Does military expenditure crowd out health-care spending? Cross-country empirics

The trade-off between military expenditure and public health spending has remained an unsettled empirical issue. This paper investigates whether military expenditure has crowded out public health spending in 116 countries (including a subsample of 87 non-OECD countries) over the period 2000–2017. Through our system generalized methods of moments (GMM) estimations, we find that military expenditure, whether it is measured on a per-capita basis or as a proportion of total government expenditure, has a positive impact on the demand for health care. Nonetheless, we find a significant crowding-out effect of military expenditure on domestic government health spending by taking into account government fiscal capacity. The evidence we present supports the long-standing view that military expenditure has a particular ability to compete government financial resources away from publicly funded health spending. By interacting the military expenditure variable with income per capita, we find that an increase in income per capita has neutralized the crowding-out effect of military expenditure on domestic government health spending – less well-off countries stand to suffer most, and wealthy ones stand to suffer least, from the crowding-out effect. The crowding-out effect is statistically more specific to middle- and low-income countries in our samples.

     

健康、环境、生产性基础设施与经济增长

在内生增长模型框架下,假设健康是由公共健康支出、生产性基础设施服务和环境质量共同组成,考察了公众健康意识的改变是如何通过影响政府对健康及环保的投入而影响经济增长。研究结果得出:存在环境质量作用于健康进而影响经济增长这一机制,福利最大化下的政府应当投入环保支出改善环境;当公众越是关心健康,政府可选择的税收支出、公共健康支出和环保支出越会不断上升,实现提升健康水平和环境质量的同时使经济持续增长。在此基础上,运用我国29个省1997—2013年的数据,通过面板计量模型验证了理论部分关于健康方程的假设,同时证实环境通过作用于健康进而影响经济增长这一传导机制的存在。     

Do health system reforms stand a chance?

While most major reforms of health systems fail, those that succeed are motivated by politicians' quest for reducing the health burden on their budget in response to a shift in voters' preferences away from public health. An Edgeworth box is used to depict their preferences, in addition to those of (potential) patients and health‐care providers. Politicians are found to severely constrain the area of mutual advantage, suggesting that only minor reforms are possible unless they promise to lower health‐care expenditure. An efficiency‐enhancing change that would enlarge the box and hence the area of mutual advantage would be to suppress the requirement imposed on health insurers to purchase domestically, rather than being free to directly import health‐care services and drugs.     

Hospital efficiency and equity in health care delivery: A study based in China

Hospital efficiency and equity in health care delivery are two enduring research topics. Yet little research has been done to examine the relationship between them. This paper studies the impact of hospital efficiency on equity in health care delivery based on a proprietary dataset of hospital characteristics and 630,000 inpatient records from 149 public hospitals in a representative Chinese city. To measure the hospitals' efficiencies, this study takes the hospitals' operational features and case-mix indexes into account, and computes the efficiency levels using data envelopment analysis with bootstrapping. Through regressions that control for a variety of the patients’ personal characteristics (e.g., age, disease, residence, hospital visit frequency), this study shows that the gap between hospitalization expenses of urban and rural inpatients in more efficient hospitals is smaller than those in less efficient hospitals. Thus efficiency enhances equity in expenditure between urban and rural patients. But the dwindling urban-rural gap in expenditure is achieved by raising the spending of rural patients, thereby undermining their access to health care. This pattern is more conspicuous in large and sophisticated high-tier hospitals. Further analysis shows that hospital efficiency impacts equity of health care delivery by inducing different lengths of stay and uncovered parts of total expenditure for urban and rural groups. The findings imply that an efficiency-oriented health care policy may lead to social benefit loss.     

Health and economic growth in high-income countries revisited: evidence from an augmented production function for the period 1980–2009

This paper uses time series data for seven industrialized countries from 1980–2009 to explore the causality between health care expenditure (HCE) and economic growth. We have set up a classical Cobb–Douglas production function including HCE, labor, capital, and an augmented function additionally including the number of patent applications (as a proxy for technology and research) and the total number of tertiary education students (as a proxy for education). Our results show that there is a long-run relationship between growth and HCE. As regards causality, in the classical production function, evidence for mutual causality between GDP and HCE is noted only in France, Germany and England, causality from HCE to GDP is noted in Italy and Japan, while no causality whatsoever is evidenced in Canada and USA. However, a completely different situation is unveiled when the augmented production function is used with mutual causality being noted in all perused variables. The novelty of our study lies first in that it contributes to the health-growth nexus literature for high-income countries which has been quite controversial and second it sets off new variables whose omission might be one of the reasons of the result dichotomy. Results of this study will be very useful for high-income countries currently afflicted by the economic crisis and embark on HCE curtailments or revisions.     

