Using the stochastic health state function to forecast healthcare demand and healthcare financing: Evidence from Singapore

Typically, healthcare financing for an ageing population requires projections on healthcare demand and cost. However, projecting healthcare demand based on projected elderly does not consider changes in population health state over time. This paper proposes a new approach to forecast health variables using a stochastic health state function and the well‐established Lee–Carter stochastic mortality model. With the estimated health state at each age over time, we project the hospitalization rate, healthcare demand, and financing cost for Singapore using historical life tables and hospital admission data. Our findings show that while hospital insurance claims increase owing to an aging population, improving health state could save costs from hospital insurance claims. This has policy implications: more attention should be given to preventive healthcare such as health screening to improve the overall health state of the population.     

Policy induced increases in private healthcare financing provide short-term relief of total healthcare expenditure growth: Evidence from OECD countries

Healthcare reforms have long been advocated as a cure to the increasing healthcare expenditures in advanced economies. Nevertheless, it has not been established whether a market solution via private financing, rather than public financing, curb aggregate healthcare expenditures. To our knowledge, this paper is the first that quantifies the impact of reforms that significantly increases (decreases) the private (public) share of healthcare financing on total healthcare expenditures relative to income in 20 OECD countries. Our reform measure is based on structural break testing of the private share of total expenditures, and verification using evidence of policy reforms. To quantify the effect of these reforms we apply Propensity Score Matching and Inverse Probability Weighted regression analysis. Over a 5-year evaluation period the reforms lead to an accumulated cost saving 0.45 percentage points of GDP. The yearly effects of the reforms are largest in the first years in the post-reform period and decreases in size as a function of time since the reform. Our findings suggest that the investigated healthcare reforms have a relatively short-lived effect on aggregate health spending relative to GDP. The findings are robust to various sensitivity tests.     

Subsidizing healthcare in the presence of market distortions

The paper develops a three-sector full-employment general equilibrium model for a small open developing economy with exogenous labour market imperfection and a non-traded sector providing healthcare services, the consumption of which generates positive externalities. Our main objective is to show that the optimal consumption subsidy to healthcare, if solely judged from the standpoint of economic growth, is strictly positive (zero) when the production technology of the healthcare sector is of the variable (fixed) coefficient type. However, in the variable coefficient case, the optimal per capita expenditure on healthcare crucially hinges on the degree of labour market imperfection and the quality of services provided by the healthcare sector. The latter result can possibly be considered as a theoretical justification why the magnitude of per capita public spending on healthcare services is significantly lower in the developing countries compared to that in the developed nations. Besides, using the Sen's (1974) index of social welfare that takes into consideration both the growth and income inequality aspects, we have proved that the optimal health subsidy is positive irrespective of the nature of production technology of the healthcare sector. Furthermore, most of these results are found to be valid even in the presence of Harris-Todaro type unemployment. Finally, the results lead to a few important policy implications in the context of the developing countries.     

Fiscal position and the financing of productive government expenditures: an application to Latin America

Government spending on public infrastructure, education, and health care can increase economic growth. However, the appropriate financing depends on a country’s fiscal position. We develop a two-sector endogenous growth model to explore how variations in the composition and financing of government expenditures affect economic growth. We find that, when tax rates are moderate, funding public investment by raising taxes may increase long-run growth. If existing tax rates are high, public investment is only growth enhancing if funded by restructuring the composition of overall public spending. Additionally, public investment that is debt financed can have adverse effects on long-run growth due to the resulting increases in interest rates and debt-servicing costs.     

Mother's autonomy: impact on the quality of children's healthcare in India

Given the poor condition of children's health in developing countries, this article seeks to examine two hypotheses concerning healthcare for children. First, does mother's autonomy influence the quality of child healthcare and, second, which is related to the first, whether mother's autonomy reduces the apparent gender bias in child healthcare. Using household survey data from Bihar and Uttar Pradesh in India the article finds that for the most part as the mother's autonomy (measured several different ways) increases, the quality of care for children improves. The results also indicate that gender bias exists in the provision of quality healthcare for children. Male children generally receive better quality care. However, for several measures of female autonomy, an increase in such autonomy reduces the bias. The results of this analysis have important policy implications and provide additional insight into the state of affairs of children's health in rural India.     

Characteristics,comorbidities, and use of healthcare resources of patients with phenylketonuria: a population-based study

Abstract

Background: Phenylketonuria is a well-known disease, yet the characteristics of the affected population and their use of healthcare resources have not been comprehensively evaluated. Patient characteristics and use of resources are subjects of interest for most governments, especially for a disease included in newborn screening programs.

Objective: The aim of this study was to determine characteristics and use of healthcare resources of patients with phenylketonuria in the region of Catalonia.

