Convergence and determinants of health expenditures in OECD countries

The doctor vote: Interactions between political ideological preferences and healthcare reform strategies among U.S. physicians

Intro

Improving the American healthcare system has consistently predominated the domestic policy agenda in the United States for decades. However, physicians have traditionally played a small role in the U.S. legislative process despite their direct observations of the obstacles that cost, access, and quality can have on their patients and their care. The goal of this study was to examine the relationship between physician political ideological preferences and health policy reform options.

Methods

We conducted a cross-sectional survey of 3,001 currently practicing U.S. physicians to predict how self-identification as liberal, moderate, or conservative impacted a physician's policy preferences under the domains of cost, access, and quality.

Results

A total of 536 (18.8%) out of 3,001 physicians responded to the survey. Overall, 32% of physicians identified as liberal, 43% as moderate, and 22% as conservative.

Conclusion

Liberal-identifying physicians favored traditionally liberal reform ideas (a national health plan or public option), while conservative physicians preferred conservative policies (free market optimization). However, variation within political groups and domains of healthcare suggest that no single reform policy will be unanimously supported by every physician within a political group. Nonetheless, physicians are unanimously dissatisfied with the state of our current system, and physician-supported healthcare reform should be a national priority.

Digital informed consent for urological surgery - randomized controlled study comparing multimedia-supported vs. traditional paper-based informed consent concerning satisfaction, anxiety, information gain and time efficiency

INTRODUCTION

Due to a lack of time and staff, informed consent (IC) in clinical practice often lacks clarity, comprehensibility and scope of information. Digital media offer great potential to enhance IC. Aim of this study is to evaluate the effectiveness of multimedia-supported compared to traditional paper-based IC.

METHODS

In the randomized, controlled, three-arm DICon (Digital Informed Consent for urological surgery) study 70 patients with an indication for prostate biopsy were randomized 1:1:1 to receive traditional paper-based IC vs. multimedia-supported information before IC vs. multimedia-supported information during IC. Patient satisfaction, anxiety and information gain were measured by validated questionnaires 2 weeks and directly before the procedure and time efficiency was recorded. Statistical analysis was performed using Kruskal-Wallis and Dunn's test (one-way ANOVA) and two-way ANOVA (with bonferroni post-test).

RESULTS

Multimedia information prior to the consultation saved 32.9% time compared to paper-based (5.3 min. vs. 9.5 min; p < 0.05) and 60.4% time compared to shared multimedia information (5.3 min. vs. 13.9 min.; p < 0.001), with no difference in satisfaction (62.6 vs. 62.7 vs. 68.6 of max. 80; p = 0.07), anxiety (8 vs. 8.1 vs. 7 of max. 16; p = 0.35), or information gain (6.5 vs. 5.7 vs. 6.7 of max. 10; p = 0.23). Results on satisfaction (56.6 vs. 62.6 vs. 66; p = 0.06), anxiety (7.2 vs. 7.2 vs. 6.8; p = 0.84), and information gain (7 vs. 6.4 vs. 5.9; p = 0.43) remained stable over time.

CONCLUSIONS

Multimedia-supported IC prior to consultation provided improved time efficiency (33% gain) compared to traditional paper-based IC, with comparable satisfaction, anxiety and information gain. Multimedia-supported information materials should therefore be used more frequently in patient education.

Contribution of high-technology procedures to public healthcare expenditures: the case of ischemic heart disease in Portugal, 2002-2015

The magnitude of the impact of technological innovations on healthcare expenditure is unclear. This paper estimated the impact of high-technology procedures on public healthcare expenditure for patients with ischemic heart disease (IHD) in Portugal. The Blinder-Oaxaca decomposition method was applied to Portuguese NHS administrative data for IHD discharges during two periods, 2008-2015 vs. 2002-2007 (N = 434,870). We modelled per episode healthcare expenditures on the introduction of new technologies, adjusting for GDP, patient age, and comorbidities. The per episode healthcare expenditure was significantly higher in 2008-2015 compared to 2002-2007 for IHD discharges. The increase in the use of high-technology procedures contributed to 28.6% of this growth among all IHD patients, and to 18.4%, 6.8%, 11.1%, and 29.2% for acute myocardial infarction, unstable angina, stable angina, and other IHDs, respectively. Changes in the use of stents and embolic protection and/or coronary brachytherapy devices were the largest contributors to expenditure growth. High-technology procedures were confirmed as a key driver of public healthcare expenditure growth in Portugal, contributing to more than a quarter of this growth.

