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Bade V, Schmitz H, Tawiah BB. Regional variations in vaccination against COVID-19 in Germany. PLoS One 2024; 19:e0296976. [PMID: 38635523 PMCID: PMC11025766 DOI: 10.1371/journal.pone.0296976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 12/25/2023] [Indexed: 04/20/2024] Open
Abstract
Vaccination willingness against COVID-19 is generally perceived as low. Moreover, there is large heterogeneity across and within countries. As a whole, Germany has average vaccination rates compared to other industrialized countries. However, vaccination rates in the 16 different German federal states differ by more than 20 percentage points. We describe variation in vaccination rates on the level of the 400 German counties using data on all vaccinations carried out until December 2022. Around 52-72% of that variation can be explained by regional differences in demographic characteristics, housing, education and political party preferences. We find indications that the remaining part may be due to differences in soft factors such as risk aversion, trust in the German government, trust in science, and beliefs in conspiracy theories regarding the origins of the Corona virus. We conclude that improving the trust in science and the fight against conspiracy theories may possibly be effective tools to improve vaccination rates and effectively fight pandemics.
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Affiliation(s)
| | - Hendrik Schmitz
- Paderborn University, Paderborn, Germany
- RWI – Leibniz Institute for Economic Research, Essen, Germany
- Leibniz Science Campus Ruhr, Essen, Germany
| | - Beatrice Baaba Tawiah
- Munich Research Institute for the Economics of Aging ans SHARE Analyses, Munich, Germany
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Ud Din MA, Dar MH, Haseen S. Inter-state disparities in government health expenditure in India: a study of national rural health mission. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2023. [DOI: 10.1108/ijhg-12-2022-0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PurposeThe study aims to compare India's public health expenditure at the international and state levels. The paper also empirically examines the regional disparities in NRHM spending across the 21 selected states of India.Design/methodology/approachThe tools of absolute β-and σ-convergence are used in the analysis to test the regional convergence. The average annual growth rate across the states is the dependent variable for β-convergence, and time is the second dependent variable but is used for s-convergence. In contrast, the initial value of NRHM expenditure and the coefficient of variation of NRHM expenditure are used as independent variables, respectively. Descriptive statistics are also used for the study. The data are annual and cover the panel from 2007 to 2020.FindingsThe study attests to the hypothesis of β-and σ-convergence for the selected states in the period mentioned. The observed convergence in NRHM expenditure is due to the shift in the government's attention from the non-high focus high focus states to high states through the national rural health mission policy. The coefficient of variation across the states also shows a declining trend and provides the robustness of the σ-convergence.Originality/valueAs far as the literature is concerned, none of the existing studies examines the convergence of a public health expenditure scheme like the National Rural Health Mission across the Indian states by applying the techniques of β-and σ-convergence. The novelty of the study is using the newly updated dataset and validating the convergence hypotheses in the National Rural Health Mission expenditure case.
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Ledesma-Cuenca A, Montañés A, Simón-Fernández MB. Disparities in premature mortality: Evidence for the OECD countries. Soc Sci Med 2022; 307:115198. [PMID: 35839668 DOI: 10.1016/j.socscimed.2022.115198] [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: 03/15/2022] [Revised: 05/17/2022] [Accepted: 07/03/2022] [Indexed: 11/28/2022]
Abstract
This paper studies the existence of international health outcome disparities. We focus on the use of the potential years of life lost for a database that includes information from 33 OECD countries and covers the period 1990-2017. The methodology proposed by Phillips and Sul (2007) allows us to reject the existence of a single pattern of behaviour between countries for both males and females, suggesting the existence of severe health outcome inequalities. This methodology estimates the existence of four convergence clubs whose composition slightly varies when comparing the male and female cases. Some socioeconomic factors are found to be very important in explaining the forces that may drive the creation of these convergence clubs. In particular, the evolution of the economy and health policies are pivotal to understanding the creation of these estimated convergence clubs. Additionally, our results offer evidence in favor of the importance of environmental policies to explain these health outcome differences.
