Recent trends in health care expenditure and utilization in OECD countries

Conclusions High unemployment and low economic growth continue to plague many OECD countries, putting strong pressures on governments to reduce social spending. Health is the second largest social expenditure program and has been one of the fastest growing. Health care financing and delivery systems which were designed to achieve access have not proven themselves effective in ensuring efficient production and consumption of services.The inability to measure the effects of health expenditures on health outcomes, the lack of clinical standards of appropriateness of treatment, and indeed the sensitivity of health status to non-medical systems' aspects of society further confound the problems of developing policies to promote efficiency and equity. Moreover, future demographic and technological changes could place substantial new budgetary pressures on governments.Understanding the nature of the problem, effective measures taken, and the transferability of such measures to particular situations or systems are essential for preserving access while assuring efficiency under current as well as future economic and demographic constraints.Invited address at the Twenty-Third International Atlantic Economic Conference and the International Health Economics and Management Conference, April 20–27, 1987, Munich, West Germany. The views expressed in this paper are those of the author and do not necessarily represent those of the OECD.     

Impact of urban-rural health insurance integration on health care: Evidence from rural China

In recent years, Chinese local governments have experimented with integrating the social health insurance system segmented between rural and urban areas to unify the administration, policy, and funds of various health insurance programs. In this study, we take advantage of the staggered implementation of the urban-rural health insurance integration across cities over time to examine the impacts of the integration on rural residents' health care utilization and health outcomes. Based on an original city-year level policy dataset and the China Health and Retirement Longitudinal Study (CHARLS) for the years 2011, 2013, and 2015, we find that the integration significantly increases the middle-aged and older rural residents' inpatient care utilization and this positive effect is particularly salient in poor areas. Moreover, we find that the positive policy effect of integration is attributed to enhanced health insurance benefits, such as a higher reimbursement rate for inpatient care. However, the integration has limited impacts on the middle-aged and older rural residents' health outcomes. This study reveals the partial success of urban-rural health insurance integration to reduce health care inequality in China.     

Human resource development and growth: improving access to and equity in the provision of education and health services in South Africa

This paper demonstrates the importance of improving access to and equity in the provision of essential services such as education and health for enhancing human development. A major constraint to accelerating and sustaining economic growth in South Africa is the shortage of skilled human resources. Human capital formation (through appropriate education, training and health) is vital for growth. However, for sustained growth to reduce poverty and unemployment, human capital of a ‘higher order’ than the system is currently producing, in both quantitative and qualitative terms, must be generated. The paper reviews progress in the education and health sectors and identifies the challenges. It stresses the need for policy makers to recognise the link between education and health outcomes and the provision of clean water, adequate sanitation, cheap and accessible transport and effective nutrition programmes. Addressing only the education and health services is unlikely to lead to optimal outcomes in these sectors.     

Provision of medical services to the population: Economic problems

Economic problems of the ongoing health reform in Russia are discussed. Various approaches to the development of the country’s medical care system are analyzed in terms of medical aid accessibility to the population. The author reviews the world’s practice to comes to the conclusion that it is necessary not just to increase the public health spending, but first to choose a financing system that will provide efficient ways of delivering quality health care to the population. In this respect a public system has a relative advantage over other ways of financing.     

Macroeconomic policies and their impact on health in Zimbabwe in the 1980s and 1990s: An analysis of the prevalence of diarrhoea,malnutrition, maternal mortality and access to health services

The main objective of this article is to examine how the changes in macroeconomic policies have shaped health outcomes, particularly with regard to diarrhoea, malnutrition, maternal mortality and access to health services, and how these health outcomes vary by income, geographical location and gender. Macroeconomic policies in Zimbabwe have tended to shape health outcomes and they have also had an impact on trends in household income levels and access to health facilities. During the 1980s, the government's health policy 'Equity in health' led to increased access to health facilities. The policy of free health for low-income households made it possible for poorer groups to access health facilities more easily. However, the introduction of economic reform programmes popularly known as the Economic Structural Adjustment Programmes in Zimbabwe, has witnessed a massive shift in macropolicies. These policy changes have tended to affect the health sector in a negative manner. The introduction of user fees as a cost recovery measure and the rollback on government expenditure on social sectors, health included, have led to a reduction in the population able to access health facilities. Results of studies have shown a positive relationship between the prevalence of diarrhoea, malnutrition and access to health facilities with income levels, rural/urban location and gender.     