Methods: Records of 289 patients admitted with phenylketonuria between 2007 and 2017 were extracted from the PADRIS database that includes admission data from primary care centers, hospitals (inpatient and outpatient care), extended care facilities, and mental health centers.

Results: The patient population was composed of 140 male patients and 149 female patients, and 102 patients were registered via newborn screening during the study period. Patients were admitted on average 2.19 times per year, mostly into primary care centers which concentrated the largest portion of direct medical expenses. Similar percentages of urgent and scheduled admissions were registered both in primary care and hospitals. Annual direct medical cost of treating patients with phenylketonuria was €667 per patient. Finally, 66.80% of the patients suffered from chronic conditions affecting two or more systems, likely to correspond to a wide variety of conditions.

Conclusions: Altogether, phenylketonuria patient demographics and direct medical costs in Catalonia have been revised. Patients diagnosed with phenylketonuria appeared 1.3-times more likely to suffer from chronic conditions in distinct organ systems, which is expected to have an effect on their use of healthcare resources. These results support the need to adapt and improve the healthcare system, taking multimorbidity into consideration in an effort to control the medical expenses derived.     

Impact of upper and lower gastrointestinal blood loss on healthcare utilization and costs: a systematic review

Abstract

Objectives:

Gastrointestinal (GI) blood loss is a common medical condition which can have serious morbidity and mortality consequences and may pose an enormous burden on healthcare utilization. The purpose of this study was to conduct a systematic review to evaluate the impact of upper and lower GI blood loss on healthcare utilization and costs.

Methods:

We performed a systematic search of peer-reviewed English articles from MEDLINE published between 1990 and 2010. Articles were limited to studies with patients ≥18 years of age, non-pregnant women, and individuals without anemia of chronic disease, renal disease, cancer, congestive heart failure, HIV, iron-deficiency anemia or blood loss due to trauma or surgery. Two reviewers independently assessed abstract and article relevance.

Results:

Eight retrospective articles were included which used medical records or claims data. Studies analyzed resource utilization related to medical care although none of the studies assessed indirect resource use or costs. All but one study limited assessment of healthcare utilization to hospital use. The mean cost/hospital admission for upper GI blood loss was reported to be in the range $3180–8990 in the US, $2500–3000 in Canada and, in the Netherlands, the mean hospital cost/per blood loss event was €11,900 for a bleeding ulcer and €26,000 for a bleeding and perforated ulcer. Mean cost/ hospital admission for lower GI blood loss was $4800 in Canada, and $40,456 for small bowel bleeding in the US.

Conclusions:

Our findings suggest that the impact of GI blood loss on healthcare costs is substantial but studies are limited. Additional investigations are needed which examine both direct and indirect costs as well as healthcare costs by source of GI blood loss focusing on specific populations in order to target treatment pathways for patients with GI blood loss.     

Determinants of healthcare spending: a state level analysis

Within the high and rising level of healthcare spending for the US as a whole is substantial variation in spending across states. Yet relatively little attention has been given to the empirical analysis of interstate differences in aggregate healthcare expenditures, and therefore little empirical evidence exists at the state level to guide policymakers. Using data for all 50 states for the year 1998, we estimate an empirical model that includes structural and reduced-form healthcare spending equations and a health production function to assess the significance, size and relative importance of factors that prior research indicates, may play an important role in explaining interstate variation in medical care expenditures, and the main pathways through which they operate. Our results indicate higher levels of healthcare spending for state populations with higher income, less education, fewer uninsured residents, less healthy lifestyles, larger proportion of elderly residents, greater availability of medical care providers and less urbanization. Our findings suggest that the most effective cost containment measures may be those that increase education and promote healthy lifestyles. Not only do these actions lead to reductions in healthcare spending, they also improve the health status of the population, and may help to achieve other important social policy goals.     

The impact of education on healthcare expenditure in China: quantity or quality

With respects to the low level of the healthcare expenditure, China has been experiencing a rapid growth of the education. This article is designed to test the education quantity and the education quality on the healthcare expenditure and conducts China’s provincial data set over the period 2001–2016. The results suggest that the education quantity has no significant effect on the healthcare expenditure, while the education quality has a positive and significant effect. Thus, it is suggested that China’s expansion on education cannot maintain the quality, and is not conducive to the improvement of human capital in education and health.     

The effect of the cost of obstetric care on antenatal and postnatal healthcare utilization: Evidence from Armenia

The high cost of obstetric care is a common reason for late or no detection of preventable preterm labor, serious complications, long-term disabilities, and neonatal and maternal death. To resolve the debate of whether affordable, high-quality healthcare can be used as a policy tool to incentivize timely and more frequent checkups during and after pregnancy, we examine the causal effect of the Obstetric Care State Certificate (OSCS) program, which fully covered the costs of all antenatal services, consultations, medical exams, delivery and postnatal care in Armenia after 2008, on utilization of prenatal and postnatal care in the country. Evidence suggests that the reform had a significant, positive effect on care utilization during and after pregnancy, with the largest effects being elicited in the subsamples of women at high risk pregnancies, and mothers who have had a miscarriage or an abortion.     

