Objectives Understanding past trends and forecasting future changes in health spending is vital for planning and reducing reliance on out-of-pocket(OOP)expenses.The current study analyzed health expenditure patterns i...Objectives Understanding past trends and forecasting future changes in health spending is vital for planning and reducing reliance on out-of-pocket(OOP)expenses.The current study analyzed health expenditure patterns in India and forecasted future trends and patterns until 2035.Methods Data on health expenditure in India from 2000 to 2019 was collected from the Organisation for Economic Co-operation and Development(OECD)iLibrary and National Health Accounts 2019 databases.Gross domestic product(GDP)data from the World Bank was also utilized.Descriptive statistics analyzed the composition and pattern,while the exponential smoothing model forecasted future health expenditures.Results The findings revealed that expenditure made by OOP is the primary health financing source,followed by government and pre-paid private spending.The percentage of GDP allocated to total health expenditure remains stable,while the per capita health expenditure fluctuates.Variations in expenditure among states are observed,with Karnataka relying heavily on pre-paid private coverage.Future projections suggest a decline in per capita and total health expenditure as a share of GDP,with a slight increase in the government’s share.Pre-paid private expenditure per capita and OOP health expenditure as a share of the total is projected to remain relatively constant but still high in absolute terms.Conclusion The study highlights variations in health spending in India,characterized by high OOP spending,limited public coverage,and a need for investments,and reforms to improve healthcare access and equity.展开更多
Overweight and obese individuals are at increased risk for many diseases and health conditions, including but not limited to the following: hypertension;osteoarthritis;dyslipidemia;type 2 diabetes;coronary heart disea...Overweight and obese individuals are at increased risk for many diseases and health conditions, including but not limited to the following: hypertension;osteoarthritis;dyslipidemia;type 2 diabetes;coronary heart disease and stroke. Consequently, individuals who are obese are more likely to use health services and are more likely to use costly health services than non-obese individuals. Between 1987 and 2001, growth in obesity related health expenditures accounted for 27 percent of the growth in inflation-adjusted per capita health care spending. Researchers, popular press and the television news media have paid considerable attention to the effect that farm subsidies have on dietary habits and obesity. Prominent researchers in the field have concluded that US farm subsidies have had a negligible impact on obesity. However, even small increases in obesity rates are associated with higher health care expenditures. The primary intent of this study is to break down the linkages from farm subsidy to health expenditure and shed light on the unintended implications of the farm subsidy program. We find that agricultural subsidies have the potential to influence health care expenditures.展开更多
It is widely recognized that developed countries have been spending more than developing countries on health care. Objective of the study is to examine determinants of health expenditure and what factors influence it....It is widely recognized that developed countries have been spending more than developing countries on health care. Objective of the study is to examine determinants of health expenditure and what factors influence it. Fifteen Asian countries and 30 OECD countries were chosen to explore the difference of their health expenditure structures. Model of health expenditure per person was estimated to be dependent on market demand, market supply, and other exogenous factors. A model with country specific and time effects of health expenditure was used and estimated. The study found a negative but insignificant relationship between price and health expenditure and a positive and significant relationship between GDP and health expenditure. Urban population density as proxy of urbanization was found to induce the health expenditure in the OECD. Out-of-pocket payment was also found to induce health expenditure for both the Asian and the OECD countries. A net effect of improvement in the health status or a lower mortality rate and a higher life expectancy caused an increase in the health expenditure among the Asian countries studied but decreased health expenditure in the OECD countries. In terms of income elasticity, it was found to be smaller than one in both groups of the countries. Since the income has changed faster than the other factors, the net effect of changes of all factors over period of time will cause rising in health care expenditure. Finally, the model indicated that both the Asian and OECD countries will continue to have a rising health expenditure per person over a period of time.展开更多
