non-contextual dimensions. CONCLUSIONS EUnetHTA's core model is limited in assessing medicines while EVIDEM's framework provides contextual dimension used by some HTAb in Europe that can be escalated to other agencies. Most of the 37 European HTAb have room to broaden their contextual assessment tools, especially when social and medical perception of need requires to be explicit to support payer's decision on reimbursement.
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Affiliation(s)
- David Elvira
- Departament de Farmacologia, de Terapèutica i de Toxicologia, Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
| | - Mercè Obach
- Servei Català de la Salut, Gerència del Medicament, Barcelona, Spain
| | - Caridad Pontes
- Departament de Farmacologia, de Terapèutica i de Toxicologia, Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain. .,Servei Català de la Salut, Gerència del Medicament, Barcelona, Spain.
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Liu W, Han G, Yan X, Zhang X, Ning G, Akhmedov AR, Hunter WC. The Impact of Mental Health Status on Health Consumption of the Elderly in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6622. [PMID: 34202967 PMCID: PMC8296420 DOI: 10.3390/ijerph18126622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022]
Abstract
Based on the national baseline survey data of the CHARLS2015, the comprehensive evaluation index of depression degree of the elderly in China is calculated using a principal component analysis method. The Tobit model is used to investigate the influence of mental health status with depression degree as a proxy variable on the health consumption of the elderly in China. The results show that the overall effect and the phased effect of depression on the health consumption of the elderly are positive. In other words, high levels of depression lead to a higher probability and amount of health consumption. Research findings show that chronic illness and increased social activity can weaken the effect of depression on the health spending of the elderly. Fully considering the factors affecting the mental health of elderly people is required to improve their level of mental health. Importantly, the quality audit system of health products and the supervision and management system of the health consumption market should be improved to realize the benign operation of the health consumption market.
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Affiliation(s)
- Wen Liu
- Business School, Shandong University, Weihai 264209, China; (W.L.); (X.Y.); (G.N.)
| | - Guosheng Han
- Business School, Shandong University, Weihai 264209, China; (W.L.); (X.Y.); (G.N.)
| | - Xiangzi Yan
- Business School, Shandong University, Weihai 264209, China; (W.L.); (X.Y.); (G.N.)
| | - Xuan Zhang
- Business School, Shandong University, Jinan 250100, China;
| | - Guangjie Ning
- Business School, Shandong University, Weihai 264209, China; (W.L.); (X.Y.); (G.N.)
| | | | - William Cannon Hunter
- Department of Convention Management, College of Hotel and Tourism, Kyung Hee University, Seoul 02447, Korea
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Zheng M, Zhu J. The Impact of the Upgrading of the Industrial Structure on the Urban Employee Basic Medical Insurance Fund: An Empirical Study in China. Risk Manag Healthc Policy 2021; 14:2133-2144. [PMID: 34079400 PMCID: PMC8163998 DOI: 10.2147/rmhp.s298145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/11/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND During the transformation of economy to a high-quality level in China, industrial restructuring and upgrading have played an important role. The upgrading of the industrial structure has affected not only the development in society and economy but also other fields, thereby having great impact on social security. In recent years, with the aging of the population and economic development, the social medical insurance fund is undertaking more payment pressure. However, the existing research rarely focuses on the impact of industrial structure upgrading on medical insurance. OBJECTIVE The main aim of this study was to analyze the impact of the upgrading of industrial structure on the income and expenditure of the urban employee basic medical insurance fund. METHODS China's provincial panel data from 2007 to 2018, collected by the National Bureau of Statistics of China, were used to establish a panel regression model in order to investigate the impact of the upgrading of the industrial structure on the income and expenditure of the urban employee basic medical insurance fund. RESULTS The research showed that the upgrading of the industrial structure, in combination with the internal upgrading in the tertiary industry, had a positive impact on the income and expenditure of the urban employee basic medical insurance fund and that there were regional differences. The simple upgrading of the three major industries had no effect on the income or expenditure of the urban employee basic medical insurance fund. In addition to the upgrading of industrial structure, other factors such as the average salary of employed persons in urban units, the proportion of retirees among all insured persons in urban employee basic medical insurance and the expenditure of urban employee basic medical insurance were also found to have impact on the income of urban employee basic medical insurance. Moreover, the expenditure of urban employee basic medical insurance was associated with the proportion of retirees among all insured persons in urban employee basic medical insurance, GDP and an aging population. CONCLUSION In the context of the upgrading of the industrial structure, measures such as strengthening employment and income security, delaying retirement, adjusting birth policy, strengthening the scientific management of personal accounts and accurately positioning the regional industrial structure were suggested to be adopted in order to minimize the payment pressures on the urban employee basic medical insurance fund.