An econometric analysis of cognitive impairment and healthcare utilization in the ageing population

The ageing population is a major concern for policy makers, with the ever-increasing strains placed on health budgets. One overlooked area of research is the impact that cognitive impairment (an early marker of potential dementia onset) has on the healthcare utilization of an ageing population. Based on the theoretical micro-economic foundations of healthcare demand, we study the relationship between cognitive functioning and impairment, measured by word recall and changes thereof, and healthcare utilization among over 50s in nine European countries. The contribution of this article is to produce estimates for cognitive functioning and impairment, as opposed to full dementia, in the context of healthcare utilization.

We apply regression models to healthcare utilization data from Waves 1, 2 and 4 of the Survey of Health, Ageing and Retirement in Europe and find that recalling one additional word is associated with a reduction in visits to a medical doctor of 0.32, per year (p<0.01). Even after controlling for self-assessed health, this association is strong at just over 0.1 visits – this is the additional impact, over and above the average number of visits for similar individuals without cognitive impairment.     

Government Expenditure Financing in a Two‐Sector Cash‐In‐Advance Model of Endogenous Growth

We show that an expansion in the government size could be desirable from the viewpoint of the economy's long‐run growth, wherein factor intensity between the sectors, the mode of public spending financing, and the form of the cash‐in‐advance (CIA) constraint are crucial. We also show that when real balances are required only for consumption purchases, money financing is equivalent to consumption tax financing, but is not equivalent to income tax financing. If both consumption and gross investment are liquidity‐constrained, then the three financing methods are mutually not equivalent. The optimal financing scheme has the following features: (1) when the CIA constraint applies only to consumption purchases, any combination of the money growth rate and the consumption tax rate that satisfies the government budget constraint constitutes an optimal financing mix; (2) when the CIA constraint applies to both consumption and investment purchases, consumption tax financing only is optimal.     

Health Policy and Equity of Health Care Financing in Australia: 1973–2010

Using data from Australian Taxation Statistics and Household Expenditure Surveys we analyze the distribution of health care financing in Australia over almost four decades. We compute Kakwani Progressivity indices for four sources of health care financing: general taxation, Medicare Levy payments, Medicare Levy Surcharge payments, and direct consumer payments, and estimate the effects of major policy changes on them. The results demonstrate that the first three of these sources of health care financing are progressive in Australia, while the distribution of direct payments is regressive. Surprisingly, we find that neither the introduction of Medicare in Australia in 1984 nor the Extended Medicare Safety Net in 2004 had significant effects on the progressivity of health care financing in Australia. By contrast, the Lifetime Cover scheme—introduced in 2000 to encourage people to buy and hold private health insurance—had a progressive effect on health care financing.     

Economic evaluation in health: saving money or improving care?

Summary

Economic evaluation, most commonly in the form of cost-effectiveness analysis, has now become an established tool of overall health financing policy. However, health policy makers choose to use or ignore the accumulated body of economic evidence for a variety of reasons. This policy review takes a step back and looks objectively at the appropriate role and use of cost-effectiveness analysis within the broader context of health system financing, and also discusses a series of technical limitations (and potential solutions) that impact on the generation of a genuinely comparable economic evidence base in health at the population level. While the explicit purpose of economic evaluation is to address the health financing objective of efficiency, the authors conclude that its application can be usefully extended to other health system goals, including financial protection (specification of core public healthcare packages for universal insurance) and equity in financing (assessment of intervention costs and effects by stakeholder or socioeconomic group). In order to contribute to these broader objectives, a sectoral or population-based approach to cost-effectiveness analysis is needed.     

Estimating healthcare resource use associated with the treatment of metastatic melanoma in eight countries

Objectives Studies reporting healthcare resourse use (HRU) for melanoma, one of the most costly cancers to treat, are limited. Using consistent, robust methodology, this study estimated HRU associated with the treatment of metastatic melanoma in eight countries.

Methods Using published literature and clinician input, treatment phases were identified: active systemic treatment (pre-progression); disease progression; best supportive care (BSC)/palliative care; and terminal care. HRU elements were identified for each phase and estimates of the magnitude and frequency of use in clinical practice were obtained through country-specific Delphi panels, comprising healthcare professionals with experience in oncology (n?=?8).

Results Medical oncologists are the key care providers for patients with metastatic melanoma, although in Germany dermato-oncologists also lead care. During the active systemic treatment phase, each patient was estimated to require 0.83–2 consultations with a medical oncologist/month across countries; the median number of such assessments in 3 months was highest in Canada (range?=?3.5–5) and lowest in France, the Netherlands and Spain (1). Resource use during the disease progression phase was intensive and similar across countries: all patients were estimated to consult with medical oncologists and 10–40% with a radiation oncologist; up to 40% were estimated to require a brain MRI scan. During the BSC/palliative care phase, all patients were estimated to consult with medical oncologists, and most to consult with a primary care physician (40–100%).

