Comparing the Income Elasticity of Health Spending in Middle-Income and High-Income Countries: The Role of Financial Protection

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.

Changes in health care utilization and financial protection after integration of the rural and urban social health insurance schemes in Beijing, China

BACKGROUND

China expanded health coverage to residents in informal economic sectors by the rural new cooperative medical scheme (NCMS) for rural population and urban resident basic medical insurance scheme (URBMI) for non-working urban residents. Fragmentation of resident social health insurance schemes exacerbated the health inequity and China started the integration of urban and rural resident medical insurance schemes since 2016. Beijing finished the insurance integration in 2017 and has been implementing a unified urban and rural resident basic medical insurance scheme (URRBMI) since the beginning of 2018. This study aims to examine changes in health care utilization and financial protection after integration of the rural and urban social health insurance schemes.

METHODS

We used household survey data from Beijing Health Services Survey in 2013 and 2018. Respondents who were 15 or older and covered by URBMI, NCMS or URRBMI were included in this study. Our study finally included 8,554 individuals in 2013 and 6,973 individuals in 2018, about 70% of which were rural residents in each year. Descriptive analysis was used to compare the healthcare utilization, healthcare expenditure and incidence of catastrophic health expenditure between different groups. A series of two-part regression models were used to analyze the changes of healthcare utilization, healthcare expenditure and incidence of catastrophic health expenditure.

RESULTS

From 2013 to 2018, urban-rural disparity in outpatient care utilization seemed widened because urban residents' utilization of outpatient care increased 131% while rural residents' utilization only increased 72%; both rural and urban residents' spending on outpatient care increased about 50%. Utilization of inpatient care changed little and poor residents still used significantly less inpatient care compared with the rich residents. Poor residents still suffered heavily catastrophic health expenditures.

CONCLUSION

From 2013 to 2018, residents' utilization of healthcare, especially outpatient care, increased in Beijing. Health insurance reforms increased residents' utilization of healthcare but failed to reduce their healthcare financial burden, especially for poor people. Our study advocates more pro-poor insurance policies and more efforts on the efficiency of health system.

The roles of economic growth and health expenditure on CO2 emissions in selected Asian countries: a quantile regression model approach

Continuous economic growth and the rise in energy consumption are linked with environmental pollution. Demand for health care expenditure increased after the COVID-19 pandemic. This study is interesting in modeling the nexus between public and private health expenditure, carbon dioxide emissions, and economic growth. To this end, the present study analyzed the nexus between public and private health care expenditure, economic growth, and environmental pollution for 36 Asian countries for the period 1991-2017. FMOLS, GMM, and quantile regression analysis confirm the EKC hypothesis in Asia. Besides, FMOLS and quantile regressions reached the reducing effects of government and private health expenditures on CO₂ emissions. While quantile regression results show that public and private health expenditures can mitigate CO₂ emissions; however, these results differ for various levels of CO₂. Findings of quantile regression show a significant impact of both public and private health expenditures in reducing CO₂ at the 50^th and 75^th quantiles but results are insignificant for the 25^th quantile. Overall, the paper concludes that both government and private health sectors' expenditures caused CO₂ emissions to decrease in Asia and that the negative impact of the private health sector on CO₂ emissions is greater than that of the government health sector. The concluding remark is that the higher the health spending, the higher the environmental quality will be in Asia. Hence, the health administrators need to increase public and private health expenditures with an effective cost-service and energy-efficient management approach to reach sustainable health services and a sustainable environment in Asia.