Evaluation of efficiency in Colombian hospitals: An analysis for the post-reform period

In this study we analyze the performance of 602 level 1 Colombian hospitals for the period 2009–2013. The analysis is carried out from both static and temporal perspectives in order to evaluate the evolution of total factor productivity (change in hospital performance) and its components throughout the period. The study also explores a question relevant not only to the Colombian health system, but to many others around the world, of whether primary care centers excessively refer patients to high-level hospitals, thereby negatively affecting the quality, efficiency, and effectiveness of all healthcare service provision. The results demonstrated that adjusted production (service provision) and levels of quality and referrals to higher-level hospitals could be improved, on average, by 44%. This increase in health service provision levels and their quality can be achieved by reducing personnel expenditure (by an average of 22%), expenditure on medicines (by 20%), and purchasing expenses (by 11%). The temporal analysis shows that total factor productivity (hospital performance change) worsened by 1% during the period, mainly due to the technological backlash experienced despite a slightly positive evolution in efficiency.     

Estimating Health Demand for an Aging Population: A Flexible and Robust Bayesian Joint Model

We analyse two frequently used measures of the demand for health—hospital visits and out‐of‐pocket health care expenditure—which have been analysed separately in the existing literature. Given that these two measures of health demand are highly likely to be closely correlated, we propose a framework to jointly model hospital visits and out‐of‐pocket medical expenditure, which allows for the presence of nonlinear effects of covariates using splines to capture the effects of aging on health demand. The findings from our empirical analysis of the US Health and Retirement Survey indicate that the demand for health varies with age. © 2015 The Authors. Journal of Applied Econometrics published by John Wiley & Sons Ltd.     

Data collection frequency effect in the National Medical Care Expenditure Survey.

The National Medical Care Expenditure Survey (NMCES) was characterized by a longitudinal survey design, with data collection targeted to five points in time covering the survey year. Field conditions did not allow for all interviews to be conducted over the targeted time periods. A subset of sampled households (holdovers) were not contacted for a particular wave of the survey and data were gathered at the subsequent time period for the two time intervals that were spanned. National estimates for a representative set of health care utilization and expenditure measures were derived from the sample of holdovers and compared with estimates derived from the respondents with five complete waves of data collection. Controlling for relevant predispositional factors in the estimation of health care utilization and expenditure measures, a test for data collection frequency effect is also considered.     

CPI revision provides more accuracy in the medical care services component.

This revision, as in the past, enabled the Bureau to update medical care service expenditure weights in the CPI, including a more complete allocation of health insurance premiums. Instead of keeping the portion of premiums that go to benefits under health insurance, the expenditure weight for each benefit category has been added to the appropriate out-of-pocket expense. The unpublished health insurance item represents only the retained earnings portion of premiums paid by households. The specific item categories included in medical care services have also been updated and expanded. A study conducted during the developmental phase of the revision indicated that the Bureau should expand the eligible priced rates for physicians in the CPI to include not only the "self-pay" rate, but also other categories of payment as well. Another study indicated that the direct pricing of health insurance is not feasible because of the difficulty of factoring out from premium changes the effect of utilization levels and modified coverage. In pricing medical care service items, as with other item categories in the CPI, BLS attempts to exclude from price movement the effect of quality changes. However, some quality changes are difficult to assess or are not readily identified, for example, a change in the ratio of nurses to patients, and such changes may be reflected as part of the price change movement in the CPI.     

