Public financing of health expenditures,insurance, and health outcomes

The effects of public financing of health expenditures, insurance coverage and other factors on health outcomes are examined within health production models estimated using 1960–1992 data across 20 OECD countries. Mortality rates are found to depend on the mix of health care expenditures and the type of health insurance coverage. Increases in the publicly financed share of health expenditures are associated with increases in mortality rates. Increases in inpatient and ambulatory insurance coverage are associated with reduced mortality. The effects of GDP, health expenditures and age structure on mortality are similar to those in previous studies. Tobacco use, alcohol use, fat consumption, female labour force participation, and education levels are also significantly related to overall mortality rates. Increases in income inequality are associated with lower mortality rates, suggesting that the negative relationship between inequality and health outcomes suggested by some previous studies does not remain when a more complete model is estimated. The result that increases in public financing increase mortality rates is robust to a number of changes in specifications and samples. Thus, as countries increase the level of their health expenditures, they may want to avoid increasing the proportion of their expenditures that are publicly financed.     

The U.S. health care expenditure: evidence from 2001 to 2009

This study utilizes state-level data from 2001 to 2009 to estimate the impact of the 2007 financial crisis upon health care expenditures. Higher death rates are consistently found to have a positive and statistically significant impact on health expenditures. While mental health and COPD are not generally found to impact expenditures, increases in the percentage of the population diagnosed with cholesterol and obesity tend to increase health expenditures. Increases in health expenditures slowed considerably after the financial crisis. Even though recessions (high unemployment rates) are generally found to have a positive impact on health expenditures, the post-financial crisis time period is estimated to have much lower health expenditures than in other time periods. Our results can be used to give insight into the conditions under which the slower rate of increase in health expenditures can be expected to increase. More research will be needed to be able to more completely explore not only the reasons for these changes in health expenditures but also whether they are likely to continue into the future.     

Health Selection and the Effect of Smoking on Mortality

We show that individuals who are in poorer health, independently from smoking, are more likely to start smoking and to smoke more cigarettes than those with better non‐smoking‐related health. We present evidence of selection, relying on extensive data on morbidity and mortality. We show that health‐based selection into smoking has increased over the last 50 years with knowledge of its health effects. We show that the effect of smoking on mortality is greater for more highly educated individuals and for individuals in good non‐smoking‐related health.     

An Analysis of the Impact of Health on Occupation

Maintaining individuals with health limitations in the labour force is a challenge of growing importance. Determining the effect of health on occupation may tell us how people adapt to their limitations, and what types of jobs make this harder or easier. This paper uses the first 14 waves of the Household, Income and Labour Dynamics in Australia Survey to examine the effect of health and changes in health on occupation for the working‐age population. I use dynamic panel models which account for selection into employment. Two measures of occupation are used to capture two aspects of occupation highlighted in the literature as being linked to health: physical job demands and status. The results of the analyses provide some evidence that a health shock reduces the likelihood of manual employment for younger men, suggesting that younger men may adapt to a health shock by reducing physical job demands. Worsening health and work‐limiting long‐term conditions are found to have a negative effect on occupational status for men and women, suggesting health selection into lower‐status jobs, and an adverse effect of poor health on occupational mobility.     

Schooling,health knowledge and obesity

The connection between schooling and health is well documented. An important empirical issue that needs to be examined, however, is whether schooling's effects are due to individual health knowledge differences. This empirical study examines this issue with an increasingly important health indicator, obesity. Since provision of health knowledge is a major tool of public agencies promoting health, this empirical study uses a new direct measure of health knowledge to test this hypothesis. The results show that knowledge is inversely related to the probability that an individual is obese. Schooling's effects on relative weight and the probability of being obese are explained by differences in knowledge. This result may imply that schooling's effect on the allocative efficiency of the household production of health is the main reason schooling is linked to health behaviour. The result also may imply that the most effective method of health education is to highlight the disease element of poor dietary habits and health. More importantly, the simulations conducted suggest positive returns to knowledge based on improvements in the probability estimates.     

Interrelationships between income,health and the environment: extending the Environmental Kuznets Curve hypothesis

This paper examines the link between the health indicators and the environmental variables for a cross-section of countries widely dispersed on the economic development spectrum. While environment and income are seen to have an inverted-U shaped relationship (Environmental Kuznets Curve (EKC) hypothesis), it is also well established that environment and health are positively related. Our study focuses on the implications of this for the relationship between health and income. In the early phases of income growth, the gains in health and the losses in environmental quality could cancel each other out and this challenges the idea that as incomes increase health would always improve. To empirically analyse these issues, we estimate a two-stage least squares model that focuses on the impact of income and the environment on health status, with environment being an endogenous variable. Our results show that the environmental stress variable has a significant negative effect on health status. At the same time, gross national product (GNP) levels are shown to vary positively with health status variables. We find that the health gains obtained through improved incomes can be negated to a significant extent if the indirect effect of income acting via the environment is ignored. Research findings in this regard would be a useful policy instrument towards maximising both the environmental and health gains that come with economic growth and development.     