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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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Health Care Expenditure in the European Union Countries: New Insights about the Convergence Process. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041991. [PMID: 35206178 PMCID: PMC8872178 DOI: 10.3390/ijerph19041991] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/20/2022] [Accepted: 02/08/2022] [Indexed: 02/06/2023]
Abstract
This paper assesses the convergence process in the health care expenditure for selected European Union (EU) countries over the past 50 years. As a novel contribution, we use bound unit root tests and, for robustness purposes, a series of tests for strict stationarity to provide new insights about the convergence process. We make a comparison between public and private health expenditure per capita and as a percentage of the gross domestic product (GDP), with a focus on six EU countries with different health care systems in place. When we consider the health expenditure per capita, we report mixed findings. We show that the spread from the group average is stationary in the cases of Finland and Portugal when the overall and public expenditure is considered. In terms of private expenditure, the convergence process is noticed only for Austria. For all other countries included in our sample, we document a non-stationary process, indicating a lack of convergence. This result is robust to the different tests we use. However, when we assess the convergence in terms of the health-expenditure-to-GDP ratio, the convergence process is recorded for Austria only. The robustness check we performed using strict stationarity tests partially confirmed the mixed results we obtained. Therefore, our findings highlight the heterogeneity of the EU health care systems and the need for identification of common solutions to the EU health care systems' problems in order to enhance their convergence processes.
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López-Mendoza H, Montañés A, Moliner-Lahoz FJ. Disparities in the Evolution of the COVID-19 Pandemic between Spanish Provinces. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5085. [PMID: 34064938 PMCID: PMC8151898 DOI: 10.3390/ijerph18105085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/04/2021] [Accepted: 05/09/2021] [Indexed: 12/11/2022]
Abstract
Spain experienced a second wave of the COVID-19 pandemic in autumn 2020, which has been approached with different measures by regional authorities. We analyze the presence of convergence in the cumulative incidence for 14 days (CI14) in provinces and self-governing cities. The Phillips-Sul methodology was used to study the grouping of behavior between provinces, and an ordered logit model was estimated to understand the forces that drive creating the different convergence clubs. We reject the presence of a single pattern of behavior in the evolution of the CI14 across territories. Four statistically different convergence clubs and an additional province (Madrid) with divergent behavior are observed. Provinces with developed agricultural and industrial economic sectors, high mobility, and a high proportion of Central and South American immigrants had the highest level of CI14. We show that the transmission of the virus is not homogeneous in the Spanish national territory. Our results are helpful for identifying differences in determinants that could explain the pandemic's evolution and for formulating hypotheses about the effectiveness of implemented measures.
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Affiliation(s)
- Héctor López-Mendoza
- Directorate-General of Public Health, Aragon Department of Health, 50017 Zaragoza, Spain;
- Preventive Medicine and Public Health Department, Lozano Blesa University Hospital, 50009 Zaragoza, Spain;
| | - Antonio Montañés
- Economic Analysis Department, University of Zaragoza, 50005 Zaragoza, Spain
| | - F. Javier Moliner-Lahoz
- Preventive Medicine and Public Health Department, Lozano Blesa University Hospital, 50009 Zaragoza, Spain;
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Does the Great Recession Contribute to the Convergence of Health Care Expenditures in the US States? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020554. [PMID: 31952256 PMCID: PMC7014266 DOI: 10.3390/ijerph17020554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 01/09/2020] [Accepted: 01/11/2020] [Indexed: 11/17/2022]
Abstract
This paper examines whether the Great Recession has altered the disparities of the US regional health care expenditures. We test the null hypothesis of convergence for the US real per capita health expenditure for the period 1980–2014. Our results indicate that the null hypothesis of convergence is clearly rejected for the total sample as well as for the pre-Great Recession period. Thus, no changes are found in this regard. However, we find that the Great Recession has modified the composition of the estimated convergence clubs, offering a much more concentrated picture in 2014 than in 2008, with most of the states included in a big club, and only 5 (Nevada, Utah, Arizona, Colorado and Georgia) exhibiting a different pattern of behavior. These two estimated clubs diverge and, consequently, the disparities in the regional health sector have increased.
