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.     

An intertemporal analysis of expenditure elasticities under three expenditure specifications for Sri Lanka

Household income has been identified as one of the major determinants of demand for household goods. In addition, other household characteristics, such as household size and composition are also found to be important factors that influence household consumption decisions. This study, using four waves (2006/07, 2009/10, 2012/13 and 2016) of Sri Lankan Household Income and Expenditure Survey data, estimates three different specifications (namely, household expenditure, per-capita expenditure and expenditure per equivalent adult) of a complete system of Box-Cox Engel curves to incorporate household size and compositional differences into the model specification. A comparison of elasticity estimates across the three specifications indicates that amongst the three, the best performing model is the one utilizing household expenditure. An intertemporal analysis of expenditure elasticities indicates that although the magnitude of expenditure elasticities has changed, the necessity or luxury classification of household commodities has mostly remained unchanged for the period 2006 ? 2016 in Sri Lanka.     

The formation and evolution of childhood skill acquisition: Evidence from India

Building on recent advances in the literature and using a rich data set for two cohorts of children aged between one and twelve for Andhra Pradesh, India, we investigate the determinants of children's cognitive as well as non-cognitive skills. We find evidence of self-productivity for cognitive skills and cross-productivity effects from cognitive on non-cognitive skills. Moreover, we demonstrate that parental investment has contemporaneously positive effects on skill levels for all age groups. Investigating other determinants of these skills, we find child health at age one to influence cognitive abilities at age five, whilst child health at age one is influenced by parental care already during pregnancy and earliest childhood. Understanding the determinants which account explicitly for the effect of a large number of child, caregiver and household characteristics provides insights with regard to possible policy interventions to improve the chances of children in poor environments of developing cognitive and non-cognitive skills crucial for success in many spheres of life.     

Expenditure behavior and children's welfare: an analysis of female headed households in Jamaica

This paper presents an analysis on the expenditure behavior and children's welfare among female-headed households in Jamaica. Included in the examination of household composition are the demographic effects, endogeneity of total expenditure, the headship variable and the endogeneity of family structure. Using the 1989 Jamaican Survey of Living Conditions (SLC), expenditure estimation on over 100 goods for 3500 household was examined. This study utilized the Ordinary Least Square estimates, 2 SLC and endogeneity tests, and partnered and unpartnered household heads. Results for the demand for preventive health care were significant among older children in female-headed households, with a 4% increase in the probability of a check-up across all ages. This study presents a partial explanation of lower morbidity rates in female-headed households despite lower budget and total per capita expenditure levels. In conclusion, this study confirms the significant influence of sex and union status of the household head on household expenditure behaviors with implications for individual household members, with more positive outcomes among children despite differences in budget allocation and lower health expenditures.     

The demand and supply of credit for households

The demand and supply of credit in the rural credit markets is investigated in this article using household data from India. The aim is to study the effects of household, farm productive characteristics and the policy variables on the demand and supply of credit. A type 3 Tobit model is estimated which corrects for sample selection and endogeniety bias. In addition, a generalized Double Hurdle model is estimated where the information on the household's access to credit is included to estimate the demand and supply of credit. The results suggest that the size of the operational holdings, net-wealth, dependency ratio, educational level of the household and the wages and output prices are important determinants of the demand and supply of credit for farm households. The Double Hurdle model confirms that the ‘size of land owned’ plays a crucial role in whether the household has access to a loan or not.     

Health spending and public pension: evidence from panel data

This article empirically investigates the determinants of aggregate health expenditure in a panel of OECD countries from 1980 to 2005. We differ from most existing studies by testing some new determinants motivated by recent theoretical advances in the literature. We find that a one percentage increase in public pension payments per elderly person leads to approximately a one third percentage increase in aggregate health spending, and this effect is significant and robust across a variety of model specifications. A back of the envelope calculation based on this estimate suggests that the expansion of the public pension programme on average accounts for approximately over one fifth of the rise in aggregate health expenditure as a share of GDP in the set of OECD countries during 1980–2005. In addition, we find that the estimated effect of GDP per capita in our model ranges from 0.66 to 0.80, which is consistent with the results from some recent studies, and thus further reinforces the finding in the literature that health care is not a luxury good.     

