Is Taking a Pill a Day Good for Health Expenditures? Evidence from a Cross Section Time Series Analysis of 19 OECD Countries from 1970 – 2000

This paper differs in two ways from previous comparative health system research. First, it focuses on the impact of pharmaceutical expenditures on total health expenditures as trends in pharmaceutical expenditures have been blamed of being a major driver of national health expenditures. In addition to pharmaceutical expenditures, other variables of interest are income, public financing, public delivery, ageing and urbanization. Second, the analysis includes a thorough sensitivity analysis on the proposed model using four samples (with and without the US, and imputed and not imputed data) to address the issue of robustness. Based on a typology of health care systems, trends of relevant explanatory variables are described using OECD Health Data 2003 data. Unlike any other of the variables, pharmaceutical expenditures show contradicting trends when measured as per capita pharmaceutical expenditures and pharmaceutical share of total health expenditures. Next, a regression analysis is performed on data from 1970 – 2000 for 19 OECD countries. Regression diagnostics indicated the absence of multicollinearity but the presence of heteroscedasticity and autocorrelation. Based on the Hausman test, a fixed effect model was chosen. As in all previous empirical research, per capita GDP turned out to be the most influential explanatory variable. While public financing of health care was always three out of four samples significantly inversely related to health expenditures, public delivery as a NHS dummy was always significantly positively related to the dependent variable. Unlike previous research, ageing is consistently and significantly related to higher total health expenditures and, so is urbanization. Finally, all samples show a highly negative relationship between share of pharmaceutical expenditures and health expenditures, suggesting support for the substitution theory.health care expenditure ; health care system ; health economics ; health policy ; comparative

The Effect of Obesity on State Health Care Expenditures: An Empirical Analysis

The purpose of this study is to examine the effects of obesity rates on per capita state health care expenditures. A two-stage least square regression model is used. In the first stage of the estimation, factors influencing obesity rates are determined. The determinants of obesity rates are outlined throughout the research process. In the second stage, the impact of obesity rates on per capita health expenditures across states is evaluated. The empirical results indicate that obesity rates do indeed have a direct effect on state health care expenditures. After reviewing the project’s results, various solutions are proposed as possible methods to slow and perhaps reverse growing obesity rates with the objective of reducing health care expenditures. The solutions offered may possibly decrease the prevalence of obesity across the nation and in turn lower per capita health care spending

Modelling health care expenditures; overview of the literature and evidence from a panel time series model

The first purpose of this paper is to give an up to date overview of the literature on health care expenditures. Secondly, this paper contributes to the existing literature by investigating the impact of several factors on health care expenditures in an empirical analysis using an error-correction model. Health care expenditures in industrial countries have been growing rapidly over the past forty years. This rapid growth jeopardizes the sustainability of public budgets and causes an increasing interest in the determinants of health care expenditures. Additional to the 'usual suspects' for rising health care expenditures, we pay attention to a somewhat neglected driving factor, which is the increase in the relative price of health care compared to other goods and services. We find that the increasing price of health care helps to explain the increase in real health care expenditures. However, the use of health care in volume terms is negatively affected by the increasing price. This effect seems to be stronger in periods of cost containment policy. Consistent with most recent findings in the literature, we find that income and ageing are important drivers of health care expenditures.

Health Expenditure Scenarios in the New Member States – Comparative Report on Bulgaria, Estonia, Hungary, Poland and Slovakia. ENEPRI Research Reports No. 43, 19 December 2007

The objective of this comparative report is to present the model of future health care system revenues and expenditures in selected Central and Eastern European countries which are now the new EU member states, and to discuss projection assumptions and results. Health expenditure analysis and projections are based on the ILO social budget model, a part of which is the health budget model. The model covers health care system revenues and expenditures. It is suitable for the analysis of impact exerted by demography (especially ageing) on health care system revenues and expenditures. The objective of AHEAD project is to examine those factors. Up to date, data and information sources in new member states that could be used for the long-term comparative projections have been limited

New Evidence on the Role of Remittances on Health Care Expenditures by Mexican Households

Using Mexico's 2002 wave of the Encuesta Nacional de Ingresos y Gastos de los Hogares (ENIGH), we find that international remittances raise health care expenditures. Approximately 6 pesos of every 100 peso increment in remittance income are spent on health. The sensitivity of health care expenditures to variations in the level of international remittances is almost three times greater than its responsiveness to changes in other sources of household income. Furthermore, health care expenditures are less responsive to remittance income among lower-income households. Since the lower responsiveness may be partially due to participation of lower-income households in public programs like PROGRESA (now called Oportunidades), we also analyze the impact of remittances by health care coverage. As expected, we find that households with some kind of health care coverage – either through their jobs or via participation in PROGRESA – spend less of remittance income increments on health care than households lacking any health care coverage. Hence, remittances may help equalize health care expenditures across households with and without health care coverage.remittances, health care, household expenditures, Mexico

