The impact of regional competition on the health care industry

We investigate factors that determine firm markups by employing data on prices and quantities of various medical procedures at major hospitals in the United States. We focus on the impact of hospital quality, rival competition and the number of medical procedures upon the health care demand. Our analysis covers health-care markets across the United States with the market definition based upon the hospital referral regions. Our findings highlight potential implications of the relationship between hospital markups and market structure.     

The determinants of health care expenditure in Australia

The objective of this article is to examine the long-run relationship and short-run dynamics of the health care expenditure in Australia during the period 1960–2003. Consistent with the conventional findings, the income elasticity for health care is found to be greater than one, suggesting that health care is a luxury good in Australia. Demographic structure is found to exert a significant positive impact on health care expenditure. An increase in the accessibility to health care services is associated with higher per capita real health care expenditure. Finally, public funding of health care appears to have a contributory effect on the formation of health care expenditure in Australia.     

Unbalanced growth and health care expenditure

Baumol's model of unbalanced growth implies that health care expenditure (HCE) is driven by wage increases in excess of productivity growth. However, it remains unclear whether the HCE in developing countries is affected by the same factor. This paper tests this hypothesis by using China provincial panel data. We show that HCE grows more rapidly if economy‐wide wage growth exceeds productivity growth in China. The results are robust to the use of housing price as an instrumental variable for the economy‐wide nominal wage and the inclusion of real GDP growth, demographic structure, government deficit, pollution emissions and health sector quality as control variables. Furthermore, our findings show that Baumol's cost disease plays a more important role in the less economically developed western regions in which the rural–urban migration is less pronounced.     

Robust determinants of health care expenditure growth

Our aim is to disclose robust explanatory variables for health care expenditure (HCE) growth by introducing to this field of research a method that is especially well suited for situations of ‘model uncertainty’: the Extreme Bounds Analysis (EBA). We analyse data for 33 OECD countries over the period 1970–2010 and include – as far as it is statistically feasible – all macroeconomic and institutional determinants of HCE growth in the EBA that have been suggested in the literature. Furthermore, we analyse to what extent outliers in the data influence the results. Our results confirm earlier findings that GDP growth and a variable representing Baumol’s ‘cost disease’ theory emerge as robust and statistically significant determinants of HCE growth. Depending on whether or not outliers are excluded, we find up to six additional robust drivers: the growth in expenditure on health administration, the change in the share of inpatient expenditure in total health expenditure, the (lagged) government share in GDP, the change in the insurance coverage ratio, the growth in land traffic fatalities and the growth in the population share undergoing renal dialysis.     

The impact of decentralization and inter-territorial interactions on Spanish health expenditure

This paper examines the determinants of regional public health expenditure in a decentralised health system. Unlike previous studies we take into account possible policy and political interactions among authorities, as well as unobserved heterogeneity. Our emprirical contribution lies in running a spatial panel specification using a dataset of all Spanish region states on aggregated and disaggregated health expenditures (pharmaceuticals, inpatient and primary care). Results are consistent with some degree of interdependence between neighboring regions in spending decisions. Empirical evidence of long term efficiency effects of health care decentralisation, suggests that a specific spatial-institutional design might improve the health system efficiency as well as regional cohesion. Political and scale effects are consistent with theoretical predictions.     

On the determination of the US aggregate health care expenditure

Per capita real health care expenditure is examined against three major groups of explanatory variables: economic, demographic, and health stock, and it is found that the three groups of variables have an impact on real health care spending. Other subcategories, such as real private, and government health care, pharmaceutical, dental, home nursing, ambulatory, personal medical consumption, and in-patient expenditures have also been examined, and have been found to be affected by the explanatory variables. For several subcomponents there is evidence of supplier inducement. Of the demographic group of variables, the ageing population had an impact only on the per capita real overall, and private health care outlay, and pharmaceutical spending. Also, cointegrating relationships were found and consistent estimators of the elasticities found.     

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.     

Restructuring hospital industry to control public health care expenditure: The role of input substitutability

In this paper we investigate the economic rationality of the bed downsizing process, characterising the hospital industry worldwide in the last decades, as a measure to control public health care expenditure. Considering a sample of Italian hospitals, we provide fresh evidence on the factor substitutability in the production of hospital services. Differently from other studies, based on North-American data and limited to pre-determined cost function models, we estimate a general specification (the Generalised Composite), and test it against traditional nested models (e.g. the Translog). For all the specifications we derive Allen, Morishima and Shadow elasticities of substitution between input pairs, obtaining a fairly consistent picture across all models and elasticity concepts. In particular, our results highlight a very limited degree of substitutability between factors in the production of hospital services, especially between beds and medical staff. These findings suggest that a restructuring policy of the hospital industry, which is confined to reducing the number of beds without involving workforce management, could not be a viable strategy for controlling public health care expenditure.     