Identifying Influential Variables on Health Expenditure of the Organisation for Economic Co-Operation and Development (OECD) Countries

Background

Health expenditures of countries have an increasing trend in general and identifying variables affecting health expenditure is an important step toward budget planning for financial sustainability. This study aimed to examine the health expenditure of the Organisation for Economic Co-operation and Development (OECD) countries and identify influential variables.

Methods

The data for the years 2000-2018 of OECD countries' current health expenditure (% of GDP) and economic, demographic, and health variables, considered to affect the health expenditure, to include in the analysis were extracted using the World Bank database (World Bank 2021). Data analys using Chi-Squared Automatic Interaction Detection (CHAID) decision tree technique. Fifteen variables in economic, demographic, and health categories are selected to build the CHAID decision tree.

Results

As a result of CHAID analysis, five variables are identified as influential on current health expenditure, which are gross domestic product per capita, life expectancy at birth, death rate, out-of-pocket expenditure, and fertility rate. Thirty-seven OECD countries are classified into eleven groups by the decision rules in terms of the current health expenditure. The high value of the correlation coefficient between the predicted values and the actual values of health expenditure of countries indicates good prediction performance. Moreover, the regression models built using the identified influential variables as explanatory variables give good forecast accuracy.

Conclusion

As an effective tool, the CHAID decision tree technique provides a rule-based model in the form of a tree with nodes and branches, illustrating the splitting process graphically with identified variables and their cut-off points for classification and prediction.

Health-led growth hypothesis and health financing systems: an econometric synthesis for OECD countries

Introduction

This study investigates the Health-Led Growth Hypothesis (HLGH) within OECD countries, examining how health expenditures influence economic growth and the role of different health financing systems in this relationship.

Methods

Utilizing a comprehensive analysis spanning 2000 to 2019 across 38 OECD countries, advanced econometric methodologies were employed. Both second-generation panel data estimators (Dynamic CCEMG, CS-ARDL, AMG) and first-generation models (Panel ARDL with PMG, FMOLS, DOLS) were utilized to test the hypothesis.

Results

The findings confirm the positive impact of health expenditures on economic growth, supporting the HLGH. Significant disparities were observed in the ability of health expenditures to stimulate economic growth across different health financing systems, including the Bismarck, Beveridge, Private Health Insurance, and System in Transition models.

Discussion

This study enriches the ongoing academic dialog by providing an exhaustive analysis of the relationship between health expenditures and economic growth. It offers valuable insights for policymakers on how to optimize health investments to enhance economic development, considering the varying effects of different health financing frameworks.

Factors influencing inequality in government health expenditures within African regional economic communities

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.

The nexus among CO2 emission, health expenditure and economic development in the OECD countries: New insights from a cross-sectional ARDL model

To find a way to realize sustainable development, this paper applied a cross-sectional ARDL (CS-ARDL) method to explore the interaction between carbon emissions, economic development, and health care expenditure for OECD countries. Firstly, we conduct a cross-sectional test to check whether the data is confronted with this issue. Secondly, we conduct a panel unit root test and cointegration test to confirm whether the ARDL-based method is suitable for our data. Thirdly, we analyze the results and provide possible explanations. Lastly, we conduct a short-term causality test to detect the connection between different variables. The main conclusion of our study includes: 1) Health care is a necessity in OECD countries. 2) Environmental deterioration places a heavy burden on health care expenditure in OECD countries. 3) Health care expenditure of last year negatively affects health care expenditure. 4) There is a short-run causality relationship from CO2, economic development, and dependency rate of youth to health care expenditure in OECD countries. Related policy proposals are provided according to our analysis of the results.

Mobile money, medical cost anxiety and welfare of individuals within the reproductive age in Malaysia

This study examines the association between mobile money, medical cost anxiety, and the welfare of households in Malaysia. The study made use of the data sourced from the Global financial survey conducted by the World Bank. The study applied the logit model and test of mean difference, probit and instrumental variable regressions to check for robustness. Findings show that mobile money has a positive and significant impact on the welfare of households in Malaysia. Mobile money enables households to access financial services easily and conveniently, which in turn leads to better financial management and increased household welfare. The study also finds that medical cost anxiety hurts household welfare. Households that are more anxious about medical costs tend to experience lower levels of welfare. The results of this study have significant implications for policymakers and financial service providers in Malaysia. To improve the welfare of households, policymakers should promote mobile money use and encourage financial inclusion. Financial service providers should also develop products and services tailored to the needs of households, especially those that are more vulnerable to medical cost anxiety. Additionally, policymakers should consider implementing policies that address rising healthcare costs and alleviate medical cost anxiety among households in Malaysia.

Physician density: will we ever close the gap?