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Affiliation(s)
- Meng Zheng
- School of Public Health, Capital Medical University, Beijing, People’s Republic of China
- Research Center for Capital Health Management and Policy, Beijing, People’s Republic of China
| | - Junli Zhu
- School of Public Health, Capital Medical University, Beijing, People’s Republic of China
- Research Center for Capital Health Management and Policy, Beijing, People’s Republic of China
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García-Goñi M, Río-Álvarez I, Carcedo D, Villacampa A. Budget Impact Analysis of Biosimilar Products in Spain in the Period 2009-2019. Pharmaceuticals (Basel) 2021; 14:ph14040348. [PMID: 33918795 PMCID: PMC8069914 DOI: 10.3390/ph14040348] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022] Open
Abstract
Since the first biosimilar medicine, Omnitrope® (active substance somatropin) was approved in 2006, 53 biosimilars have been authorized in Spain. We estimate the budget impact of biosimilars in Spain from the perspective of the National Health System (NHS) over the period between 2009 and 2019. Drug acquisition costs considering commercial discounts at public procurement procedures (hospital tenders) and uptake data for both originator and biosimilar as actual units consumed by the NHS were the two variables considered. Two scenarios were compared: a scenario where no biosimilars are available and the biosimilar scenario where biosimilars are effectively marketed. All molecules exposed to biosimilar competition during this period were included in the analysis. The robustness of the model was tested by conducting multiple sensitivity analyses. From the payer perspective, it is estimated that the savings produced by the adoption of biosimilars would reach EUR 2306 million over 11 years corresponding to the cumulative savings from all biosimilars. Three molecules (infliximab, somatropin and epoetin) account for 60% of the savings. This study provides the first estimation of the financial impact of biosimilars in Spain, considering both the effect of discounts that manufacturers give to hospitals and the growing market share of biosimilars. We estimate that in our last year of data, 2019, the savings derived from the use of biosimilars relative total pharmaceutical spending in Spain is 3.92%. Although more research is needed, our evidence supports the case that biosimilars represent a great opportunity to the sustainability of the NHS through rationalizing pharmaceutical spending and that the full potential of biosimilar-savings has not been achieved yet, as there is a high variability in biosimilar uptake across autonomous regions.
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Affiliation(s)
- Manuel García-Goñi
- Department of Applied & Structural Economics and History, Faculty of Economics and Business, Complutense University of Madrid, Campus de Somosaguas, Pozuelo de Alarcón, 28223 Madrid, Spain
- Correspondence: ; Tel.: +34-91-394-30-00
| | | | - David Carcedo
- Hygeia Consulting S. L., 28046 Madrid, Spain; (D.C.); (A.V.)
| | - Alba Villacampa
- Hygeia Consulting S. L., 28046 Madrid, Spain; (D.C.); (A.V.)
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Fonseca R, Michaud PC, Galama T, Kapteyn A. Accounting for the Rise of Health Spending and Longevity. JOURNAL OF THE EUROPEAN ECONOMIC ASSOCIATION 2021; 19:536-579. [PMID: 33679266 PMCID: PMC7935060 DOI: 10.1093/jeea/jvaa003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We estimate a stochastic life-cycle model of endogenous health spending, asset accumulation and retirement to investigate the causes behind the increase in health spending and longevity in the U.S. over the period 1965-2005. Accounting for changes over time in taxes, transfers, Social Security, income, health insurance, smoking and obesity, and technological progress, we estimate that technological progress is responsible for half of the increase in life expectancy over the period. Substantial growth in health spending over the period is largely the result of growth in economic resources and the generosity of health insurance, with a modest role for medical technological progress. The growth in spending does not come from changes in a single source, but sources jointly interacted to increase spending: complementarity effects explain up to 26.3% of the increase in health spending. Overall, for those born in 1940, the combined changes in resources and health insurance that occurred over the period are valued at 35.7% of lifetime consumption.