On the relationship between GDP and health care expenditure: A new look

In this paper we analyze the relationship between income and health expenditure in 31 Organization for Economic Cooperation and Development (OECD) countries. We focus on the differences between short and long term elasticities and we also check the adjustment process of health care expenditure to changes in per capita Gross Domestic Product (GDP) and its cyclical and trend components. In both cases, we test if results differ in countries with a higher share of private expenditure on total health expenditure. Econometric results show that the long-run income elasticity is close to unity, that health expenditure is more sensitive to per capita income cyclical movements than to trend movements, and that the adjustment to income changes in those countries with a higher share of private health expenditure over total expenditure is faster.     

Aggregate health care expenditure in the United States: evidence from cointegration tests

Unlike recent studies that are based on international cross-sectional series, this paper attempts to quantify the role of the determinants of aggregate health care expenditure per capita, using time-series data for the period of 1960–87 for the United States. The paper applies the relatively new procedures of unit root testing, cointegration and error-correction modelling. The evidence supports cointegration. Although, the results indicate that per capita income, age of the population, number of practising physicians, and public financing of health care are important determinants, the age structure of the population and number of practising physicians emerge as the major determinants of aggregate health care expenditure in the United States.     

The impact of the correlation between health expenditure and survival probability on the demand for insurance

This paper studies the effects of health shocks on the demand for health insurance and annuities, along with precautionary saving in a dynamic life-cycle model. I argue that when the health shock can simultaneously increase health expenses and reduce longevity, rational agents would neither fully insure their uncertain health expenses nor fully annuitize their wealth because the correlation between health expenses and longevity provides a self-insurance channel for both uncertainties. That is, when the agent is hit by a health shock (which simultaneously increases health expenses and reduces longevity), she can use the resources originally saved for consumption in the reduced period of life to pay for the increased health expenses. Since the two uncertainties partially offset each other, the precautionary saving generated in the model should be smaller than in a standard model without the correlation between health expenses and longevity. In a quantitative life-cycle model calibrated using the Medical Expenditure Panel Survey dataset, I find that the health expenses are highly correlated with the survival probabilities, and this correlation significantly reduces the demand for actuarially fair health insurance, while its impact on the demand for annuities and precautionary saving is relatively small.     

The impact of scientific research on health care: Evidence from the OECD countries

This paper investigates the impact of scientific research on health care productivity in a set of OECD countries, in the years from 1960 to 2008. To this end, we have matched information collected from the OECD Health Data 2010 with data gathered from the Scopus database on the papers published and their relative citations. Our empirical results suggest that medical research plays an important role in explaining health care productivity, although various countries are characterized by different velocities in assimilating scientific knowledge. Another important result that emerges from our work is that countries characterized by a faster absorption of academic science, such as the US, have on average a milder impact of scientific research on health productivity, compared with countries with slower absorption. As one would expect, we also find that countries absorbing more scientific research also bear higher health costs.Results from this study may support policy makers in designing incentive mechanisms to improve the impact of medical research on the health care system.     

Price and quantity in international comparisons of health care expenditure

An important omission from earlier cross-national comparisons of health care expenditure has been the failure to distinguish between price and quantity. Using recent data on purchasing power parities, the purpose of this article is to report some preliminary results regarding health care expenditure and quantity across 22 OECD countries. The article concludes that, contrary to what has been suggested in some recent articles, the relative price of health care is not correlated to the aggregate per capita income. The fraction of the national income that is devoted to health care provision increases with the per capita income regardless of whether health care is measured in terms of expenditure or quantity. The relative price of health care has a rationing effect on the quantity of health care that is offered, with a price alasticity close to minus one. The latter finding means that the health care expenditure is not greater in countries with higherprices. Furthermore, the differences in health care expenditure or quantity between countries persist after correction for the relative price and the income level. Part of these differences can be explained by differences in the definition of health care in the various countries.     