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Yang C, Delcher C, Shenkman E, Ranka S. Expenditure variations analysis using residuals for identifying high health care utilizers in a state Medicaid program. BMC Med Inform Decis Mak 2019; 19:131. [PMID: 31299965 PMCID: PMC6626330 DOI: 10.1186/s12911-019-0870-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/04/2019] [Indexed: 11/25/2022] Open
Abstract
Background High utilizers receive great attention in health care research because they have a largely disproportionate spending. Existing analyses usually identify high utilizers with an empirical threshold on the number of health care visits or associated expenditures. However, such count-and-cost based criteria might not be best for identifying impactable high utilizers. Methods We propose an approach to identify impactable high utilizers using residuals from regression-based health care utilization risk adjustment models to analyze the variations in health care expenditures. We develop linear and tree-based models to best adjust per-member per-month health care cost by clinical and socioeconomic risk factors using a large administrative claims dataset from a state public insurance program. Results The risk adjustment models identify a group of patients with high residuals whose demographics and categorization of comorbidities are similar to other patients but who have a significant amount of unexplained health care utilization. Deeper analysis of the essential hypertension cohort and chronic kidney disease cohort shows these variations in expenditures could be within individual ICD-9-CM codes and from different mixtures of ICD-9-CM codes. Additionally, correlation analysis with 3M™ Potentially Preventable Events (PPE) software shows that a portion of this utilization may be preventable. In addition, the high utilizers persist from year to year. Conclusions After risk adjustment, patients with higher than expected expenditures (high residuals) are associated with more potentially preventable events. These residuals are temporally consistent and hence may be useful in identifying and intervening impactable high utilizers.
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Affiliation(s)
- Chengliang Yang
- Department of Computer & Information Science & Engineering, University of Florida, Gainesville, FL, USA.
| | - Chris Delcher
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Elizabeth Shenkman
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Sanjay Ranka
- Department of Computer & Information Science & Engineering, University of Florida, Gainesville, FL, USA
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Clemente J, Lázaro-Alquézar A, Montañés A. Convergence in Spanish Public health expenditure: Has the decentralization process generated disparities? Health Policy 2019; 123:503-507. [PMID: 30910477 DOI: 10.1016/j.healthpol.2019.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 06/15/2018] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Abstract
This study examines the per capita public health expenditures among the Spanish regions. To that end, we employ the database elaborated by the BBVA Fundation and IVIE (2013) which covers the years 1991-2010. We first test for the null hypothesis of convergence by employing the methodology proposed in Phillips and Sul (2007) in order to determine whether the evolution of the public health expenditures has followed a similar path across the Spanish regions. This methodology leads us to reject the null hypothesis of convergence, which implies the absence of a unique pattern of behavior in the evolution of the Spanish regional public health expenditures. Instead, we find several convergence clubs which reveal the existence of different patterns of behavior and serious disparities in the Spanish health system. When trying to determine the forces which drive the creation of these clubs, we also find some partisan behavior, in the sense that the longer a right-wing party governs, the lower the per capita public health expenditure in this region of Spain.
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Affiliation(s)
- Jesús Clemente
- Department of Economic Analysis, University of Zaragoza, Gran Vía 2, 50.005, Zaragoza, Spain
| | | | - Antonio Montañés
- Department of Economic Analysis, University of Zaragoza, Gran Vía 2, 50.005, Zaragoza, Spain.