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Affiliation(s)
| | | | - Titus Galama
- University of Southern California; Vrije Universiteit, Amsterdam; Erasmus University, Rotterdam, Tinbergen Institute
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Qin X, Godil DI, Khan MK, Sarwat S, Alam S, Janjua L. Investigating the effects of COVID-19 and public health expenditure on global supply chain operations: an empirical study. OPERATIONS MANAGEMENT RESEARCH 2021. [PMCID: PMC7786342 DOI: 10.1007/s12063-020-00177-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This fresh examination was a thought-provoking area that was required to be undertaken and to fill this gap, the researchers have examined the impact of Covid-19 and health expenditure on the global supply chain by utilizing balanced panel data for the period from January 2020 to June 2020. This study utilized a random effect, fixed effect, GMM, and FGLS approach. The outcomes of COVID-19 demonstrate a significant negative influence as per the FGLS model, whereas the health expenditure demonstrates a significant negative effect on the global supply chain under both the dynamic models i.e. GMM and FGLS. As far as manufacturing value-added is concerned it indicates a positive and significant influence on the global supply chain according to the FGLS model whereas, last but not least the logistics performance index has a significant positive effect on the global supply chain according to the results of GMM and FGLS models respectively. The global supply chain is the lifeline for the global economy; thus, it is suggested that under COVID-19 pandemic situation policymakers need to react quickly and take suitable policy actions to deal with this unprecedented pandemic driven economic crises and further the cross-border trading activities should not be stopped, rather governments should formulate smart lockdown strategies.
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Affiliation(s)
- Xuanlong Qin
- College of Transportation Engineering, Chang’an University, Xi’an, 710064 China
| | - Danish Iqbal Godil
- Business Studies Department, Bahria Business School, Bahria University Karachi Campus, Karachi, Pakistan
| | | | - Salman Sarwat
- Benazir Bhutto Shaheed University Lyari, Karachi, Pakistan
| | - Sadaf Alam
- Bahria Business School, Bahria University Islamabad Campus, Islamabad, Pakistan
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Elek P, Bíró A. Regional differences in diabetes across Europe - regression and causal forest analyses. ECONOMICS AND HUMAN BIOLOGY 2021; 40:100948. [PMID: 33276258 DOI: 10.1016/j.ehb.2020.100948] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 06/12/2023]
Abstract
We examine regional differences in diabetes within Europe, and relate them to variations in socio-economic conditions, comorbidities, health behaviour and diabetes management. We use the SHARE (Survey of Health, Ageing and Retirement in Europe) data of 15 European countries and 28,454 individuals, who participated both in the 4th and 7th (year 2011 and 2017) waves of the survey. First, we estimate multivariate regressions, where the outcome variables are diabetes prevalence, diabetes incidence, and weight loss due to diet as an indicator of management. Second, we study the heterogeneous impact of demographic, socio-economic, health and lifestyle indicators on the regional differences in diabetes incidence with causal random forests. Compared to Western Europe, the odds of a new diabetes diagnosis over a six-year horizon is 2.2-fold higher in Southern and 2.6-fold higher in Eastern Europe. Adjusting for individual characteristics, the odds ratio decreases to 1.8 in the South-West and to 2.0 in the East-West dimension. These remaining differences are mostly explained by country-specific healthcare indicators. Based on the causal forest approach, the adjusted East-West difference is essentially zero for the lowest risk groups (tertiary education, employment, no hypertension, no overweight) and increases substantially with these risk factors, but the South-West difference is much less heterogeneous. The prevalence of diet-related weight loss around the time of diagnosis also exhibits regional variation. The results suggest that the regional differences in diabetes incidence could be reduced by putting more emphasis on diabetes prevention among high-risk individuals in Eastern and Southern Europe.
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Affiliation(s)
- Péter Elek
- Health and Population "Lendület" Research Group, Centre for Economic and Regional Studies, Budapest, Hungary; Institute of Economics, Corvinus University of Budapest, Hungary; Department of Economics, Eötvös Loránd University (ELTE), Budapest, Hungary.
| | - Anikó Bíró
- Health and Population "Lendület" Research Group, Centre for Economic and Regional Studies, Budapest, Hungary.