Between European integration and regional autonomy: the case of Italy from an economic perspective

Italy has experienced a double political phenomenon over the last few decades: a transfer of powers to a supranational entity (the EU) and a move towards regional autonomy. This paper aims to evaluate how policy competences are attributed to and exercised by the European, national and regional institutions. It develops a set of quantitative indicators analysing the legislative production of the EU, the Italian parliament and the Italian regions in various policy areas. The main findings indicate a certain substitutability between European and national legislation and that different levels of government share competences in a larger number of sectors than suggested by the economic theory.

The impact of lifestyle health risk on the bottom line: a case study

As the Lifestyle Advantage study continues, HPS expects to follow the utilization trends for a consistent group of participants and nonparticipants, maintaining full confidentiality. Several key issues will be addressed in the process: As the participation rate increases, will the claims payment gap between participants and nonparticipants be reduced? Can a company hope to see a return on an investment in a health promotion program? If so, over what period of time? Finding answers to these questions will contribute to the larger issues of long-term health care cost containment and health care reform.     

The nature of regional unemployment in Italy

Taking as a starting point the evidence of growing disparities for most of the 1984–2007 period, this article investigates the nature of regional unemployment in Italy. In particular, we assess whether the Italian regional unemployment rates contain a unit root and are, thus, subject to pure hysteresis, considering as alternative hypotheses both a linear and a non-linear stationary process. For that purpose, we employ three recently developed panel unit-root tests, taking account of structural breaks, cross-section dependence and non-linearities. Contrary to previous studies in the literature, our results reject the pure hysteresis hypothesis and support the characterisation of regional unemployment in Italy as a stationary but non-linear process, subject to multiple equilibria, in line with the ‘structuralist hypothesis’ advanced by Phelps (1994).     

Impact of remittances on household health care expenditure: Evidence from the Nepal Living Standards Survey

This paper examines the effect of remittance inflows on health care expenditure in Nepal using the Nepal Living Standards Survey 2010–2011. Using the recursive three‐stage least square regression method, the propensity score matching method, and the Oaxaca–Blinder decomposition method, we find a positive and significant effect of remittances on health care expenditure. In particular, our analysis shows a 0.099% increase in health care expenditure for every 1% increase in overall remittances. This effect increases to 0.189% for earned remittances (remittances received from a household member). We also find that remittance‐receiving households with at least one migrant family member have different health care spending behavior than those with no migrant members.     

Health spending in Italy: The impact of immigrants

The welfare impact of immigration is a highly debated issue especially for countries on the external borders of the European Union. This paper studies how immigrants affect public health expenditure across Italian regions during the period 2003–2016 using NUTS II level data. Identification strategy is based on shift–share instruments, which are made robust to pull factors that might attract immigrants in Italy and to internal migration of natives. We find that a 1 percentage point increase in immigrants over total resident population leads to a decrease in public health expenditure per capita by about 3.8% (i.e. around 69 euro per capita). Among possible channels, we find no support for any crowding out effect from public to private health services by natives due to increasing immigration or for any role played by different levels of efficiency across regional health systems. Our results are driven by immigrants' demographic structure: they are mostly males and younger workers that call for less health spending, according to a positive selection mechanism. Moreover, linguistic barriers contribute to limiting the immigrants' reliance on public healthcare, which is confirmed also by the use of the European Health Interview Survey microdata.     

The impact of degree programmes on university expenditure

This research examines the impact of the number and mix of academic degree programmes on university operating expenditure in the United States. Statistical results are based on data for doctoral and research institutions without medical schools. After controlling for other factors influencing expenditure, additional degree programmes are associated with significant increases in expenditure, with doctoral programmes having a 40% higher marginal impact on total expenditure than baccalaureate programmes. Most institutions are found to be smaller than the expenditure-minimizing size and to have higher expenditure per full-time-equivalent student. As specified, the models explain a large amount of the variation in expenditure across the institutions.     

Human development and decentralization: The importance of public health expenditure

In this article, we empirically analyze the impact of central and subnational government spending on human development in a sample of 57 developed and developing countries over the period 2000–18. Specifically, we focus on the effects of health and education public expenditure on the Human Development Index (HDI) and its dimensions (life expectancy, education, and income). Applying data panel analysis, our empirical evidence shows the importance of central and subnational government health expenditure positively impacting on HDI and each of its components, while in the case of the education expenditure, this positive effect is only confirmed on the educational dimension of HDI. Our study shows how governments can stimulate human development, improving the well-being of citizens, by allocating more resources to healthcare through the different administrative levels.