Government response to increased demand for public services: The cyclicality of government health expenditures in the OECD

The more that health care expenditures are financed by general taxation, the greater the discretion governments are likely to exercise when timing increases in health care expenditures. Vote-maximising governments time increases in health care expenditures to occur in economic upturns, when voters are not as aware of the required increase in taxation. In recessions, they have an incentive to sustain expenditures on health care by diverting expenditures from other public expenditure programmes that voters perceive as low priority. In this way, government pursuit of a political agenda is likely to exert a systematic influence on the cyclicality of government expenditure. Predictions are tested with reference to the cyclicality of government health expenditures, for a sample of OECD countries from 2000 to 2012.     

The determinants of the demand for private health insurance under Medicare

Since the introduction of Medicare in 1984, the proportion of the Australian population with private health insurance has declined considerably. Insurance for health care consumption is compulsory for the public health sector but optional for the private health sector. In this paper, we explore a number of important issues in the demand for private health insurance in Australia. The socio-economic variables which influence demand are examined using a binary logit model. A number of simulations are performed to highlight the influence and relative importance of various characteristics such as age, income, health status and geographical location on demand. A number of important policy issues in the private health insurance market are highlighted. First, evidence is provided of adverse selection in the private health insurance pool, second, the notion of the wealthy uninsured is refuted, and finally it is confirmed that there are significant interstate differences in the demand for private health insurance.     

The long-run effect of aid on health: evidence from panel cointegration analysis

Although a major objective of aid donors is to improve health outcomes in recipient countries, there is relatively little research on whether aid to the health sector leads to improved health outcomes, and even less on the impact of total aid. This paper examines the relationship between total aid and population health using panel cointegration and causality techniques designed to deal with problems afflicting previous aid-health studies: spurious regressions, omitted variables, endogeneity, cross-sectional dependence, and parameter heterogeneity. The main results are: (i) aid has, on average, a small but negative long-run effect on health, (ii) while the long-run (or trend) effect of aid on health is negative, the short-run (temporary) effect of aid on health is positive, (iii) causality runs in only one direction, from aid to health, and (iv) aid worsens health mainly in sub-Saharan countries, but has a positive, albeit statistically insignificant, long-run impact on health in Latin American and Caribbean countries and in countries with negative values of net ODA.     

Tax Expenditures on Health in Australia: 1960–61 to 1988–89

Commonwealth government tax expenditures arise because departures from the tax structure produce favourable tax treatment of particular types of activities or taxpayers. Such tax concessions can be used in the same way as direct expenditures to give effect to government policies, and in fact are often used as substitutes for direct expenditures. Although estimates of tax expenditures on health in more recent times are readily available, this form of subsidisation of the health sector has not been used heavily since the introduction of Medicare in 1984. It is for the period spanning the 1960s and the 1970s, when tax expenditures were a much more important source of health care finance, that consistent estimates are lacking. This article presents estimates of the revenue cost of income tax concessions for health in Australia over the period 1960–61 to 1988–89 and integrates these estimates into the currently available health expenditure statistics. It is concluded that failure to allow for tax expenditures on health when analysing public expenditures on health in Australia can lead to misleading conclusions about the net fiscal impact of changes in the Commonwealth's health expenditure policy. In particular, the fiscal effect of introducing Medihank in 1975 is significantly lower if account is taken of changes to tax concessions on health occurring at the same time. Likewise, the net cost of the introduction of Medicare in 1984 is overstated by measures based on direct outlays alone.     

人口转变、经济发展与卫生支出增长——以人口普查为基础的因素分解

采用因素分解方法考察中国卫生支出在过去近30年的增长特点,将卫生总费用增长及卫生总费用占GDP比重的变化,分解为人口数量增长、人口结构变动、健康模式变化和非人口学因素影响四个独立可比的部分。结果显示,尽管非人口学因素决定着卫生总费用增长,人口学因素却主导着卫生总费用占GDP比重的变化。人口学因素中,人口总量缓慢增长和人口结构快速转变推动着卫生支出规模不断上升,但健康模式变化显著削弱了这种趋势。     

The effect of health investment on growth: A causality analysis

The aim of this paper is to analyze the effect of health investment on productivity as an important variable associated with human capital accumulation. The authors also study the possible existence of endogeneity by using instrumental variables estimation. The results that are obtained may be interpreted as evidence of the positive impact of health expenditure on income growth. Furthermore, the authors looked at the bounded gains of health status and divided the sample according to the median of total health expenditure and found that the countries with lower levels of health spending obtain larger benefits when the other determinants of growth are held constant.     

The effects of health aid on child health promotion in developing countries: cross-country evidence

Although epidemiological knowledge in relation to child health has improved in the last few decades, around 3 million children die each year in developing countries from preventable diseases. The international development community views increased immunization coverage for children as an important step in eliminating or reducing these deaths. Many developing countries have very limited resources to tackle major health problems and have to rely on external finance. This article examines the impact of foreign aid devoted to the health sector on child health promotion in developing countries. Two proxies for child health promotion are used: (a) immunization against measles and (b) immunization against Diphtheria–Pertussis–Tetanus (DPT). A range of model specifications and panel data econometric techniques are applied to data covering the period 1990 to 2005. This article finds a positive and statistically significant link between health aid and the measures of child health promotion.     