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Vanness DJ, Lomas J, Ahn H. A Health Opportunity Cost Threshold for Cost-Effectiveness Analysis in the United States. Ann Intern Med 2021; 174:25-32. [PMID: 33136426 DOI: 10.7326/m20-1392] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cost-effectiveness analysis is an important tool for informing treatment coverage and pricing decisions, yet no consensus exists about what threshold for the incremental cost-effectiveness ratio (ICER) in dollars per quality-adjusted life-year (QALY) gained indicates whether treatments are likely to be cost-effective in the United States. OBJECTIVE To estimate a U.S. cost-effectiveness threshold based on health opportunity costs. DESIGN Simulation of short-term mortality and morbidity attributable to persons dropping health insurance due to increased health care expenditures passed though as premium increases. Model inputs came from demographic data and the literature; 95% uncertainty intervals (UIs) were constructed. SETTING Population-based. PARTICIPANTS Simulated cohort of 100 000 individuals from the U.S. population with direct-purchase private health insurance. MEASUREMENTS Number of persons dropping insurance coverage, number of additional deaths, and QALYs lost from increased mortality and morbidity, all per increase of $10 000 000 (2019 U.S. dollars) in population treatment cost. RESULTS Per $10 000 000 increase in health care expenditures, 1860 persons (95% UI, 1080 to 2840 persons) were simulated to become uninsured, causing 5 deaths (UI, 3 to 11 deaths), 81 QALYs (UI, 40 to 170 QALYs) lost due to death, and 15 QALYs (UI, 6 to 32 QALYs) lost due to illness; this implies a cost-effectiveness threshold of $104 000 per QALY (UI, $51 000 to $209 000 per QALY) in 2019 U.S. dollars. Given available evidence, there is about 14% probability that the threshold exceeds $150 000 per QALY and about 48% probability that it lies below $100 000 per QALY. LIMITATIONS Estimates were sensitive to inputs, most notably the effects of losing insurance on mortality and of premium increases on becoming uninsured. Health opportunity costs may vary by population. Nonhealth opportunity costs were excluded. CONCLUSION Given current evidence, treatments with ICERs above the range $100 000 to $150 000 per QALY are unlikely to be cost-effective in the United States. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- David J Vanness
- Pennsylvania State University, University Park, Pennsylvania (D.J.V., H.A.)
| | - James Lomas
- University of York, York, United Kingdom (J.L.)
| | - Hannah Ahn
- Pennsylvania State University, University Park, Pennsylvania (D.J.V., H.A.)
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Maudgil DD. Cost effectiveness and the role of the National Institute of Health and Care Excellence (NICE) in interventional radiology. Clin Radiol 2020; 76:185-192. [PMID: 33081990 PMCID: PMC7568486 DOI: 10.1016/j.crad.2020.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/16/2020] [Indexed: 12/12/2022]
Abstract
Healthcare expenditure is continually increasing and projected to accelerate in the future, with an increasing proportion being spent on interventional radiology. The role of cost effectiveness studies in ensuring the best allocation of resources is discussed, and the role of National Institute of Health and Care Excellence (NICE) in determining this. Issues with demonstrating cost effectiveness have been discussed, and it has been found that there is significant scope for improving cost effectiveness, with suggestions made for how this can be achieved. In this way, more patients can benefit from better treatment given limited healthcare budgets.
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Affiliation(s)
- D D Maudgil
- Radiology Department, Wexham Park Hospital, Frimley Health Foundation Trust, Wexham Street, Slough, Berks, SL2 4HL, UK.
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Li L, Du T, Hu Y. The Effect of Population Aging on Healthcare Expenditure from a Healthcare Demand Perspective Among Different Age Groups: Evidence from Beijing City in the People's Republic of China. Risk Manag Healthc Policy 2020; 13:1403-1412. [PMID: 32943957 PMCID: PMC7473975 DOI: 10.2147/rmhp.s271289] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/14/2020] [Indexed: 11/30/2022] Open
Abstract
Background With population aging (PA), the healthcare expenditure (HE) increases. The aim of this study is to analyze the HE of different age groups and the effect of age on HE among different age groups. Methods Combining PA and HE data, this study used the fixed effect model and parameter estimation method to evaluate the influence of different age groups on HE from 2008 to 2014. Results The age effect of HE for the population aged 65 or over was the most significant among the different age groups. Based on PA and HE data, HE per capita of the age group 65 years or over is 7.25 times as much as the population aged < 25 years, 1.61 times as much as the population aged 25~59 years, and 3.47 times as much as the population aged 60~64 years. Based on the result of the fixed effect model, HE per capita of the age group <25 years was 218.39 Yuan (CNY) (USD $31.2). HE per capita of the age group 25~59 years old increased to 1,548.62 Yuan (CNY) (USD $221.2). HE per capita of the 60~64 years age group will be 921.56 Yuan (CNY) (USD $131.7), 4.22 times as much as that of the age group < 25 years. HE per capita in the age group of 65 years or over is 2,538.88 Yuan (CNY) (USD $362.7), 11.63 times as much as that of the age group <25 years. Conclusion The results suggest that PA in China is intensifying. In order to control the rising of HE, the government should not only address the supply side such as reforming medical insurance payment, developing new technologies, but also focusing on solving the demand side such as improving the quality of healthcare services, solving environmental pollution, and improving the residents’ health.