Distress financing of out‐of‐pocket health expenditure in India

In the absence of a universal health insurance mechanism, the increasing burden of out‐of‐pocket (OOP) health expenditure has become a growing concern in India. To cope with the cost of illness, people use either their savings and income, or they have to rely upon distress means of finance such as depletion of household assets, borrowings from banks and moneylenders, and contributions from family and friends. This paper analyses the changes that have taken place in the incidence and covariates of distress financing in India by using data from National Sample Survey Organisation for the years 2004 and 2014. Results indicate that during this period the incidence of distress sources as a means to finance OOP health expenditure has hovered around 50%. Further, the results reveal a significant socioeconomic gradient in the incidence of distress financing. Socioeconomic and health‐related covariates significantly impact the likelihood of distress financing as a means to cope with OOP health expenditure. The results indicate the need for government action to formulate a comprehensive plan through an increase in public spending on health care that will improve the quantity and quality of the public health‐care system and enhance the scope of health insurance in India.     

妇幼保健院规模与妇幼保健水平的关系:基于全国省级面板数据的研究

妇幼保健院在中国医疗卫生领域具有相当特殊的地位。在妇幼保健院对中国妇幼健康水平有积极作用的假设下,采用31个省级地区的面板数据构建实证模型,研究妇幼保健院规模对妇幼保健水平和医疗费用的影响。妇幼保健院床位数与孕产妇死亡率有显著的正相关,对活产数有显著的消极影响,出现这一现象的原因可能是妇幼保健院相对落后的医疗技术条件。同时,妇幼保健院床位数的增长对卫生机构支出存在正向影响,但对于居民家庭人均医疗支出则存在城乡差异。建议应重视妇幼保健院的发展,全面提升妇幼保健院的技术和服务水平,缓解大综型医疗机构接诊压力。     

Nutrient consumption in India: Evidence from a village study

Adequate nutrition is generally regarded as a core dimension in any evaluation of well‐being. In the context of India, a country with a high prevalence of poor nutrition, there is a dearth of nutrition studies with adequate coverage and comparability. Using primary data on food consumption from a village in a poorer state of India, we study the consumption of five key nutrients, namely, calories, protein, carbohydrates, calcium and iron. Among the various determinants of nutrition, we find that expenditure has a significant impact on nutrition and the expenditure elasticity of nutrition is comparatively high for all the key nutrients. By correcting for potential endogeneity, we demonstrate a causal link from expenditure and food subsidy provided by the public distribution system to nutritional intake. There is some evidence that household characteristics such as household size and gender of the household head matter for nutrition; however, they are not robust under various specifications.     

老年慢病家庭灾难性卫生支出影响因素及其不平等分析

利用中国健康与养老追踪调查(China Health and Retirement Longitudinal Study,CHARLS)数据,实证分析了老年慢病家庭灾难性卫生支出风险及相关影响因素,同时测算了灾难性卫生支出风险的不平等及其决定因素。中国老年慢病家庭灾难性卫生支出风险较高,且存在倾向于低收入家庭的不平等。农村低收入老年慢病家庭灾难性卫生支出的发生率和发生强度最高。家庭相关因素和慢病患者的就医行为会显著影响老年慢病家庭灾难性卫生支出的发生率和发生强度,同时也决定了灾难性卫生支出风险的不平等。政府应当对老年慢病人群特别是农村低收入老年慢病人群提供系统性的经济风险保护,降低疾病的经济负担。     

Functional income distribution and effective demand in India: An applied post Keynesian model

This article is an attempt to understand the relationship between functional income distribution and aggregate demand in India. To this end, the article (a) highlights trends in growth and class distribution of income in India; (b) constructs a post Keynesian macro model that links short run growth with profit share, where the latter is itself driven by movements in output and real exchange rate; (c) discusses and, wherever required, estimates key parameters relevant to the Indian case; and (d) simulates the model and discusses the effect of shocks to distributive as well as autonomous demand variables on growth performance. The article finds that, although a possibility of wage-led growth in India cannot be ruled out, by and large, distributive shocks do not have a strong impact on output growth. On the other hand, an increase in public expenditure growth, although it has a strong effect on output growth, tilts income distribution toward profit earners. A comprehensive agenda involving greater public expenditure and higher wages to stimulate growth and improve distribution is therefore recommended.     