内蒙古财政支出结构的分析及其对经济增长影响的研究

对财政支出结构的研究是当前我国的一个热门课题,它既可以帮助财政支出目标的实现,又可以考察财政支出结构是否促进经济增长。文章首先对财政支出的相关指标测算内蒙古财政支出的规模,其次根据财政支出职能划分内蒙古财政支出结构进行分析,然后应用回归模型分析内蒙古财政支出结构对经济增长的影响,最后根据以上分析的结论,提出优化内蒙古财政支出结构的相关建议。     

Including the Feedback of Local Health Improvement in Assessing Costs and Benefits of GHG Reduction

Ancillary benefits of greenhouse gas (GHG) mitigation refer to benefits from GHG mitigation in addition to lowered adverse impacts of global climate change. A major ancillary benefit of GHG mitigation is reduced local air toxins, which improves health. The purpose of the study is not to determine whether ancillary benefits of GHG mitigation can or cannot justify GHG mitigation. Rather, we discuss how an important benefit of addressing GHG emission — the local health effects — should and can be incorporated using the approaches put forth. A CGE model is used for simulating a carbon tax policy. A health effects submodel takes the local air emissions output from the CGE model and assesses the implications for ambient air concentration, health, and labor supply. Labor and medical expenditure changes are fed back into the economy. Applying this approach to Thailand, when health feedback is included we find that: (1) negative impact on GDP under a carbon tax drops by 45%, and (2) welfare improves for households and cleaner producers.     

我国医疗保险制度存在的问题及对策研究

我国新医改方案推行3年来,用最短的时间编织了世界最大全民医保网,但还存在着社会医疗保障供给与老百姓的医疗保障需求之间差距较大;社会医疗保险的责任范围较小;老百姓的医疗费用负担较重;医疗机构改革滞后等问题。为切实满足人民群众的健康需求,应在建立所有公民都享受全国平均水平的医疗保障体系,有效的实现社会公平和每个公民的健康保障权;本着"最基本的筹资水平、最基本的医疗服务"的理念,建立符合社会主义初级阶段的医疗保险费用筹措制度;在基本医疗的界定和选择上,采用国际上成本效果的评价方法和思想理念;建立行业管理、统筹规划的医疗保险管理体制,促进现代医疗市场的发育和完善;发挥政府、市场两个主体的作用,把商业保险作为对医疗保险的有效补充等方面扎实推进工作。     

Evaluating consumer sentiments as predictors of UK household consumption behavior: Are they accurate and useful?

This paper investigates empirically whether consumer sentiments indices, based on surveys complied by GfK, forecast household consumption types for the UK. Firstly, we use a quantitative equation approach to assess whether the indices are able to forecast household consumption growth in addition to traditional variables, which are included as control variables. Subsequently, using qualitative directional analysis, we investigate whether the indices are accurate and useful predictors as well. We find that, broadly speaking, both the headline, or aggregate, and the major purchasing indices have some predictive powers in addition to the control variables and are also directionally accurate and useful.     

Finland and the mobile phone industry: A case study of the return on investment from government-funded research and development

The sudden and dramatic growth of the mobile phone manufacturing sector in Finland is an interesting case study for science and technology (S&T) policy analysts. Mostly on account of the rapidity of this growth against a relatively static situation for the other sub-sectors, the Finnish economic data over the period 1990–2001 can be used without ambiguity to quantify the return of an initial public sector research and development (R&D) expenditure on the growth of a sectoral economy. Although it is apparent from the data that this economic success story is to some extent now running out of steam, the returns to date for all the participants have been astonishing. Using the Patterson–Hartmann model, which has been developed to link company-level R&D expenditure with product revenue, it is shown that government has managed to achieve a multiplier effect of about 66 on its initial R&D expenditure through initially a leveraging of business R&D expenditure (at a level of 1:3) and then the translation of the latter into an increase in gross domestic product (GDP) (at a level of 1:22). These figures are extraordinarily high, even in comparison to the multipliers obtained by large private sector companies.The keys to the success were both the vision and foresight of the Finnish R&D community, who identified cell phones as a major growth opportunity, the sharing of risk by the various role players (government, universities and industry) as can happen in an efficient national system of innovation, and finally a sustained commitment to R&D by the industry leaders. The latter has now reached a level of 3.5% of GDP (2005), which makes Finland a global leader in R&D expenditure (as a percentage of GDP). The lessons for developing countries such as South Africa, which are moving towards higher levels of R&D expenditure but within a resource constrained context, are apparent.     