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Affiliation(s)
- Lele Li
- School of Public Policy and Management, Tsinghua University, Beijing 100084, People's Republic of China
| | - Tiantian Du
- Institute for Hospital Management, Tsinghua University, Shenzhen City 518055, Guangdong Province, People's Republic of China
| | - Yanping Hu
- Department of Medical Engineering, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
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Isabelle M, Stabile M. Local inequality and departures from publicly provided health care in Canada. HEALTH ECONOMICS 2020; 29:1031-1047. [PMID: 32558020 DOI: 10.1002/hec.4117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 01/22/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
This paper examines the relationship between changes in income inequality and the provision of resources in a health care system (the public-private mix). Specifically, we investigate whether increases in income inequality, as separate from overall income levels and growth, have changed the availability of both private clinics and privately financed physicians in a context where the dominant market player is the public system. Our findings provide reasonable evidence that increases in income inequality have led to substantial increases in both. We find that moving from median level of inequality across neighborhoods to the top 1% level of inequality increases the probably of a private clinic by 40% and the probability of having physicians who have opted out of the public system by 170%.
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Affiliation(s)
- Maripier Isabelle
- Département d'économique, Université Laval, Quebec City, Quebec, Canada
| | - Mark Stabile
- Economics and Political Science Area, INSEAD, Fontainebleau, France
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Russell H, Hall M, Morse RB, Cutler GJ, Macy M, Bettenhausen JL, Lopez MA, Shah SS, Sills MR. Longitudinal Trends in Costs for Hospitalizations at Children's Hospitals. Hosp Pediatr 2020; 10:797-801. [PMID: 32747333 DOI: 10.1542/hpeds.2020-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Children's hospitals are increasingly focused on value-based improvement efforts to improve outcomes and lower costs. Such efforts are generally focused on improving outcomes in specific conditions. Examination of cost drivers across all admissions may facilitate strategic prioritization of efforts. METHODS Pediatric Health Information System data set discharges from 2010 to 2017 were aggregated into services lines and billing categories. The mean annual growth per discharge as a percentage of 2010 total costs was calculated for aggregated medical and surgical service lines and 6 individual service lines with highest rates of growth. The mean annual growth per discharge for each billing category and changes in length of stay was further assessed. RESULTS The mean annual growth in total costs was similar for aggregated medical (2.6%) and surgical (2.7%) service lines. Individual medical service lines with highest mean annual growth were oncology (3.5%), reproductive services (2.9%), and nonsurgical orthopedics (2.8%); surgical service lines with highest rate of growth were solid organ transplant (3.7%), ophthalmology (3.3%), and otolaryngology (2.9%). CONCLUSIONS Room costs contributed most consistently to cost increases without concomitant increases in length of stay. Value-based health care initiatives must focus on room cost increases and their impacts on patient outcomes.
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Affiliation(s)
- Heidi Russell
- Department of Pediatrics and .,Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Rustin B Morse
- Children's Health, Children's Medical Center, Dallas, Texas.,Department of Pediatrics, University of Texas Southwestern, Dallas, Texas
| | - Gretchen J Cutler
- Children's Minnesota Research Institute, Children's Minnesota, Minneapolis, Minnesota
| | - Michelle Macy
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | | | - Samir S Shah
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and
| | - Marion R Sills
- Department of Pediatrics, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
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Abstract
The motive behind this article is investigating alternative indicator measures for the effectiveness of public health expenditure on pandemic preparedness, to explain the reasons behind country variations in containing crises such as Coronavirus disease 2019 (COVID-19). The purpose is to analyse the shortcomings in the relationship between global public health expenditure and pandemic preparedness. The research methodology includes a macro-analysis of global health spending patterns, empirical and theoretical literature on global health expenditure, global health security indexes, and country case studies pre- and post-crisis. The results show that gaps in pandemic preparedness were already existent pre-COVID-19, calling for a new mind-set in the way public health expenditure is structured. Healthcare sustainability indicators should transition from traditional measures such as economic growth rates, public health expenditure rates, revenue coming from the healthcare sector, and rankings in the global health security index, to new awareness indicators. Public health expenditure, a facilitator of pandemic preparedness, coupled with the resilience of healthcare systems, could be used in conjunction with the traditional factors, along with the time element of a quick response to pandemic through preparedness schemes, the progress towards achieving sustainable health through the implementation of the United Nations Sustainable Development Goals, and investment in national healthcare capital to ensure efficient resource allocation. The policy recommendations are the restructuring of public expenditure to expand the absorptive capacities of healthcare institutes, eventually leading to sustainability and universal health insurance.