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Shrestha SS, Thompson TJ, Kirtland KA, Gregg EW, Beckles GL, Luman ET, Barker LE, Geiss LS. Changes in Disparity in County-Level Diagnosed Diabetes Prevalence and Incidence in the United States, between 2004 and 2012. PLoS One 2016; 11:e0159876. [PMID: 27487006 PMCID: PMC4972249 DOI: 10.1371/journal.pone.0159876] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/08/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In recent decades, the United States experienced increasing prevalence and incidence of diabetes, accompanied by large disparities in county-level diabetes prevalence and incidence. However, whether these disparities are widening, narrowing, or staying the same has not been studied. We examined changes in disparity among U.S. counties in diagnosed diabetes prevalence and incidence between 2004 and 2012. METHODS We used 2004 and 2012 county-level diabetes (type 1 and type 2) prevalence and incidence data, along with demographic, socio-economic, and risk factor data from various sources. To determine whether disparities widened or narrowed over the time period, we used a regression-based β-convergence approach, accounting for spatial autocorrelation. We calculated diabetes prevalence/incidence percentage point (ppt) changes between 2004 and 2012 and modeled these changes as a function of baseline diabetes prevalence/incidence in 2004. Covariates included county-level demographic and, socio-economic data, and known type 2 diabetes risk factors (obesity and leisure-time physical inactivity). RESULTS For each county-level ppt increase in diabetes prevalence in 2004 there was an annual average increase of 0.02 ppt (p<0.001) in diabetes prevalence between 2004 and 2012, indicating a widening of disparities. However, after accounting for covariates, diabetes prevalence decreased by an annual average of 0.04 ppt (p<0.001). In contrast, changes in diabetes incidence decreased by an average of 0.04 ppt (unadjusted) and 0.09 ppt (adjusted) for each ppt increase in diabetes incidence in 2004, indicating a narrowing of county-level disparities. CONCLUSIONS County-level disparities in diagnosed diabetes prevalence in the United States widened between 2004 and 2012, while disparities in incidence narrowed. Accounting for demographic and, socio-economic characteristics and risk factors for type 2 diabetes narrowed the disparities, suggesting that these factors are strongly associated with changes in disparities. Public health interventions that target modifiable risk factors, such as obesity and physical inactivity, in high burden counties might further reduce disparities in incidence and, over time, in prevalence.
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Affiliation(s)
- Sundar S. Shrestha
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, United States of America
| | - Theodore J. Thompson
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, United States of America
| | - Karen A. Kirtland
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, United States of America
| | - Edward W. Gregg
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, United States of America
| | - Gloria L. Beckles
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, United States of America
| | - Elizabeth T. Luman
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, United States of America
| | - Lawrence E. Barker
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, United States of America
| | - Linda S. Geiss
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, United States of America
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Göpffarth D, Kopetsch T, Schmitz H. Determinants of Regional Variation in Health Expenditures in Germany. HEALTH ECONOMICS 2016; 25:801-815. [PMID: 25962986 DOI: 10.1002/hec.3183] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 03/02/2015] [Accepted: 03/24/2015] [Indexed: 06/04/2023]
Abstract
Health care expenditure in Germany shows clear regional differences. Such geographic variations are often seen as an indicator for inefficiency. With its homogeneous health care system, low co-payments and uniform prices, Germany is a particularly suited example to analyse regional variations. We use data for the year 2011 on expenditure, utilization of health services and state of health in Germany's statutory health insurance system. This data, which originate from a variety of administrative sources and cover about 90% of the population, are enriched with a wealth of socio-economic variables, data on pollutants, prices and individual preferences. State of health and demography explains 55% of the differences as measured by the standard deviation while all control variables account for a total of 72% of the differences at county level. With other measures of variation, we can account for an even greater proportion. A higher proportion of variation than usually supposed can thus be explained. Whilst this study cannot quantify inefficiencies, our results contradict the thesis that regional variations reflect inefficiency. Copyright © 2015 John Wiley & Sons, Ltd.