OBJECTIVE

Physician density is a crucial element of a well-functioning health system. Previous research has investigated factors affecting country-level physician supply. To date, however, no evidence has been provided about the patterns of convergence in physician density among countries. This paper thus tested club convergence in physician density in 204 countries worldwide from 1990 to 2019. A nonlinear time-varying factor model was adopted to identify potential clubs, wherein groups of countries tend to converge towards the same level of physician density. Our primary purpose was to document the potential long-lasting disparity in future global physician distribution.

RESULTS

Despite physician density increasing in all regions globally from 1990 to 2019, we found no evidence in favor of the hypothesis of global convergence. Conversely, the clustering algorithm successfully identified three main patterns (i.e., three final clubs). With few exceptions, the results indicated an uneven physician distribution between the majority of North and Sub-Saharan African countries (where physician density would remain well below the estimated threshold of at least 70% of the Universal Health Coverage Services Index) and the rest of the world. These findings support the WHO's global strategy to reverse the chronic under-investment in human resources for health.

Greenhouse gas emissions, economic globalization, and health expenditures nexus: does population aging matter in emerging market economies?

Papers on population aging and the effects of environmental quality on health expenditure have critical policy consequences. However, findings in the relevant literature are mixed, and papers generally focus on developed countries. To provide new information to the literature, this paper examines the impact of globalization, economic growth, greenhouse gas emissions, and population aging on health expenditures in emerging market economies with annual data for the period 2000 to 2018. The paper follows a second-generation advanced panel data method that considers cross-sectional dependency. The estimation results reveal that population aging, economic growth, and greenhouse gas emissions have an increasing effect on health expenditures, while globalization has a decreasing effect. Furthermore, one-way causality running from population aging to health expenditures is confirmed, while a feedback causality relationship is observed between health expenditures and other indicators (globalization, economic growth, and greenhouse gas emissions). After all, the outputs of this paper can provide critical policy implications about the relationships between aging, globalization, air quality, and health expenditures in developing countries.

The effects of provider contract types and fiscal decentralization on the efficiency of the Polish hospital sector: A data envelopment analysis across 16 health regions

BACKGROUND

Expenditures on hospitals constitute a large proportion of total health expenditures. In Poland the share of hospital spending is higher than the European Union average. The efficiency of the Polish hospital sector merits investigation.

RESEARCH GOAL

The goal of this study is to estimate the relative technical efficiencies of Polish hospital regions, and to measure the impacts of provider contract types, fiscal decentralization, and the 2017 reform on the relative efficiencies.

METHODS

Using data from 16 hospital regions in Poland for the years 2007 to 2019, we estimate relative technical efficiencies and their determinants using a two-stage approach. In the first stage, we apply Data Envelopment Analysis, in which we assume variable returns to scale and an output orientation. In the second stage we use a truncated regression with double bootstrapping.

RESULTS

Our findings are threefold. First, fiscal decentralization may reduce technical efficiency, but the results was not statistically significant. Second, efficiency tended to be higher in regions where a greater proportion of nurses and midwives were offered employment as opposed to consulting contracts. Contract types offered to physicians were not statistically significant. Third, the 2017 reforms seem to have had a positive impact on efficiency to date.

CONCLUSION

Policy makers may wish to consider offering less fiscal autonomy and control to regions and encouraging employment contracts with nurses and midwives.

Inter-state disparities in government health expenditure in India: a study of national rural health mission

Purpose

The 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/approach

The 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.

Findings

The 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/value

As 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.

Resiliency of healthcare expenditure to income shock: Evidence from dynamic heterogeneous panels

Using the World Bank data over the period of 1960-2019, this study aims at estimating the resiliency of health expenditures against gross domestic product (GDP). Long-run and short-run elasticities are calculated using the type of panel time series methods that are exclusively designed for dynamic heterogeneous panels: Mean Group, Pooled Mean Group, and Dynamic Fixed Effects estimators. These methods permit better estimations of elasticity with considerable heterogeneity across the 177 countries included in this study. Along with a standard elasticity estimation, this study estimates country-specific long-run and short-run elasticities along with error correction components. The study finds that the long-run elasticity of income is very close to unity, but short-run coefficients are insignificant for most nations. In addition, most countries revert to long-run equilibrium reasonably quickly if there is shock as the error correction coefficients are negative and, in many cases, very close to one. While for most developed countries, the short-run elasticities are lower in comparison with the short-run elasticities of developing countries indicating that many developing countries may face a larger decrease in health expenditure with the forecasted decline in income due to impending economic recession. Therefore, although this study is not directly intended to capture the post-COVID-19 effects, the study estimates may project the potential responses in health expenditure across countries due to potential income shocks.