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Rural Population Aging and the Hospital Utilization in Cities: The Rise of Medical Tourism in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134790. [PMID: 32635241 PMCID: PMC7369718 DOI: 10.3390/ijerph17134790] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 11/17/2022]
Abstract
The disparity of rural and urban hospital utilization has aroused much concern. With the improvement of their living standards, patients in rural areas have an emerging need for traveling across borders for better medical treatment in China. This paper reveals the medical tourism of rural residents towards urban hospitals driven by hospital needs and points out that such disparities may be caused by medical tourism. The ratio of people aged 65 and above in total rural populations was used to identify the potential target customers for medical tourism. Based on rural and urban datasets ranging from 2007-2017 on the provincial level, this paper presents a mobile treatment model and market concentration model with an ecological foundation. The feasible generalized least squared approach was used in the estimation of the fixed-effect regressions. The study found that there was a positive and significant relationship between rural old-age ratios and urban inpatient visits from different income groups. On average, a one percent rise in rural old-age ratio would increase the inpatient visits of urban hospitals by 138 thousand persons. There was also a positive and significant relationship between the rural old-age ratio and the market concentration of urban inpatient visits. It was found that the rural old-age ratio significantly influenced the market concentration of urban inpatient visits in the middle-high income regions. The research showed that each income group from the rural aged population had participated in medical tourism, traveled to urbanized regions and made inpatient visits to urbanized medical facilities. It was also indicated that the rural aged population, especially from the middle-high income groups had a positive and significant influence on the market concentration of urban inpatient visits in the province.
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Rodriguez Santana I, Aragón MJ, Rice N, Mason AR. Trends in and drivers of healthcare expenditure in the English NHS: a retrospective analysis. HEALTH ECONOMICS REVIEW 2020; 10:20. [PMID: 32607791 PMCID: PMC7325682 DOI: 10.1186/s13561-020-00278-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND In England, rises in healthcare expenditure consistently outpace growth in both GDP and total public expenditure. To ensure the National Health Service (NHS) remains financially sustainable, relevant data on healthcare expenditure are needed to inform decisions about which services should be delivered, by whom and in which settings. METHODS We analyse routine data on NHS expenditure in England over 9 years (2008/09 to 2016/17). To quantify the relative contribution of the different care settings to overall healthcare expenditure, we analyse trends in 14 healthcare settings under three broad categories: Hospital Based Care (HBC), Diagnostics and Therapeutics (D&T) and Community Care (CC). We exclude primary care and community mental health services settings due to a lack of consistent data. We employ a set of indices to aggregate diverse outputs and to disentangle growth in healthcare expenditure that is driven by activity from that due to cost pressures. We identify potential drivers of the observed trends from published studies. RESULTS Over the 9-year study period, combined NHS expenditure on HBC, D&T and CC rose by 50.2%. Expenditure on HBC rose by 54.1%, corresponding to increases in both activity (29.2%) and cost (15.7%). Rises in expenditure in inpatient (38.5%), outpatient (57.2%), and A&E (59.5%) settings were driven predominately by higher activity. Emergency admissions rose for both short-stay (45.6%) and long-stay cases (26.2%). There was a switch away from inpatient elective care (which fell by 5.1%) and towards day case care (34.8% rise), likely reflecting financial incentives for same-day discharges. Growth in expenditure on D&T (155.2%) was driven by rises in the volume of high cost drugs (270.5%) and chemotherapy (110.2%). Community prescribing grew by 45.2%, with costs falling by 24.4%. Evidence on the relationship between new technologies and healthcare expenditure is mixed, but the fall in drug costs could reflect low generic prices, and the use of health technology assessment or commercial arrangements to inform pricing of new medicines. CONCLUSIONS Aggregate trends in HCE mask enormous variation across healthcare settings. Understanding variation in activity and cost across settings is an important initial step towards ensuring the long-term sustainability of the NHS.
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Affiliation(s)
| | - María José Aragón
- Centre for Health Economics, Alcuin A Block, University of York, York, YO10 5DD, UK
| | - Nigel Rice
- Centre for Health Economics, Alcuin A Block, University of York, York, YO10 5DD, UK
| | - Anne Rosemary Mason
- Centre for Health Economics, Alcuin A Block, University of York, York, YO10 5DD, UK.
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