<strong>Background:</strong> Despite having one of the most successful health systems in the world, annual medical expenditures in Japan have been increasing year to year. We sought to clarify regional dif...<strong>Background:</strong> Despite having one of the most successful health systems in the world, annual medical expenditures in Japan have been increasing year to year. We sought to clarify regional differences in medical expenditures by analyzing the relationship between the specific health examination coverage and medical care expenditure by prefecture of Japan. <strong>Methods:</strong> We used data from the National Database of Health Insurance Claims and Specific Health Checkups (NDB) Open Data Japan (2015) and Overview of 2015 National Medical Expenses to compare medical care expenditure per capita and proportions of persons receiving specific health examination between Japan nationally and individual prefectures. <strong>Results: </strong>National medical expenditures were 42.3 trillion Japanese yen (JPY) (3851 hundred million dollars), with a national per capita rate of JPY347,219 (USD3156). Per capita medical expenditure rates by prefecture ranged from JPY290,900 (USD2645) in Saitama Prefecture to JPY 444,000 (USD4036) in Kochi Prefecture. The proportion of persons receiving specific health examinations was 49.0% for Japan overall and ranged from 39.3% in Hokkaido Prefecture to 63.4% in Tokyo Prefecture. We observed a significant negative correlation between per capita medical expenditures and the proportion of persons receiving specific health examinations (R = 0.553, p < 0.001).<strong> Conclusion: </strong>We found a significant negative correlation between per capita medical expenditures and the proportion of persons receiving health examinations: prefectures with lower expenditures tended to have higher rates of medical examinations. Interventions to increase the proportion of persons receiving specific health examinations by prefecture could reduce per capita medical expenditures and reduce prefectural disparities in expenditures.展开更多
Using data from 60th round of the National Sample Survey, this study attempts to measure the incidence and intensity of ‘catastrophic’ maternal health care expenditure and examines its socio-economic correlates in u...Using data from 60th round of the National Sample Survey, this study attempts to measure the incidence and intensity of ‘catastrophic’ maternal health care expenditure and examines its socio-economic correlates in urban and rural areas separately. Additionally, it measures the effect of maternal health care expenditure on poverty incidence and examines the factors associated with such impoverishment due to maternal health care payments. We found that maternal health care expenditure in urban households was almost twice that of rural households. A little more than one third households suffered catastrophic payments in both urban and rural areas. Rural women from scheduled tribes (ST) had more catastrophic head counts than ST women from urban areas. On the other hand, the catastrophic head count was greater among illiterate women living in urban areas compared to those living in rural areas. After adjusting for out-of-pocket maternal health care expenditure, the poverty in urban and rural areas increased by almost equal percentage points (20% in urban areas versus 19% in rural areas). Increasing education level, higher consumption expenditure quintile and higher caste of women was associated with increasing odds of impoverishment due to maternal health care expenditure. To reduce maternal health care expenditure induced poverty, the demand-side maternal health care financing programs and policies in future should take into consideration all the costs incurred during prenatal, delivery and postnatal periods and focus not only on those women who suffered catastrophic expenditure and plunged into poverty but also those who forgo maternal health care due to their inability to pay.展开更多
For a while since the inception of economic system reform programs in 1980s,China's government investment in health was weakened.This resulted in healthcare provider's increasing reliance on user charges for t...For a while since the inception of economic system reform programs in 1980s,China's government investment in health was weakened.This resulted in healthcare provider's increasing reliance on user charges for their income,poorer access to healthcare for the vulnerable population groups,and increasing socioeconomic disparities in health and healthcare.To address these problems,China initiated a series of health sector reforms since late 1990s.Our comprehensive review study has found that indeed Chinese government spending on health has been increasing in recent years,especially since 2009,when the new Healthcare Reform Plan was announced.Still,China needs to both further strengthen government investment in health and address the structural imbalances in government health financing,in order to make the overall Chinese health system more equitable and more efficient.展开更多