Spatiotemporal Evolution and Drivers of Total Health Expenditure across Mainland China in Recent Years

A substantially growing health expenditure has become an important global issue. Thus, how and why health expenditure is rising should be urgently investigated in systematic research. The Bayesian space-time model and the Bayesian least absolute shrinkage and selection operator (LASSO) model were employed in this study to investigate the spatiotemporal trends and influence patterns of total health expenditure per capita (THEPC) and total health expenditure (THEE) as a share of the gross domestic product (GDP) on the Chinese mainland from 2009 to 2018. The spatial distribution of THEE as a share of GDP in mainland China has shaped a distinct geographical structure with the characteristic of 'west high/east low'. Its local increasing trends formed a geographical structure that exhibited a 'north high/south low' feature. The heterogeneity of the influence patterns of health expenditure was observed from east to west across China. Natural environmental factors, such as air pollution and green coverage, along with changes in dietary structures, have increasingly influenced the growth of health expenditures.

The magnitude and importance of perceived health dimensions define effective tailor-made health-promoting interventions per targeted socioeconomic group

Recent insights and developments on health and society urge a critical look at the positive relationship between socioeconomic status (SES) and health. We challenge the notions that it is sufficient to distinguish only between two groups of SES (low and high) and that only overall health is taken into account. A new grouping of SES was developed based on both income and education, resulting in six SES groups. Health was defined in terms of a new positive health concept, operationalized into six health dimensions generating a measure of total general health (TGH). Next, six socioeconomic and demographic determinants of health were included. Linear regression, T-tests and one-way ANOVA were applied to investigate the relationships in a Dutch sample. A subjective way to measure health was applied: self-rated health (SRH). As a result, four out of six dimensions of health determined TGH: bodily functions, daily functioning, quality of life, and social and societal participation. Three out of six socioeconomic and demographic determinants impacted TGH: housing situation, age, and difficulties meeting financial obligations. While this is the general picture for the entire sample, there were interesting similarities and differences between the six SES groups. The similarities lie in the positive impact of the evaluation of bodily functions and daily functioning on TGH in all SES groups. The other dimensions affected TGH in some groups, and some dimensions only in one SES group. None of the socioeconomic and demographic determinants affected TGH in all SES groups. New insights on health inequalities are provided. It is concluded, first that the well-known positive relationship between SES and health is confirmed in this study. Second, further refining the health concept into six dimensions provides more detailed insights on which dimensions impact health the most. The subjective approach applied offers more refined information to better understand which health issues really matter to people. This yields new insights to develop tailor-made interventions aimed at increasing healthy behaviour in specific societal groups.

Drivers of respiratory health care demand in Acre state, Brazilian Amazon: a cross-sectional study

Background

The scarce knowledge about the drivers of demand for respiratory health care in the Brazilian Amazon, where the gap of human and physical health care resources is wide, is expanded with two surveys conducted in the west of the region, in Acre state. Potential drivers, informed by a review of twelve recent papers, were classified into seven categories capturing the individual, household, community and macroeconomic dimensions.

Methods

Quantitative field surveys were conducted in 2017 and 2019 based on coupled conglomerate-quota randomization sampling. Adults responded about their own health or their children’s health. The probability of seeking physician care for the latest episode of respiratory illness or dry cough was analysed with multiple nonlinear regressions, having as covariates the potential predictors informed by the literature.

Results

The propensity to seek health care and to purchase medication was larger for children. Influenza-like illness (Despite the exact diagnostic stated by respondents being “influenza”, a virus detection test (such as the PCR test) is not commonly applied, as informed by the Acre state public health service. In consistency, the term “influenza-like illness” is used.) was the most frequently diagnosed disease, followed by pneumonia, suggesting that a health care-seeking rate below 40% may perpetuate health impairment and local contagion. Illnesses’ severity, including the pain experienced, was the main predictor, revealing that subjective perception was more influential than objective individual and household characteristics.

Conclusions

The results suggest that subjective underestimation of respiratory illnesses’ consequences for oneself and for local society could prevent health care from being sought. This is in line with some previous studies but departs from those emphasizing the role of objective factors. Social consequences, of, for instance, a macroeconomic nature, need to be highlighted based on studies detecting long-run relationships among health care demand, health and economic performance at the national level. Depending on the intensity of the trade-off between the costs imposed on the health system by increased demand and on the economy by the reduced productivity of the ill, policy could be adopted to change subjective perceptions of illnesses with nudges and educational and informational interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14171-z.

