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.     

破解医改难题关键在于纠正市场与政府的双失灵——中国医疗体制改革的经济学分析

医疗卫生关系人们的生命健康,建立一个科学完善的医疗卫生体制是构建和谐社会的重要内容。目前,中国医疗卫生体制改革失败的事实要求我们深入分析其背后深层次的原因。中国医疗体制改革失败的根本原因在于市场与政府的双失灵,破解医改难题关键在于纠正市场与政府的双失灵。     

Is health care a luxury? The debate revisited with new evidence from emerging economies

This paper studies the long-run relationship between health care expenditure and income using a panel data set of emerging economies over the period 1995–2012. The results show that expenditure on health care and income are non-stationary and cointegrated. After controlling for cross-sectional dependence and unobserved heterogeneity among different countries, we find that the income elasticity of health care is less than 1, indicating that health care is a necessity and not a luxury. Government expenditure and out-of-pocket expenditure turn out to be important determinants of health care expenditure. Among non-monetary factors, results show that old age dependency and female education seem to have significant bearings on health care expenditures. Policy recommendations suggest that government should increase spending on health care in emerging economies since higher incomes may not automatically translate into higher health care spending by the people of these countries.     

Governing for improved quality and patient safety

Board members have a critical oversight role to play in monitoring and providing direction to improve health care quality and safety. In the emerging environment of health care reform, the board's role in overseeing quality and safety on behalf of stakeholders will become as or even more important than its financial oversight role. Nurses can expand their impact by joining the ranks of health care organization governing boards to lead and guide the entire health care enterprise to realize the goal of improved care and outcomes for all patients.     

Efficiency of health care delivery systems: effects of health insurance coverage

Health insurance expansions may increase the demand for care-creating incentives for health systems to increase input consumption. The possibility remains that added capacity and personnel will have little effect on health outcomes, decreasing the technical efficiency of health care delivery systems. We estimate that a 1 percentage point increase in health insurance coverage decreases the technical efficiency of health care delivery by 1.3 percentage points, translating into approximately 50 billion dollars in additional health expenditures. This finding uncovers a previously unexplored consequence of changes in health insurance on the supply side of health care markets suggesting one avenue through which health care costs growth may occur.     

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.     

Cost-effectiveness of a symptom management intervention: improving physical activity in older women following coronary artery bypass surgery

Older women have lower levels of physical functioning and higher associated health care costs than men after coronary artery bypass surgery (CABS). Clinical trials have demonstrated that interventions to increase physical activity levels can reduce the risk of recurrent cardiac events, reduce health care expenditures, prolong life, improve functional capacity, and increase quality of life in the elderly cardiac population. It is important for the patients, providers, health care payers, and policymakers to identify a cost-effective recovery intervention that has the potential to increase women's physical activity and functioning during their early recovery from CABS, especially in this time of limited health care resources. This home-based symptom management intervention has the potential to reduce the risk of recurrent cardiac events and health care cost by improving women's physical activity level after surgery. This information is vital to nursing leaders in making resource decisions regarding followup care of women who have had heart surgery.     

Complex home care: Part 2- family annual income, insurance premium, and out-of-pocket expenses

Annual costs paid by families for intravenous infusion of home parenteral nutrition (HPN) health insurance premiums, deductibles, co-payments for health services, and the wide range of out-of-pocket home health care expenses are significant. The costs of managing complex chronic care at home cannot be completely understood until all out-of-pocket costs have been defined, described, and tabulated. Non-reimbursed and out-of-pocket costs paid by families over years for complex chronic care negatively impact the financial stability of families. National health care reform must take into account the long-term financial burdens of families caring for those with complex home care. Any changes that may increase the out-of-pocket costs or health insurance costs to these families can also have a negative long-term impact on society when greater numbers of patients declare bankruptcy or qualify for medical disability.     

Supplementary private health insurance and health care utilization of people aged 50+

Does supplementary private health insurance (PHI) coverage influence health care utilization in countries where the coverage ratio with public health insurance is high? I estimate this effect using the Survey of Health, Ageing and Retirement in Europe. Handling the potential endogeneity of supplementary insurance coverage and the large fraction of zero observations in the utilization models influences the empirical results. I show that the effect of PHI coverage on inpatient and outpatient care utilization is not trivial even in countries with generous public health funding. The main finding is that supplementary PHI coverage increases dental care utilization, but decreases the visits to general practitioners. Private insurance is estimated to have little and insignificant influence on the utilization of inpatient care and outpatient specialist care. The magnitude of the effect of supplementary PHI on health care utilization varies with the characteristics of the health care systems.     

Firm turnover,restructuring and labour productivity in transition: the case of Poland

Many studies have found strong and positive relationship between per capita income and health care expenditure. These studies usually adopt the assumptions that (1) the relationships among the variables are constant; and/or (2) the supply-side market for health care could be treated by using standard demand functions models. To take into account of the supply side of health care, we use the demand and supply approach with the cointegration model to re-examine this issue. By using Taiwan health care expenditure data, our results show that the real income elasticity is smaller than unity and the health care expenditures are primarily for ‘curing’ rather than ‘caring’.     