Prioritization of government expenditure on health in India: A fiscal space perspective

Unequal distribution of fiscal resources and lower prioritization of budget towards healthcare are the most important challenges in achieving universal health coverage in India. This study has examined relationships between government health expenditure and fiscal space (i.e. tax revenue, non-tax revenue, fiscal transfer, and borrowings) in twenty-one states of India for the period of 1980–2014. Our panel regression results imply that mobilization of tax revenue has a positive impact, while borrowings have a negative impact on the allocation of government expenditure on healthcare in the long-run. The panel quantile regression results show that states associated with the low and middle level of revenue growth have been mobilizing finance through central government transfer and borrowings in short-run. Further, the panel vector error correction models show that sum of the lagged coefficients of borrowings have a greater impact on health financing process as compared to other sources of fiscal space at short-run, and the speed of adjustment towards long-run equilibrium is relatively slower. The overall analysis concludes that less domestic revenue mobilization and higher dependency of borrowings for healthcare financing may create fiscal stress on state finances in the long-run, and thereby it could possibly reduce the prioritization of spending. Therefore, improvement in revenue growth and proper utilization of fiscal transfer would be appropriate policy implications from this study.     

Accounting and the ‘Insoluble’ Problem of Health-Care Costs

Health service accounting reforms are frequently promoted, explained or justified with reference to aging populations, expensive medical technologies and their purported implications for the cost of health care. Drawing on Foucault’s genealogical method, we examine the emergence of concerns regarding health expenditure in the wake of the creation of the British National Health Service in 1948, and their relationship with health service accounting practices. We argue that concerns regarding the cost of health care are historically contingent rather than inescapable consequences of demographic and technological change, and that health service accounting practices are both constitutive and reflective of such concerns. We conclude by relating our analysis to current attempts to control costs and increase efficiency in the health services.     

On the relationship between healthcare expenditure and longevity: evidence from the continuous wavelet analyses

This study applies the continuous wavelet analyses to identify four possible perspectives on the causality between healthcare expenditure and longevity: health as a determinant of healthcare expenditure (longevity leads), healthcare expenditure as a determinant of health (healthcare expenditure leads), feedback (bidirectional relation) and neutrality (no correlation). Our results show that none of these four perspectives regarding the causality of healthcare expenditure and longevity prevail over the period of 1963–2010 in the US. Healthcare expenditure is likely to serve as a predictor to predict the volatility of longevity in the short, medium, and long run, while longevity is likely to serve as a predictor to predict the volatility of healthcare expenditure only in the medium run.     

二元经济结构视角下民生性财政支出与消费关系研究

习近平总书记指出目前中国正处于新发展阶段,我们要加快构建新发展格局,扩大内需,刺激消费。在此背景下,论文依托中国2013-2019年31个省相关的统计数据,利用个体固定效应模型分析民生性财政支出各组成部分对城乡居民消费水平的共性和差异化影响。研究表明,环境保护和住房保障支出对于城乡居民消费水平都没有显著的作用,而教育支出、社会保障和就业这两项支出对城镇居民消费水平的作用较为显著,医疗卫生支出对农村居民来说是正向的。     

影响中国城市增长的因素:地级及以上城市的实证检验

论文以国内外相关城市增长理论为基础,构建了分析中国城市增长的系统模型,并利用206个城市1990年与2005年的社会经济统计数据进行了实证研究.研究结果表明:(1)中国城市的经济增长主要是由劳动生产率提高而非人口规模增长推动的;(2)政府财政支出和城市人力资本积累是目前中国城市经济增长的主要驱动力;(3)人力资本积累并没有在工资增长上得到体现;(4)城市公共设施和环境的改善引致了城市人口增长,但对城市经济发展却没有明显的作用.在以上研究结果基础上,论文提出了保持城市可持续发展的一些政策建议.     

Does politics make a difference?

Abstract

The concern of this article is the nature of the politics of public expenditure and whether changes in government between the Conservative Governments of Mrs Thatcher and the Blair Governments did reflect differences in policy priorities? The Thatcher Government in 1979 had announced that public expenditure was at the heart of Britain's economic problems. The Blair Governments did not seek to change the expenditure plans outlined by the outgoing Chancellor Kenneth Clarke. This study seeks to show that the analysis of data using long term trends for the post war period that the during the years of the Thatcher Government they government did manage to hold expenditure below its long term grwoth trends which in turn meant reductions in health and education spending while there were additional spending in law and order and defence. By contrast the Blair Government has managed to reverse this trend so that during the years of the Balir Government expenditure on socal provision has been expanding above the trend.