Impact of Environmental Quality on Healthcare Expenditures in Developing Countries: A Panel Data Approach

Objective: The deterioration in environmental quality has an economic and social cost. The aim of this study is to analyze the impact of environmental factors on health expenditures in developing countries. Method: To analyze the relationship between environmental quality (air pollution and temperature) and health expenditure in thirty-three developing countries, the study uses system generalized method of moments (GMM) using data from 2000 to 2017. Results: The results suggest a positive effect of both air pollution and temperature on health expenditure. However, the effect is highest for government health expenditure, followed by private and total health expenditure in the studied countries. The results further suggest that the impact of environmental factors is greater in higher-income countries when we divide the studied countries into two groups, i.e., higher- and lower-income countries. Conclusion: Our results are interesting and informative for the policy makers to design such policies to attain better environmental quality and social well-being. The increased healthcare expenditures due to increased air pollution and climate change necessitate for an efficient, reliable, affordable and modern energy policy by emphasizing the use of clean and renewable energy in these countries that ensure better health for the masses. Furthermore, a smart and sustainable environmentally friendly economic growth policy is necessary to ensure better health for the masses.

Testing Club Convergence in Female Smoking Prevalence

In this paper, we applied the concept of convergence to examine the evolution of smoking prevalence among women in 191 countries worldwide from 1990 to 2019. First, the non-linear time-varying factor model proposed by Phillips and Sul was adopted to identify potential clusters (clubs), wherein groups of countries converge to similar female smoking rates. Second, an ordered logit regression model was used to assess the impact of cigarette affordability on the probability of falling within a given cluster. The hypothesis of global convergence was rejected. However, the clustering algorithm successfully identified five and nine clubs, within countries with increasing and decreasing smoking prevalence, respectively. A higher relative income-price ratio (i.e., lower cigarette affordability) increased the likelihood of belonging to a club of countries with a low prevalence of female tobacco smoking.

Sericulture and the edible-insect industry can help humanity survive: insects are more than just bugs, food, or feed

The most serious threat which humans face is rapid global climate change, as the Earth shifts rapidly into a regime less hospitable to humans. To address the crisis caused by severe global climate change, it will be necessary to modify humankind's way of life. Because livestock production accounts for more than 14.5% of all greenhouse gas (GHG) emissions, it is critical to reduce the dependence of humans on protein nutrients and calories obtained from livestock. One way to do so is to use insects as food. Compared with typical livestock, farming edible insects (or "mini-livestock") produce fewer GHG emissions, require less space and water, involve shorter life cycles, and have higher feed conversion rates. It has been recently reported that consumption of certain insects can prevent or treat human diseases. This review goes beyond entomophagy to entomotherapy and their application to the food industry.

Forecasting Iran national health expenditures: General model and conceptual framework

BACKGROUND

Forecasting the future trend of health expenditures is an important step toward sustainable financing of health-care systems. This study aims to develop a conceptual framework for forecasting Iran health spending growth.

MATERIALS AND METHODS

At first, we concentrated on the general model and conceptual framework of health expenditure projection by reference to a broad literature review and smart classifications of the origins of health spending and indicators. At the second step, we developed a time series modeling for econometric estimation and forecasting national health expenditure without restrictive assumptions except for current laws and regulatory environment. In the third step, we tested the accuracy of model by forecasting Iran real per capita health expenditures (2017-2025).

RESULTS

The results of the literature review represented a distinct classification of the origins of health spending and indicators, applicable to any health system and health spending projection model. Furthermore, the model of expenditure forecasting shows the power of certainty of no spurious estimation, assessment of the normal state of a health system, and test of the accuracy of forecasting results. The projection by the Iranian health system database showed that the real per capita health spending will grow 43 percent till 2025 in the absence of any unforeseen disturbance in the future.

CONCLUSIONS

The presented model provides estimates that are compatible with actual trends of health spending and can be applied to forecast health expenditure in the near future. The forecasted image of Iran's health spending growth implies that health authorities need to concentrate more on the growth rate of the health budget and its fiscal space in the near future.

Health Care Expenditure in the European Union Countries: New Insights about the Convergence Process

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.

Factors Associated with Out-of-Pocket Health Expenditure in Polish Regions

Out-of-pocket (OOP) payments are perceived as the most regressive means of health financing. Using the panel-data approach and region-aggregated data from Statistics Poland, this research investigated associations between socio-economic factors and OOP health spending in 16 Polish regions for the period 1999–2019. The dependent variable was real (inflation-adjusted) monthly OOP health expenditure per person in Polish households. Potential independent variables included economic, labour, demographic, educational, health, environmental, and lifestyle measures based on previous research. A set of panel-data estimators was used in regression models. The factors that were positively associated with OOP health spending were disposable income, the proportions of children (aged 0–9) and elderly (70+ years) in the population, healthcare supply (proxied by physicians’ density), air pollution, and tobacco and alcohol expenditure. On the other hand, the increased unemployment rate, life expectancy at age 65, mortality rate, and higher sports participation were all related to lower OOP health spending. The results may guide national strategies to improve health-care allocations and offer additional financial protection for vulnerable groups, such as households with children and elderly members.