Background:Missed clinic appointments negatively impact clinic patient flow and health outcomes of people living with HIV(PLHIV).PLHIV likelihood of missing clinic appointments is associated with direct and indirect e...Background:Missed clinic appointments negatively impact clinic patient flow and health outcomes of people living with HIV(PLHIV).PLHIV likelihood of missing clinic appointments is associated with direct and indirect expenditures made while accessing HIV care.The objective of this study was to examine the relationship between out-of-pocket(OOP)health expenditures and the likelihood of missing appointments.Method:Totally 618 PLHIV older than 18 years attending two HIV care and treatment centres(CTC)in Northern Tanzania were enrolled in the study.Clinic attendance and clinical characteristics were abstracted from medical records.Information on OOP health expenditures,demographics,and socio-economic factors were self-reported by the participants.We used a hurdle model.The first part of the hurdle model assessed the marginal effect of a one Tanzanian Shillings(TZS)increase in OOP health expenditure on the probability of having a missed appointment and the second part assessed the probability of having missed appointments for those who had missed an appointment over the study period.Results:Among these 618 participants,242(39%)had at least one missed clinic appointment in the past year.OOP expenditure was not significantly associated with the number of missed clinic appointments.The median amount of OOP paid was 5100 TZS per visit,about 7%of the median monthly income.Participants who were separated from their partners(adjusted odds ratio[AOR]=1.83,95%confidence interval[CZ]:1.11-8.03)and those aged above 50 years(AOR=2.85,95%CI:1.01-8.03)were significantly associated with missing an appointment.For those who had at least one missed appointment over the study period,the probability of missing a clinic appointment was significantly associated with seeking care in a public CTC(P=0.49,95%CI:0.88-0.09)and aged between>25-35 years(P=0.90,95%CI:0.11-1.69).Conclusion:Interventions focused on improving compliance to clinic appointments should target public CTCs,PLHIV aged between>25-35 years,above 50 years of age and those who are separated from their partners.展开更多
This research builds an index to describe the inequality in health care expenditure related to pollution,and the measurement with Chinese provincial data set suggests that health care expenditure inequality related to...This research builds an index to describe the inequality in health care expenditure related to pollution,and the measurement with Chinese provincial data set suggests that health care expenditure inequality related to pollution is obvious negative,which confirms that residents located in high-polluted areas cannot get the better health care resources.Meanwhile,the absolute value of health care expenditure inequality related to pollution is even larger than that related to income,which suggests the inequality related to pollution cannot be ignored.展开更多
Turkey launched a project in 2003 known as "Health Transformation Programme" (HTP), which enabled Turkey to make considerable progress and radical changes to the health care system. The programme in 2003 included ...Turkey launched a project in 2003 known as "Health Transformation Programme" (HTP), which enabled Turkey to make considerable progress and radical changes to the health care system. The programme in 2003 included the effectiveness and the efficiency factors within the process by setting them as the primary objectives to increase the health status of the population (effectiveness) and to use resources in the best possible manner and at the lowest possible cost (efficiency). Accessing services according to the need of patients and state benefits according to their ability to pay would be viable under these objectives. In this study, initially, Turkish National Health System will be articulated on a literature-study basis approach to measure the efficiency of public expenditure on health. Then, the measured level of the efficiency will be analysed in Turkey, The paper serves a purpose to analyse the efficiency based on the outcomes of heath service such as satisfaction with public health services over the period of 2003-2013. A simple linear regression was employed to test the degree of statistical relation between public health expenditure and satisfaction with public health care services.展开更多
By social expenditure on health service(SEHS)we refer to the sum total of money paid by thewhole society during a certain period of year for the sake of preventing and treating diseases andof protecting and improving ...By social expenditure on health service(SEHS)we refer to the sum total of money paid by thewhole society during a certain period of year for the sake of preventing and treating diseases andof protecting and improving the people’s health.It reflects objectively the total level of SEHSduring a certain period;the levels of health service expenditures on the parts of the whole society,enterprises,and individuals;the ratio between SEHS and total social expenditure;and the ratiosof SEHS to gross national product and to national income.The article discussed and展开更多