森林旅游引入心理保健功能的可行性分析

随着我国经济体制的转型和社会现代化程度的提高,国民心理健康问题也日益突出。当前,我国心理保健事业的发展与人民群众日益增长的心理保健需求之间还存在差距。本文运用多学科的相关理论,分析了我国传统心理保健技术问题、传统森林旅游对身心健康的关注、森林心理保健的物理条件。最后进行森林旅游引入心理保健功能的受众分析,提出了森林旅游引入心理保健的模式,并从改善心理保健技术、开发森林心理保健旅游产品等方面提出可行性建议。     

城镇基本医疗保险中逆向选择的检验

本文利用城镇居民基本医疗保险试点评估调查的数据,实证检验了我国城镇居民和职工基本医疗保险中的逆向选择问题。本文的实证结果证实了逆向选择的存在:在未被城镇职工基本医疗保险覆盖的城镇人群中,健康状况较差的个体更倾向于参加城镇居民基本医疗;城镇居民基本医疗保险的参保者接受门诊和住院服务利用率的概率更高;保险对住院服务利用率的影响大于对门诊的影响。另一方面,我们还发现在已被城镇职工基本医疗保险覆盖的人群中,健康状况较差的职工也更倾向于购买补充商业医保,但是健康状况最差的个体购买补充商业医保的概率最低,而购买商业医保后住院率显著增加。     

城镇基本医疗保险中逆向选择的检验

本文利用城镇居民基本医疗保险试点评估调查的数据,实证检验了我国城镇居民和职工基本医疗保险中的逆向选择问题。本文的实证结果证实了逆向选择的存在:在未被城镇职工基本医疗保险覆盖的城镇人群中,健康状况较差的个体更倾向于参加城镇居民基本医疗;城镇居民基本医疗保险的参保者接受门诊和住院服务利用率的概率更高;保险对住院服务利用率的影响大于对门诊的影响。另一方面,我们还发现在已被城镇职工基本医疗保险覆盖的人群中,健康状况较差的职工也更倾向于购买补充商业医保,但是健康状况最差的个体购买补充商业医保的概率最低,而购买商业医保后住院率显著增加。     

Does the relationship between income and child health differ across income groups? Evidence from India

This study explores the relationship between child health and socioeconomic status (health-income gradient) using the Indian Human Development Survey-II (2011-12) for children up to 5 years of age. Unlike previous studies our empirical analysis allows the gradient to vary across different income intervals using linear and cubic spline regressions. We use objective measure of child health - height-for-age Z-scores and find that an increase in income, on an average leads to reduction in prevalence of stunting. We also find differential effect of income on health across the income distribution with no effect of income on child health for very poor households. Further we explore underlying factors explaining the gradient and find that maternal health, housing quality, sanitation, non-infectious environment, media exposure to women and a safe neighbourhood are transmission channels that affect child health and together they explain almost 40% of the overall income effect. One of the major implication of our findings is that any policy to increase income of poor households should be complemented with a health policy designed specifically towards children as poor households are less likely to allocate additional income to child health.     

Public–private mix of health expenditure: A political economy and quantitative analysis

This paper constructs a simple model to examine decisions on public and private health spending under majority voting. In the model, agents with heterogeneous incomes choose how much to consume and spend on health care and vote for public health expenditure. The health status of an agent is determined by a CES composite of public and private health expenditure. The existence and uniqueness of the voting equilibrium are established. A quantitative exercise reveals the importance of the relative effectiveness of public and private health expenditure and their substitutability in determining the public‐private mix of health expenditure and in accounting for the observed differences across a sample of 22 advanced democratic countries.     

公园环境的健康恢复影响研究进展

越来越多的研究证实公园环境对人们身心健康产生 积极的影响，其健康恢复思想可以追溯到人们择居、医疗和园 林建设实践。从治理与康复功能、缓解精神压力与消除疲劳、 增强身体健康、陶冶情操和增进社会交往5个层面论述了公园 环境的健康恢复功效，以及公园环境的健康恢复影响机制。同 时对研究重心、评价方法与发展趋势进行了系统总结与评述， 最后讨论了公园环境健康恢复研究面临的问题与展望，以期为 推动公园环境健康恢复理论的完善提供参考价值。     

中国农村的收入差距与健康

随着收入差距的扩大,收入分配对健康和健康不平等的影响日益受到关注。本文利用中国健康营养调查(CHNS)1997年和2000年农村的面板数据回答两个问题:收入差距对健康的影响以及影响健康的方式;收入差距的扩大是否会导致健康不平等的加剧,尤其是低收入人群的健康是否受到更为不利的影响。研究发现,首先收入差距对健康的影响存在滞后效应;其次,收入差距对健康的影响呈现“倒U”型,在收入差距较高时,收入差距对健康的影响主要为负向的,一个可能的原因是收入差距影响到公共卫生设施的供给。再次,收入差距的扩大会加强收入效应,其含义是如果低收入人群的收入更容易受到负向冲击,那么收入差距对低收入人群的健康更为不利。