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Fernandez JL, Forder J. Local variability in long-term care services: local autonomy, exogenous influences and policy spillovers. HEALTH ECONOMICS 2015; 24 Suppl 1:146-157. [PMID: 25760589 DOI: 10.1002/hec.3151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 11/25/2014] [Accepted: 11/25/2014] [Indexed: 06/04/2023]
Abstract
In many countries, public responsibility over the funding and provision of long-term care services is held at the local level. In such systems, long-term care provision is often characterised by significant local variability. Using a panel dataset of local authorities over the period 2002-2012, the paper investigates the underlying causes of variation in gross social care expenditure for older people in England. The analysis distinguishes between factors outside the direct control of policy makers, local preferences and local policy spillovers. The results indicate that local demand and supply factors, and to a much lesser extent local political preferences and spatial policy spillovers, explain a large majority of the observed variation in expenditure.
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Affiliation(s)
- José-Luis Fernandez
- PSSRU, London School of Economics and Political Science, London, WC2A 2AE, UK
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Chicklis C, MaCurdy T, Bhattacharya J, Shafrin J, Zaidi S, Rogers D. Regional Growth in Medicare Spending, 1992-2010. Health Serv Res 2015; 50:1574-88. [PMID: 25676603 DOI: 10.1111/1475-6773.12287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine if regions with high Medicare expenditures in a given setting remain high cost over time. DATA SOURCES/STUDY SETTING One hundred percent of national Medicare Parts A and B fee-for-service beneficiary claims data and enrollment for 1992-2010. STUDY DESIGN Patients are classified into regions. Claims are price-standardized. Risk adjustment is performed at the beneficiary level using the CMS Hierarchical Condition Categories model. Correlation analyses are conducted. DATA COLLECTION/EXTRACTION METHODS The data were obtained through a contract with CMS for a study performed for the Institute of Medicine. PRINCIPAL FINDINGS High-cost regions in 1992 are likely to remain high cost in 2010. Stability in regional spending is highest in the home health, inpatient hospital, and outpatient hospital settings over this time period. Despite the persistence of a region's relative spending over time, a region's spending levels in all settings except home health tend to regress toward the mean. CONCLUSIONS Relatively high-cost regions tend to remain so over long periods of time, even after controlling for patient health status and geographic price variation, suggesting that the observed effect reflects real differences in practice patterns.
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Affiliation(s)
- Camille Chicklis
- Departments of Mathematics and Religion, Williams College, Acumen, LLC and SPHERE Institute, Burlingame, CA
| | - Thomas MaCurdy
- Department of Economics, University of Chicago, Acumen, LLC and SPHERE Institute, Burlingame, CA.,Department of Economics, University of Washington, Acumen, LLC and SPHERE Institute, Burlingame, CA
| | - Jay Bhattacharya
- Department of Economics, Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Jason Shafrin
- Department of Economics, University of California, San Diego, La Jolla, CA.,Department of Business and Policy, Wharton School, University of Pennsylvania, Philadelphia, PA.,Spanish Department, School of Arts & Sciences, University of Pennsylvania, Philadelphia, PA.,Precision Health Economics, Los Angeles, CA
| | - Sajid Zaidi
- Princeton Department of Economics, Acumen, LLC, Burlingame, CA
| | - Daniel Rogers
- Departments of Economics and Mathematics, University of California, Berkeley, Acumen, LLC, Burlingame, CA
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Apergis N, Padhi P. Health expenses and economic growth: convergence dynamics across the Indian States. ACTA ACUST UNITED AC 2013; 13:261-77. [PMID: 24037442 DOI: 10.1007/s10754-013-9130-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 08/27/2013] [Indexed: 10/26/2022]
Abstract
In this paper we explore convergence of real per capita output and health expenses across the Indian States. The new panel convergence methodology, developed by Phillips and Sul (Econometrica 75:1771-1855, 2007), is employed. The empirical findings suggest that these States form distinct convergent clubs, exhibiting considerable heterogeneity in the underlying growth and health expenses factors. These findings should help policy makers in designing appropriate growth-oriented and/or health sector programs and setting priorities in their implementation.
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Affiliation(s)
- Nicholas Apergis
- Department of Banking and Financial Management, University of Piraeus, Piraeus, Greece,
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