In this present-day global pandemic that has not been completely resolved,health is a major concern among people,and correspondingly,people are demanding higher standards for public health products and services provid...In this present-day global pandemic that has not been completely resolved,health is a major concern among people,and correspondingly,people are demanding higher standards for public health products and services provided by the government.In this paper,we measure the technical efficiency of public health expenditure in each province by using the data envelopment analysis(DEA)model,and examine the impact of decentralization on the efficiency of public health expenditure under the fiscal decentralization system using the panel data from 31 provinces from 2012-2019 in a panel model subject to fixed effects.展开更多
Objective: Colorectal cancer(CRC) causes a substantial burden of disease in China and the evidence of economic burden triggered is fundamental for priority setting. The aim of this survey was to quantify medical expen...Objective: Colorectal cancer(CRC) causes a substantial burden of disease in China and the evidence of economic burden triggered is fundamental for priority setting. The aim of this survey was to quantify medical expenditures and the time trends for CRC diagnosis and treatment in China.Methods: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 13 provinces across China. For each eligible CRC patient diagnosed from 2002 to 2011, clinical information and expenditure data were extracted using a uniform questionnaire. All expenditure data were reported in Chinese Yuan(CNY)using 2011 values.Results: Of the 14,536 CRC patients included, the average age at diagnosis was 58.2 years and 15.8% were stageI cases. The average medical expenditure per patient was estimated at 37,902 CNY [95 % confidence interval(95%CI): 37,282-38,522], and the annual average increase rate was 9.2% from 2002 to 2011(P for trend <0.001), with a cumulative increase of 2.4 times(from 23,275 CNY to 56,010 CNY). The expenditure per patient in stages Ⅰ, Ⅱ, Ⅲ and Ⅳ were 31,698 CNY, 37,067 CNY, 38,918 CNY and 42,614 CNY, respectively(P<0.001). Expenditure significantly differed within various subgroups. Expenses for drugs contributed the largest proportion(52.6%).Conclusions: These conservative estimates illustrated that medical expenditures for CRC diagnosis and treatment in tertiary hospitals in China were substantial and increased rapidly over the 10 years, with drugs continually being the main expense by 2011. Relatively, medical expenditures are lower for CRC in the earlier stages. These findings will facilitate the economic evaluation of CRC prevention and control in China.展开更多
AIM To evaluate the association between mortality-to-incidence ratios(MIRs) and health disparities.METHODS In this study, we used the GLOBOCAN 2012 database to obtain the cancer incidence and mortality data for 57 cou...AIM To evaluate the association between mortality-to-incidence ratios(MIRs) and health disparities.METHODS In this study, we used the GLOBOCAN 2012 database to obtain the cancer incidence and mortality data for 57 countries, and combined this information with the World Health Organization(WHO) rankings and total expenditures on health/gross domestic product(e/GDP). The associations between variables and MIRs were analyzed by linear regression analyses and the 57 countries were selected according to their data quality. RESULTS The more developed regions showed high gastric cancer incidence and mortality crude rates, but lower MIR values than the less developed regions(0.64 vs 0.80, respectively). Among six continents, Oceania had the lowest(0.60) and Africa had the highest(0.91) MIR. A good WHO ranking and a high e/GDP were significantly associated with low MIRs(P = 0.001 and P = 0.001, respectively).CONCLUSION The MIR variation for gastric cancer would predict regional health disparities.展开更多
Objective:This study aimed to estimate the out-of-pocket expenditure of families on the health care of children younger than 5 years in a rural area of Kancheepuram district.Methods:A cross-sectional descriptive study...Objective:This study aimed to estimate the out-of-pocket expenditure of families on the health care of children younger than 5 years in a rural area of Kancheepuram district.Methods:A cross-sectional descriptive study was performed in a rural area of Kancheepuram district for 5 months.All households with at least one child younger than 5 years were eligible for the study,and 153 households were selected for the fi nal study.A semistructured and pretested schedule was used to obtain information about various study variables during home visits.Ethics approval was obtained before the start of the study.Data were entered into Microsoft Excel,and statistical analysis was done with IBM SPSS Statistics version 23.Frequency distributions were calculated for all the variables.Results:The fi ndings indicate that most children younger than 5 years were males(62.7%).The maximum out-of-pocket expenditure was for accidents/trauma and in cases of fever/malaria.Further,96 households(53.1%)preferred private-sector health care for their ailments.Conclusion:The fi ndings indicate that 93 of the children younger than 5 years(60.8%)had experienced one episode of illness in the previous 3 months.Further,the maximum out-of-pocket expenditure was for accident/trauma cases,and overall the largest share was for buying medica-tions for the treatment.展开更多