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.     

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.     

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.     

Perceived quality of public services, liquidity constraints, and the demand of private specialist care

In this article we offer direct evidence on the role of perceived quality differences in publicly provided health care services, in determining the incentive to opt out for private services and, for poor individuals, short-run credit constraints in the access to these services. We concentrate on private specialist care, a category of services for which disparities in the access are highest. We use Bank of Italy—SHIW data to first study the determinants of demand for private and public specialist care, estimating probit and bivariate probit models, and ZIP models. We then apply the Carneiro–Heckman procedure to identify the share of people constrained and study how perceived quality of public services affects the percentage of people short run constrained. Our estimates suggest the presence of large territorial differences, as for the role of income and the quality of public services.     

Anthropometric failure and persistence of poverty in rural India

Recent studies have drawn attention to the high prevalence of stunting among children in rural India. In fact, these estimates point to more pervasive deprivation than conventional measures of poverty based on income or consumption expenditure shortfalls imply. Since stunting reflects cumulative nutritional and health deprivation, it is likely to persist despite higher incomes. With a view to shedding some new light on this issue, an analysis of the determinants of stunting is carried out, based on a recent all‐India survey of rural households. While income matters, other factors acting independently of it matter too. These include household size, whether household head is male, caste affiliation, mother’s age at marriage, mother’s age, age composition of children, male–female wage differences, hygiene and sanitation facilities, and prices of food items. So, while higher incomes will help mitigate stunting, careful attention must also be given to enhancing women’s autonomy through more remunerative employment opportunities for them, enabling households to improve hygiene and sanitation facilities, and facilitating more competitive local markets for food.     

The demand for medical care services: evidence from Kuwait based on households’ out-of-pocket expenses

This article used a data set containing information on 1267 households from Kuwait to investigate the determinants of demand for medical care services by examining households’ out-of-pocket expenses. To deal with the problems associated with households’ health expenditure data, a two-part model (TPM) was estimated. Given Kuwait’s demographic composition, the model was estimated for full sample, nationals only and expatriates only. Prior to estimating the model, tests were conducted to select a transformation that reduces problems associated with heteroscedasticity and non-normality of the errors. In addition, tests were performed to determine if differences in the estimated coefficients across population groups were statistically significant.     

Household food demand in rural China

This article explores rural household food consumption behaviour in China using a large household data set from Jilin Province. Data are classified into four main food groups—grain, vegetable products, animal products and other foods. A household food demand system, incorporating four household characteristics, is estimated using an LA-AIDS model, assuming a three-stage budgeting procedure. Expenditure elasticities for a range of food groups are estimated, with a particular focus on animal products. The inclusion of household characteristics did not have a big impact on the elasticity values in any of the three stages of the budgeting process. The total expenditure elasticity for grain (Stage II) was 0.64, suggesting substantial future growth in household demand for fine grains such as rice and wheat, as per capita incomes continue to grow in rural areas. The highest conditional and total expenditure elasticity values were for the animal products (Stage II) group, 1.22 and 0.76, respectively. Within this group the elasticities were highest for the meat sub-group at 1.14 and 0.87, respectively, suggesting an almost proportionate increase in demand as household incomes grow. Added demand pressures from animal production will likely keep grain policy high on the political agenda.     

Demand for cigarettes in Turkey: an application of count data models

Household cigarette demand in Turkey is examined using the zero-inflated negative binomial model to account for a large portion of households not reporting cigarette smoking or purchase and estimated using the data from the national household survey implemented in 2003. Data were divided into two main groups: families with and without teenagers. Results identify relevant household head and household characteristics needed to develop effective public policy to prevent the decision to begin to smoke and to reduce cigarette purchase to lower the future growth of government healthcare expenditures. Specifically, healthcare expenditure share, income, and cigarette-price elasticities are relevant in lowering cigarette purchases. The calculated price elasticities for cigarette demand falls within the range determined by studies conducted for developed countries including the member states of the European Union. An estimate of the effect of an increase in the excise tax lowering demand is provided.