New evidence on factors affecting the level and growth of US health care spending

The dual problems of high and rising medical care expenditures and substantial differences in spending across geographic regions have long plagued the US health care system. We provide new evidence to explain why some states and regions of the country spend much more on medical care than others, and why health care spending for the nation as a whole has been growing rapidly over the last several decades. To do this, we estimate a health care spending panel data model using annual data on all 50 states for the period 1993–2009. Our model includes a number of socio-economic, health care provider, lifestyle and environmental variables that past studies indicate may affect the level or growth of aggregate health care spending. We exploit the time effect component of our model to obtain an upper-bound estimate of the effect of advances in medical technology. Our findings indicate that the most important factors influencing the level of spending are availability of providers, income, excessive alcohol consumption, Medicaid coverage, HMO health plans and the proportion of the population elderly and African-American. The principal drivers of growth have been the continual introduction of new medical technologies, and the growth of providers and income.     

我国城镇已婚妇女照料父母与自评健康的关系研究

我国老年人以非正式照料为主,妇女承担了主要的照料责任。政府减少对非正式老年照料的支持以及老年人口的快速增长将会加重家庭中女性的照料负担。利用1997、2000、2004和2006年中国营养与健康调查(CHNS)数据和Ordered Probit模型来研究城镇已婚妇女照料父母及其自评健康的关系。在我国城镇,与不照料父母相比,照料父母的已婚妇女更倾向于报告较差的健康水平,并且"自评健康状况非常好"的概率减小,而"自评健康状况一般"的概率增大。应该关注日益繁重的照料责任,以及工作与家庭照料之间的激烈竞争可能给妇女的心理、身体和社会福利带来的负面影响。     

Engaging patients and families in ehealth

National Health IT Week, which ran from September 11-16, 2011, served as a time to highlight the importance of efficient information systems that protect the privacy and security of personal health information while improving the delivery of health care in the United States. During the week, the health IT community came together to raise national awareness regarding the consistent breakthroughs and hard work industry professionals, providers, and consumers have put forward to ensure they are moving toward the common goal of advancing the future of health care through private and secure health IT. Two events during the week (the Consumer Health IT Summit and the launch of the HealthlT.gov web site) brought home a theme increasingly seen as important to improving our health care system--patients participation in their care. Nurses will need to work with patients so they understand the importance of their participation as a partner in their care, instead of playing a passive role. One way we can do that is to encourage our patients to actively use technology to manage their own health care and to share information with their health care providers.     

中国中老年人预防保健服务需求及其与住院需求的关系研究

利用中国健康与营养调查(CHNS)数据,采用二元双因变量Probit模型,分析我国45岁以上中老年人预防保健服务需求及其与住院需求的关系。中老年人的预防保健服务有效需求不足;医疗保险、收入状况对预防保健服务利用有显著影响;预防保健服务利用减少了后期住院的可能性。     

Immigration and health care reform: shared struggles

The connection between health care and immigration share overlaping key areas in policy reform. General concern, anger, and fear about immigration has been spreading nationwide. While illegal immigrants' use of expensive emergency department services does add to the cost for uncompensated care, this expenditure is not a primary cost driver but more a symptom of little or no access to preventative or primary health care. As a result of federal inaction, more state politicians are redefining how America copes with illegal residents including how or whether they have access to health care. The overlap of immigration and health care reform offers an opportunity for us to enter the next round of debate from a more informed vantage point.     

Essential health care: affordable for all?

Access to affordable health care has become a national crisis. The uninsured have many faces and many reasons for being uninsured. The nation cannot afford to sustain this broken system; not in terms of resources, nor in terms of the deteriorating health of the public. Universal coverage could offer a promising opportunity to begin to ameliorate the unsustainable use of expensive illness care now substituting for effective low-cost prevention and early detection. A proposal for essential health care coverage, a balance between cost and choice to maximize use of beneficial care, is presented.     

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.     

Socio-economic evaluation of mental health as a basis for financing health care in Sweden

The objective of this paper is to examine hypotheses about the relationships between socio-economic factors, risk factors in working life, and the occurrence of mental illness, together with the degree of quality of life and consumption of health care, costs for health care, and costs for social insurance. This is a prospective and longitudinal study of 1,347 individuals of an active working age, 18–64 years, who have been on sick leave for more than 30 days. The group is characterized by the prevalence of risk factors in their work environment and welfare losses, such as multiple health problems, poor quality of life, inability to work, and dependency on society's support from health care and social insurance. The costs for health care were just over 2.8 million SEK, or 30 percent higher for those with psychological distress as compared to the group without. The payments from social insurance also increased by approximately 15 percent. The relatively greater weighting of health care costs and sickness cash benefits were motivating factors to study whether this group had an optimal amount and quality of health care, or if the resources available for health care should be distributed in another way that better satisfies the needs of the group.     

Do Consumers Purchase Too Much Health Insurance? The Role of Market Power in Health‐Care Markets

Several authors have suggested that consumers purchase too much health insurance in private markets. We readdress this issue within a model that combines excess health‐care demand due to health insurance with market power due to monopolistic production of health‐care services. We evaluate the market equilibrium in terms of consumer welfare and social welfare. The consumer welfare criterion suggests that in the market equilibrium consumers in fact purchase too much health insurance coverage. The social welfare criterion, in contrast, suggests that because profits of the health‐care industry are properly accounted for, consumers should purchase more insurance coverage than they choose to do in the market equilibrium.     

Hospitality and service: leading real change

A patient's decision to recommend a health care organization and the patient's loyalty scores are largely determined by the interaction patients and their families have with the nurses. Hospitality is how the delivery of that product makes the person feel and is a dialogue that requires the server to be "on the guest's side" throughout the experience. The challenge for health care is to help our patients and their families transcend the usual routine care of our health care world and to experience an emotional connection that provides that sense of affiliation and emotional kinship with the organization and the staff. Moving from the service mindset in health care to the hospitality mindset that engages people positively and emotionally is what healing is all about.