The health inequities remain high in India with government and private health expenditures clearly favoring the rich, urban population and organized sector workers and the Out Of Pocket (OOP) spending as high as 80%, ...The health inequities remain high in India with government and private health expenditures clearly favoring the rich, urban population and organized sector workers and the Out Of Pocket (OOP) spending as high as 80%, afflicting the poor in the worst manner. The focus of the paper is to examine the potential Community Based Health Insurance (CBHI) offers to improve the healthcare access to rural, low-income population and the people in unorganized sector. This is done by drawing empirical evidence from various countries on their experiences of implementing CBHI schemes and its potential for applications to India, problems and challenges faced and the policy and management lessons that may be applicable to India. It can be concluded that CBHI schemes have proved to be effective in reducing the Catastrophic Health Expenditure (CHE) of people. But success of such schemes depends on its design, benefit package it offers, its management, economic and non-economic benefits perceived by enrollees and solidarity among community members. Collaboration of government, NGO’s and donor agencies is very crucial in extending coverage;similarly overcoming the mistrust that people have from such schemes and subsidizing the insurance for the many who cannot pay the premiums are important factors for success of CBHI in India. One of the biggest challenges for the health system is to address the piecemeal approach of CBHI schemes in extending health insurance and inability of such schemes to cover a large number of poor and the unorganized sector workers. Also, there is a need for a stronger policy research to demonstrate: 1) how such schemes can create a larger risk pool, 2) how such schemes can enroll a large number of people in the unorganized sector, 3) the interaction of CBHI schemes with other financing schemes and its link to the health system.展开更多
Context: To facilitate financial access to care for the population, health insurance mechanisms have been established, in particular the National Health Insurance Institute, which covers civil servants and their depen...Context: To facilitate financial access to care for the population, health insurance mechanisms have been established, in particular the National Health Insurance Institute, which covers civil servants and their dependents. In addition, other voluntary and community mechanisms have been developed. After several years of implementation, the level of catastrophic health expenditures among insured individuals shows that there is still a considerable level of financial risk associated with health care. This study aims to assess the impact of health insurance in Togo on insured populations. Methodology: The data used in this study come from the harmonized survey on household living conditions carried out in 2018 by the National Institute of Statistics, Economic and Demographic Studies. The propensity score matching method was used according to the following steps: estimation of propensity scores, verification of the conditional independence hypothesis (balancing property) and estimation of the average treatment effect on treated. Stata V14.2 software was used. Findings: The average effect of health insurance on household financial protection is −0.012 for the nearest neighbor method, −0.013 for the matching radius method, −0.015 for the Kernel and −0.016 for the stratification method. Results showed that health insurance contributes to reducing catastrophic health expenditures, but their effect remains very limited. This could be explained by the level of care package covered and the cost covered. Conclusion: Health insurance contributes to the reduction of catastrophic health expenses for households. However, it is important to widen the range of care covered and the cost covered. In addition, measures to extend this coverage to a larger proportion of the population will make it possible to have a greater impact.展开更多