Why do Education Expenditures Fail to Reduce Child Labor? Looking for an Optimal Composition of the Social Expenditures

In a framework, where child labor results from a risky choice between working and schooling, we study the reason why public education expenditures may fail to reduce child labor. We determine an optimal composition of social expenditures between education and health which minimizes child labor for a given government's budget. This is tested with panel data over 81 developing countries. It is evidenced that the unbalanced structure of the social spending favourable to education to the detriment of health often observed in the poor countries is inefficient to reduce child labor. More generally, our statements shed light on the need to reconsider the conventional wisdom viewing public health and education expenditures as substitutes.Child Labor, Education Expenditures, Health Expenditures

State-Level and County-Level Estimates of Health Care Costs Associated with Food Insecurity.

IntroductionFood insecurity, or uncertain access to food because of limited financial resources, is associated with higher health care expenditures. However, both food insecurity prevalence and health care spending vary widely in the United States. To inform public policy, we estimated state-level and county-level health care expenditures associated with food insecurity.MethodsWe used linked 2011-2013 National Health Interview Survey/Medical Expenditure Panel Survey data (NHIS/MEPS) data to estimate average health care costs associated with food insecurity, Map the Meal Gap data to estimate state-level and county-level food insecurity prevalence (current though 2016), and Dartmouth Atlas of Health Care data to account for local variation in health care prices and intensity of use. We used targeted maximum likelihood estimation to estimate health care costs associated with food insecurity, separately for adults and children, adjusting for sociodemographic characteristics.ResultsAmong NHIS/MEPS participants, 10,054 adults and 3,871 children met inclusion criteria. Model estimates indicated that food insecure adults had annual health care expenditures that were $1,834 (95$1,073-2,595, P < .001) higher than food secure adults. For children, estimates were 80 higher, but this finding was not significant (95% CI, -$171 to$329, P = .53). The median annual health care cost associated with food insecurity was $687,041,000 (25th percentile,$239,675,000; 75th percentile, $1,140,291,000). The median annual county-level health care cost associated with food insecurity was$4,433,000 (25th percentile, $1,774,000; 75th percentile,$11,267,000). Cost variability was related primarily to food insecurity prevalence.ConclusionsHealth care expenditures associated with food insecurity vary substantially across states and counties. Food insecurity policies may be important mechanisms to contain health care expenditures

Do economic crises lead to health and nutrition behavior responses?: analysis using longitudinal data from Russia

Using longitudinal data on more than 2,000 Russian families spanning the period between 2007 and 2010, this paper estimates the impact of the 2009 global financial crisis on food expenditures, health care expenditures, and doctor visits in Russia. The primary estimation strategy adopted is the semi-parametric difference-in-difference with propensity score matching technique. The analysis finds that household health and nutritional behavior indicators do not vary statistically between households that were crisis-affected and households that were not affected by the crisis. However the analysis finds that crisis-affected poor families curtailed their out-of-pocket health expenditures during and after the crisis more than poor families that were not affected by the crisis did. In addition, crisis-affected vulnerable groups changed their health behavior. In particular, households with low educational attainment of household heads and households with more elderly people changed their health and nutrition behavior response when affected by the crisis. The results are invariant to the propensity score matching techniques and parametric fixed effects estimation models

Ageing and changes in medical practices : reassessing theinfluence of demography

On the basis of French individual data, this paper compares the effect of demographic change, changes in morbidity and changes in practices on the growth in health expenditures that occurred between 1992 and 2000. Microsimulations show that the rise in expenditures due to aging is relatively small and that the impact of changes in practices is 3.8 times larger. Furthermore, changes in morbidity induce savings which more that offset the increase in spending due to the population aging.Aging - Health Expenditures - Micro-Simulations

Redistributing to the sick: How should health expenditures be integrated into the tax system?

I study the optimal joint taxation of income and health expenditures in a model in which individuals face idiosyncratic prices for leisure and health. First-best redistribution based on potential wage rates and health status is not feasible. Within a class of quasi-linear schedules, the conditions for an optimal tax/subsidy system depend on the own and cross price compensated elasticities of demand for leisure and health in a way that generalizes the standard results from the optimal linear income tax literature. Numerical simulations are employed to illustrate the sensitivity of tax and subsidy rates to the correlation between health status and wages. In these simulations, the effective marginal income tax rate optimally increases with health expenditures. However, the welfare gain from optimally incorporating health expenditures into the tax system appears to be very limited, compared with the effect of properly designing the income tax itself.Optimal taxation, health subsidies, redistribution