Inequalities in catastrophic health expenditures in conflict-affected areas and the Colombian peace agreement: an oaxaca-blinder change decomposition analysis

BACKGROUND

The present study analyzes inequalities in catastrophic health expenditures in conflict-affected regions of Meta, Colombia and socioeconomic factors contributing to the existence and changes in catastrophic expenditures before and after the sign of Colombian Peace Agreement with FARC-EP guerilla group in 2016.

METHODS

The study uses the results of the survey Conflicto, Paz y Salud (CONPAS) conducted in 1309 households of Meta, Colombia, a territory historically impacted by armed conflict, for the years 2014 and 2018. We define catastrophic expenditures as health expenditures above 20% of the capacity to pay of a household. We disaggregate the changes in inequalities in catastrophic expenditures through the Oaxaca-Blinder change decomposition method.

RESULTS

The incidence of catastrophic expenditures slightly increased between 2014 to 2018, from 29.3 to 30.7%. Inequalities in catastrophic expenditures, measured through concentration indexes (CI), also increased from 2014 (CI: -0.152) to 2018 (CI: -0.232). Results show that differences in catastrophic expenditures between socioeconomic groups are mostly attributed to an increased influence of specific sociodemographic variables such as living in rural zones, being a middle-aged person, living in conflict-affected territories, or presenting any type of mental and physical disability.

CONCLUSIONS

Conflict-deescalation and the peace agreement may have facilitated lower-income groups to have access to health services, especially in territories highly impacted by conflict. This, consequently, may have led to higher levels of out-of-pocket expenditures and, therefore, to higher chances of experiencing catastrophic expenditures for lower-income groups in comparison to higher-income groups. Therefore, results indicate the importance of designing policies that guarantee access to health services for people in conflict -affected regions but also, that minimize health care inequalities in out-of-pocket payments that may arouse between people at different socioeconomic groups.

The Effect of 24/7, Digital-First, NHS Primary Care on Acute Hospital Spending: Retrospective Observational Analysis

BACKGROUND

Digital health has the potential to revolutionize health care by improving accessibility, patient experience, outcomes, productivity, safety, and cost efficiency. In England, the NHS (National Health Service) Long Term Plan promised the right to access digital-first primary care by March 31, 2024. However, there are few global, fully digital-first providers and limited research into their effects on cost from a health system perspective.

OBJECTIVE

The aim of this study was to evaluate the impact of highly accessible, digital-first primary care on acute hospital spending.

METHODS

A retrospective, observational analysis compared acute hospital spending on patients registered to a 24/7, digital-first model of NHS primary care with that on patients registered to all other practices in North West London Collaboration of Clinical Commissioning Groups. Acute hospital spending data per practice were obtained under a freedom of information request. Three versions of NHS techniques designed to fairly allocate funding according to need were used to standardize or "weight" the practice populations; hence, there are 3 results for each year. The weighting adjusted the populations for characteristics that impact health care spending, such as age, sex, and deprivation. The total spending was divided by the number of standardized or weighted patients to give the spending per weighted patient, which was used to compare the 2 groups in the NHS financial years (FY) 2018-2019 (FY18/19) and 2019-2020 (FY19/20). FY18/19 costs were adjusted for inflation, so they were comparable with the values of FY19/20.

RESULTS

The NHS spending on acute hospital care for 2.43 million and 2.54 million people (FY18/19 and FY19/20) across 358 practices and 49 primary care networks was £1.6 billion and £1.65 billion (a currency exchange rate of £1=US $1.38 is applicable), respectively. The spending on acute care per weighted patient for Babylon GP at Hand members was 12%, 31%, and 54% (£93, P=.047; £223, P<.001; and £389, P<.001) lower than the regional average in FY18/19 for the 3 weighting methodologies used. In FY19/20, it was 15%, 35%, and 51% (£114, P=.006; £246, P<.001; and £362, P<.001) lower. This amounted to lower costs for the Babylon GP at Hand population of £1.37, £4.40 million, and £11.6 million, respectively, in FY18/19; and £3.26 million, £9.54 million, and £18.8 million, respectively, in FY19/20.

CONCLUSIONS

Patients with access to 24/7, digital-first primary care incurred significantly lower acute hospital costs.