Limited access to services for the urban poor in Windhoek,Namibia

The majority of the population living in the informal settlements of Windhoek, Namibia, have limited access to public municipal services. This paper integrates results from a sample of 97 randomly selected households, interviews with experts and community leaders and review of literature to describe and analyse the relationship between land tenure and municipal services in the informal settlements. Findings from our study show that formalised land tenure is a condition for households to access municipal services privately. However, 85% of the sample of the households in the informal settlements do not own land under current land tenure policy. Further, the need for communities ‘to own land’ seemed more immediate and pressing compared to water access, which is seen as a way to govern themselves towards raising funds for land acquisition. But lack of land ownership remains a constraint.     

Identification and prioritisation of access problems in rural areas

The concept of rural transportation planning has changed over the years. Nowadays a needs-based approach is generally used where the accessibility of the population to the activity centres or services is given more emphasis than the earlier concept of only the construction of motorable roads. In the process, a new approach known as Integrated Rural Accessibility Planning (IRAP) has been developed. One of the steps in IRAP is the quantification of villagers' accessibility levels to different activities or services. An attempt has been made in this article to improve the existing method of quantification and prioritisation by introducing the concept of the Accessibility Shortfall Index (ASI).     

Resource allocation, equality of access and health

Based upon the experience of Tanzania, this paper relates resource allocation in the health sector to the output of health, by contrasting access to and utilization of available health services by urban and rural populations. The writer argues that increased health expenditures alone cannot yield an efficient health care return unless the additional expenditure is spread ‘thinly’, in keeping with the realities of population distribution, transport possibilities, and disease patterns in most poor countries. Detailed data are presented for recurrent and capital expenditures for health facilities at different levels, and the output of those institutions is considered in terms of the volume of services offered. Those services are then measured according to their utilization by urban and rural populations. Because referral systems are found to function only marginally, it is argued that further building of large hospitals is not justified in the present situation of most poor countries. Specifically, the writer describes the ways in which Tanzania is changing its inefficient and unjust health care system. The paper concludes that the major obstacles to change are not shortages of resources or technologic ignorance but social systems that do not place high value upon the health care needs of rural peasants. It is in this way that the professional and elitist interests of the few are often destructive of the needs of the many.     

Effects of public health policies on the health status and medical service utilization of Chinese internal migrants

This paper examines the effects of the “Equalization Program of Basic Public Health and Family Planning Services for Migrants” (EHFPSM), a novel internal migrant-targeted public health policy, of China implemented in 2013. By combining the individual-level data from the “China Migrants Dynamic Survey” and city-level statistical data, we find that EHFPSM contributes to a 6.9% statistically significant increase in the probability of electronic health records coverage and a 7.2% increase in the probability of reimbursement in the last inpatient visit, as well as a 1.2% decrease in the probability of one-year prevalence. The mechanism test shows that this program promotes the migrants' understanding of the policies and social insurance coverage to enhance their health status. EHFPSM brings about more significant decreases in disease prevalence for male and less-educated migrants, and higher reimbursement probability for urban hukou migrants. Our paper facilitates better understanding of the role of public health policies in promoting the internal migrants' health from the perspective of China.     

Education and family health care spending

Michael Grossman's seminal work on the demand for health extended the concept of a household production function to the commodity “good health.” In this framework, education represents an “environmental variable” that enhances the monetary returns to investments in health through the use of time and medical care in health production. Using data from the 2004 to 2012 Medical Expenditure Panel Survey (MEPS), we examine the association between parental education and family health care spending in single-mother and two-parent families. We estimate one- and two-part expenditure models for total family health care spending, for specific components of such spending, and also examine the impact of parental education on selected measures of family health. Controlling for family income and health insurance status, we find consistent evidence that parental education beyond 12 years of schooling is associated with increases in family health care spending and with reductions in the likelihood of adverse health conditions.     

Impact of the new health care reform on hospital expenditure in China: A case study from a pilot city

This study evaluates the preliminary effects of the new healthcare reform plan for hospital expenditures in China. Cross-sectional patient-level data are used for the analysis. We employ an endogenous switching regression model to account for heterogeneity and sample selection. The results show that the reform plan can significantly reduce total hospitalization expenses and medication fees for patients who select the pilot hospital. It may exert inadequate control over inspection fees, but as the advance of the reform, the control is likely to improve gradually. Our findings underscore the importance of realigning incentives for healthcare providers in China.     