Limitations Panelists were from centers of excellence, thus results may not reflect care within smaller hospitals; data obtained from experts may be less variable than data from broader clinical practice. Treatments for metastatic melanoma are continually emerging, thus some elements of our work could be superseded.

Conclusions HRU estimates were substantial and varied across countries for some resources. These data could be used with country-specific costs to elucidate costs for the management of metastatic melanoma.     

Effect of regulated user fee on quality of healthcare for the poor and the non-poor

User fee for healthcare continues to be used in many countries despite the extensive documentation on the impoverishing effect on households. The literature has also analyzed the effect of user fee on the quality of care for both rich and poor. The purpose of this study is to find the factors affecting the physician’s behavior, under a user fee payment mechanism with an exemption program for the poor, when choosing treatment for poor and non-poor patients. The factors examined were treatment effort input, the fine, cost of investigation, costliness of government, severity of illness for the non-poor and for the poor, and the proportion of non-poor patients. The results showed that regulated user fee cannot be effectively implemented without government investigation or monitoring of the health provider’s treatment choice. The possibility of investigation provides incentive for the provider to choose the proper treatment quality when the poor are likely to be high risk than the non-poor. An important result is that regulated user fee can deteriorate the quality of care received by the rich, through excessive treatment, especially in developing economies where there is a small proportion of the rich. Improvement in innovative technologies that reduce the cost of investigation, government revenue collection, and treatment effort input is likely to improve the quality of care provided to patients regardless of income status.     

The political economy of long-term care

We build a two-dimensional political economy model to explain the provision and financing of long-term care and income redistribution. Voting agents differ in need and income opening up two conflicts: one sets families with disabled parents, who are in favor of a public long-term care program, against the ones without such parents who oppose public financing. The other sets the poor against the rich with the former preferring heavier income taxation than the latter. We show that a structure induced equilibrium always exists and that it is unique if informal care is provided in equilibrium. The equilibrium not only explains the negative association of income inequality and long-term care financing but also allows predictions about how demographic change might impact long-term care arrangements and expenses.     

Does the impact of private education on growth differ at different levels of credit market development?

Using an overlapping generations model, we show that the impact of private financing of education on growth depends on credit market development, being positive when credit markets are adequately developed but negative if sufficiently low levels of credit market development occur alongside relatively high private financing intensities. Employing cross-country data, we find that reduced-form growth relationships are statistically significant and robust under various controls and samples. We also lay out conditions under which economies with missing credit markets are dynamically efficient and outperform, in terms of growth, economies with complete credit markets. The latter may explain large cross-country differences in savings and growth, while facilitating the evaluation of policies on financing education.     

Challenging the dominant logic in the healthcare industry: the case of precision medicine

The study on the impact of precision medicine (PM) in its surrounding political and business milieu has burgeoned in recent years. Recent advances in biomedical sciences suggest that PM has the potential to fundamentally alter the existing business logic in the healthcare landscape and the relationship between how medical care is delivered and organised. While barriers and policy challenges to the introduction of pharmacogenomics into healthcare system are widely noted, relatively little is known about whether and to what extent PM alters or even destroys the dominant logics of the pharmaceuticals and diagnostics industry, which constitute the core segment of the PM. In this paper, the shifting nature of dominant logic in the field of PM is studied by means of qualitative analysis. Several dimensions are identified to help develop a better understanding of changing business models and collaborative network structures.     

Public investment,national debt,and economic growth: The role of debt finance under dynamic inefficiency

Public investment is a central issue in the dynamic analyses of fiscal policy and economic growth. Debt financing for public investment and its effects have recently received great attention because interest rates have been low, almost invariably remaining below economic growth rates. This paper presents examination of the effects of debt-financed public investment subject to a simple fiscal rule in an overlapping generations model with public capital. This topic includes capital budgeting and the debt–deficit criterion of the Maastricht treaty. We show herein that debt financing for public investment enhances economic growth if an economy is dynamically inefficient and if public capital has a sufficiently large productivity effect. Moreover, it reduces economic growth rates in a dynamically efficient economy. Debt and growth can have a monotonic or non-monotonic relation, depending on the steady-state interest rate, growth rate, and productivity effect of public investment. The findings indicate that debt–growth relations match with controversial empirical evidence. Furthermore, existing generations choose perfect debt finance if dynamic inefficiency exists. In contrast, a balanced budget is preferred in a dynamically efficient economy with low productivity effects of public capital. However, an economy with high productivity effects of public capital might cho ose debt financing. This paper contributes to the elucidation of currently emphasized issues of public investment.