Accessibility and site suitability for healthcare services using GIS-based hybrid decision-making approach: a study in Murshidabad, India

Healthcare accessibility and site suitability analysis is an elongated and complex task that requires evaluation of different decision factors. The main objective of the present study was to develop a hybrid decision-making approach with geographic information systems to integrate spatial and non-spatial data to form a weighted result. This study involved three-tier analyses for assessing accessibility and selecting suitable sites for healthcare facilities, and analysing shortest-path network. The first tier of analysis stressed the spatial distance, density and proximity from existing healthcare to find more deprived and inaccessible areas in term of healthcare facilities. The result revealed that spatial discrepancy exists in the study area in term of access to healthcare facilities and for achieving equal healthcare access, it is essential to propose new plans. Thus, require finding suitable sites for put forward new healthcare service, which was highlighted in the second tier of analysis based on land use land cover, distancing to road and rail, proximity to residential areas, and weighted overlay of accessibility as decision factors. Finally, in the third tier of analysis, the most suitable site among the proposed healthcare was identified using the technique for order of preference by similarity to ideal solution. The road network analysis was also performed in this study to determine the shortest and fastest route from these healthcare facilities to connect with district medical hospital. The present study found some suitable sites throughout the district on inaccessible zones where people are deprived from better healthcare facilities. This attempt will highly helpful for preparing a spatial decision support system which assists the health authorities regarding the healthcare services in inaccessible, underprivileged, and rural areas.

An empirical study on the determinants of health care expenses in emerging economies

BACKGROUND

Emerging countries continue to suffer gravely from insufficient healthcare funding, which adversely affects access to quality healthcare and ultimately the health status of citizens. By using panel data from the World Development Indicators, the study examined the determinants of health care expenditure among twenty-two (22) emerging countries from the year 2000 to 2018.

METHODS

The study employed cross-section dependence and homogeneity tests to confirm cross-sectional dependence and to deal with homogeneity issues. The Quantile regression technique is employed to test for the relationship between private and public health care expenses and its determinants. The Pooled mean group causality test is used to examine the causal connections among the variables.

RESULTS

The outcome of the quantile regression test revealed that economic growth and aging population could induce healthcare costs in emerging countries. However, the impact of industrialization, agricultural activities, and technological advancement on health expenses are found to be noticeably heterogeneous at the various quantile levels. Unidirectional causality was found between industrialization and public health expenses; whereas two-way causal influence was reveled amongst public health expenditure and GDP per capita; public health expenditure and agricultural activities.

CONCLUSION

It is therefore suggested that effective and integrated strategies should be considered by industries and agricultural sectors to help reduce preventable diseases that will ultimately reduce healthcare costs among the emerging countries.

Study of influential factors of provincial health expenditure -analysis of panel data after the 2009 healthcare reform in China

BACKGROUND

Total Healthcare Expenditure (THE) has increased substantially in all countries. Since the health system reform and health policy environment differ from each country, it is necessary to analyze the motivations of THE in a specific country.

METHODS

The objective of this study was to analyze the influential factors of Provincial THE (PTHE) per capita in China by using spatiotemporal panel data across 31 provinces (including provinces, autonomous regions, and municipalities, all called provinces in here) from 2009 to 2016 at the provincial and annual level. Generalized Estimating Equation (GEE) was used to identify the influential factors of PTHE per capita.

RESULTS

The number of beds per 10,000 population explained most of the variation of PTHE per capita. The results also showed that health expenditure in China reacts more to mortality compared with the Gross Domestic Product (GDP) per capita. But mortality and Out-Of-Pocket Payments (OOP) as a percentage of THE were associated with PTHE per capita negatively. The rate of infectious diseases and THE as a percentage of GDP had no statistical significance. And the Proportion of the Population Aged 65 and Over (POP65) impact PTHE per capita positively. But the coefficient was small.

CONCLUSIONS

In response to these findings, we conclude that the impact of the increasing percentage of OOP in THE diminishes the PTHE. Furthermore, we find that both the "baseline" health level and health provision are positively correlated with PTHE, which outweighs the effect of GDP.