Botox and bridges: South African exports of health and construction services

Until relatively recently, policy makers and academics directed little attention to trade in services. This has changed in recognition of the increasing role of services in economic growth, trade and investment. In World Trade Organisation (WTO) and other trade negotiations, discussions on services have become as important a. s., if not more important than, those on trade in goods. Despite the growing contribution of services to exports and economic development, trade in services remains highly regulated, especially in developing countries. This article outlines the main methodological and policy challenges facing developing countries, such as South Africa, in trying to understand the economic implications of service liberalisation. This is achieved largely by means of two case studies of the construction and health services sectors. While the findings are preliminary and the policy conclusions speculative, the article provides some examples of the key analytical difficulties that arise in services analysis. More importantly, it highlights the need for the government to develop integrated service sector strategies that recognise the contribution of trade to development policy and the impact of domestic regulations on trade.     

The Cuban health care system: Responsiveness to changing population needs and demands

The health of the Cuban population has improved dramatically since 1960. The health care system has rightfully taken a share of the credit. Health services have evolved in stages corresponding to changing health needs and population pressures.Presently a program of neighborhood family physicians is being implemented while simultaneously the emphasis on tertiary care and basic research is being increased. This paper examines the reasons for this latest reorganization of health services and the mechanisms that have made it possible. The implications for health care services in other developing countries are considered.     

基于公平正义原则的基本公共卫生服务均等化路径与对策

基本公共卫生服务均等化是我国新医改提出的目标。文章以公共产品理论和资源配置理论为分析工具,通过调查和历史数据分析,对我国基本公共卫生服务均等化的现状进行分析。以公平、正义理念为指导,根据帕累托改进原则,在城乡发展战略框架下构建城市与农村统筹的基本公共卫生服务供给制度,提出我国基本公共卫生服务均等化的有效路径和对策。     

Impact of supplementary private health insurance on hospitalization and physical examination in China

Private health insurance (PHI) is considered an important supplement to the basic social health insurance schemes in the Chinese healthcare system. However, whether the strategy of engaging PHI as supplementary coverage is effective cannot be determined without knowing the impact of supplementary PHI on healthcare access and utilization, the evidence on which is currently absent in China. Therefore, we aimed to investigate the effects of supplementary PHI on hospitalization and physical examination to provide such evidence in the Chinese setting. We conducted a cross-sectional analysis using data from the 2015 wave of China Health and Retirement Longitudinal Study (CHARLS). Using probit models and bivariate probit models with instrumental variables (IVs), we evaluated the effects of supplementary PHI on the utilization of hospitalization and physical examination. Our analyses provided evidence that supplementary PHI increased the probability of physical examination but decreased that of hospitalization.Our findings suggest that supplementary PHI in China may effectively promote the use of high-value preventive care, thereby reducing subsequent utilization of expensive medical services. The present study provided preliminary evidence that the China healthcare system can benefit from engaging PHI as supplements to SHI.     

Federal health care policy and the public-general hospital

Conclusion Although a stringent policy environment adversely affects both private and public hospitals, the market circumstances are worse for public hospitals. Because they are providers of last resort, they do not have as much flexibility as private hospitals in determining the quantity and scope of services they provide.     

教师职业病的预防和保健

久做办公室会患许多疾病,通过运动健身可以预防职业病的发生,合理饮食的还可起到保健作用。     

Unequal access to education and income distribution

Summary This paper attempts a new specification of the education variable in accounting for differences in income distribution in a cross-sectional analysis of 49 countries. The specification refers to the steepness of the educational pyramid, as measured by the coefficient of variation of enrolments within a given country. This variable alone explains 23 per cent of income inequality across countries (as measured by the Gini coefficient), while in the presence of it the traditional (catch-all) per capita income variable becomes insignificant.This finding indicates the importance of the supply side in relative income determination. It is also suggestive that a policy aiming at equalisation of access to the different levels of education might help in reducing income inequality.I would like to thank Arnold Anderson, Mary Jean Bowman, Jan Tinbergen and Peter Wiles for commenting on an earlier draft of this paper.     

文化产业发展问题与对策探析

在我国"十五"计划中,文化产业第一次被正式纳入国家经济社会发展计划;党的"十六大"报告进一步强调:"发展文化产业是市场经济条件下繁荣社会主义文化,满足人民群众精神文化需求的重要途径。"种种迹象表明,文化产业已经成为当今世界十分引人注目的新兴产业。本文试图通过对国内