Healthcare Digitalization and Pay-For-Performance Incentives in Smart Hospital Project Financing

This study aims to explore the impact of healthcare digitalization on smart hospital project financing (PF) fostered by pay-for-performance (P4P) incentives. Digital platforms are a technology-enabled business model that facilitates exchanges between interacting agents. They represent a bridging link among disconnected nodes, improving the scalable value of networks. Application to healthcare public-private partnerships (PPPs) is significant due to the consistency of digital platforms with health issues and the complexity of the stakeholder's interaction. In infrastructural PPPs, public and private players cooperate, usually following PF patterns. This relationship is complemented by digitized supply chains and is increasingly patient-centric. This paper reviews the literature, analyzes some supply chain bottlenecks, addresses solutions concerning the networking effects of platforms to improve PPP interactions, and investigates the cost-benefit analysis of digital health with an empirical case. Whereas diagnostic or infrastructural technology is an expensive investment with long-term payback, leapfrogging digital applications reduce contingent costs. "Digital" savings can be shared by key stakeholders with P4P schemes, incentivizing value co-creation patterns. Efficient sharing may apply network theory to a comprehensive PPP ecosystem where stakeholding nodes are digitally connected. This innovative approach improves stakeholder relationships, which are re-engineered around digital platforms that enhance patient-centered satisfaction and sustainability. Digital technologies are useful even for infectious disease surveillance, like that of the coronavirus pandemic, for supporting massive healthcare intervention, decongesting hospitals, and providing timely big data.

Other considerations than: how much will universal health coverage cost?

Globally, countries have agreed to pursue the progressive realization of universal health coverage (UHC) and there is now a high level of political commitment to providing universal coverage of essential health services while ensuring that individuals are financially protected against high health spending. The aim of this paper is to help policy-makers think through the progressive realization of UHC. First, the pitfalls of applying global normative expenditure targets in estimating the national revenue required for UHC are discussed. Then, several recommendations on estimating national revenue are made by moving beyond the question of how much UHC will cost and focusing instead on the national health-care reforms and policy choices needed to progress towards UHC. In particular, costing exercises are recommended as a tool for comparing different service delivery options and investment in data infrastructure is recommended for improving the information needed to identify the best policies. These recommendations are intended to assist health policy-makers and international and national agencies who are developing country plans for the progressive realization of UHC.

Does the Great Recession Contribute to the Convergence of Health Care Expenditures in the US States?

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.

Drivers of hospital expenditure and length of stay in an academic medical centre: a retrospective cross-sectional study

BACKGROUND

As healthcare expenditure and utilization continue to rise, understanding key drivers of hospital expenditure and utilization is crucial in policy development and service planning. This study aims to investigate micro drivers of hospital expenditure and length of stay (LOS) in an Academic Medical Centre.

METHODS

Data corresponding to 285,767 patients and 207,426 inpatient visits was extracted from electronic medical records of the National University of Hospital in Singapore between 2005 to 2013. Generalized linear models and generalized estimating equations were employed to build patient and inpatient visit models respectively. The patient models provide insight on the factors affecting overall expenditure and LOS, whereas the inpatient visit models provide insight on how expenditure and LOS accumulate longitudinally.

RESULTS

Although adjusted expenditure and LOS per inpatient visit were largely similar across socio-economic status (SES) groups, patients of lower SES groups accumulated greater expenditure and LOS over time due to more frequent visits. Admission to a ward class with greater government subsidies was associated with higher expenditure and LOS per inpatient visit. Inpatient death was also associated with higher expenditure per inpatient visit. Conditions that drove patient expenditure and LOS were largely similar, with mental illnesses affecting LOS to a larger extent. These observations on condition drivers largely held true at visit-level.

CONCLUSIONS

The findings highlight the importance of distinguishing the drivers of patient expenditure and inpatient utilization at the patient-level from those at the visit-level. This allows better understanding of the drivers of healthcare utilization and how utilization accumulates longitudinally, important for health policy and service planning.

Pharmaceutical expenditure and total health-care expenditure in OECD countries and China: bidirectional Granger causality on the basis of health level

BACKGROUND

Previous studies have ignored the bidirectional causality and the heterogeneity of health level. This study explored the bidirectional causality between pharmaceutical expenditure (PE) and total health-care expenditure (Total HCE) considering the health level for effective health investment and national health improvement.

METHODS

Based on the panel data on PE and Total HCE in 32 OECD countries and China, the Granger causality test was applied. Countries were divided into low- and high-health-level (LH and HH) groups according to their life expectancies.

RESULTS

A 1% increase in the growth rate of per capita PE boosted a 0.11% increase in that of per capita Total HCE of the following year in HH group, whereas no such causality existed in LH group. A 1% increase in the growth rate of per capita Total HCE boosted a 0.46% increase in that of the per capita PE of the following year in LH group, whereas no such causality existed in HH group.

CONCLUSION

High-health-level countries should continue to increase the health investment by promoting rational PE growth such as expanding insurance coverage for innovative medicine for health improvement. Low-health-level countries should take optimizing policy to increase health investment in pharmaceutical for medicine accessibility and national health.