With the advancement of technology and health sciences,health care delivery costs are steadily increasing.This affects both households and governments.Unfortunately,the present truth is that health has become an essen...With the advancement of technology and health sciences,health care delivery costs are steadily increasing.This affects both households and governments.Unfortunately,the present truth is that health has become an essential but unaffordable commodity.This is very concerning.Quality,up-to-date,costeffective health care delivery is one of the prime objectives,and focuses on administration and health care authority.As the per capita spent on health from public/government funds is very poor in developing countries,the responsibility of cost-effective health care delivery falls primarily on the shoulder of the treating physicians.Anesthesiologists are becoming an indispensable part of health care delivery,having a diverse role in the emergency,critical care,pain,and perioperative care of patients.As the population ages,the need for surgical care is also increasing.Therefore,the anesthesiologist can also play a more significant role in delivering cost-effective health care,and minimize the cost without affecting the quality.This brief narrative review analyzes the current practice of anesthesiologists in two prime areas in the context of cost-savings:Preoperative investigation and low/minimal flow anesthesia.展开更多
Norwegian authorities recommend that adults and elderly people be physically active for at least 30 min every day at moderate to high levels of intensity. This is equivalent to approximately 10,000 steps a day. This r...Norwegian authorities recommend that adults and elderly people be physically active for at least 30 min every day at moderate to high levels of intensity. This is equivalent to approximately 10,000 steps a day. This research study seeks to determine whether golf is beneficial to individual health as defined by the governmental recommendations. The study included 29 participants, whose heart rate, playing time, and walked distance were measured as they carried a GPS (global position system) receiver. Male players walked on average 11,256 + 830 m while female players walked on average 10,000 ~ 595 m. Thus, men tended to walk 1.98 times the course length while women walked 2.13 times the course length. The duration of the golf round averaged 269 ~ 25.4 rain (i.e., 4 h 29 min); for men, the mean duration was 271 rain, and for women, it was 267 rain. The average heart rate was 104.1 ~ 14.5 bpm for male players and 110.8 ~ 16.9 bpm for the female players. Based on the energy expenditure in kcal on the golf course, male players used 2,467 kcal on average while female players used 1,587 kcal on average during a round of golf. Comparing the hilliness of two different golf courses, it indicated that golf playing could be a form of interval training. Our results strongly indicate that golf is beneficial to health as defined in the governmental recommendations.展开更多
文摘Objectives Understanding past trends and forecasting future changes in health spending is vital for planning and reducing reliance on out-of-pocket(OOP)expenses.The current study analyzed health expenditure patterns in India and forecasted future trends and patterns until 2035.Methods Data on health expenditure in India from 2000 to 2019 was collected from the Organisation for Economic Co-operation and Development(OECD)iLibrary and National Health Accounts 2019 databases.Gross domestic product(GDP)data from the World Bank was also utilized.Descriptive statistics analyzed the composition and pattern,while the exponential smoothing model forecasted future health expenditures.Results The findings revealed that expenditure made by OOP is the primary health financing source,followed by government and pre-paid private spending.The percentage of GDP allocated to total health expenditure remains stable,while the per capita health expenditure fluctuates.Variations in expenditure among states are observed,with Karnataka relying heavily on pre-paid private coverage.Future projections suggest a decline in per capita and total health expenditure as a share of GDP,with a slight increase in the government’s share.Pre-paid private expenditure per capita and OOP health expenditure as a share of the total is projected to remain relatively constant but still high in absolute terms.Conclusion The study highlights variations in health spending in India,characterized by high OOP spending,limited public coverage,and a need for investments,and reforms to improve healthcare access and equity.
文摘Overweight and obese individuals are at increased risk for many diseases and health conditions, including but not limited to the following: hypertension;osteoarthritis;dyslipidemia;type 2 diabetes;coronary heart disease and stroke. Consequently, individuals who are obese are more likely to use health services and are more likely to use costly health services than non-obese individuals. Between 1987 and 2001, growth in obesity related health expenditures accounted for 27 percent of the growth in inflation-adjusted per capita health care spending. Researchers, popular press and the television news media have paid considerable attention to the effect that farm subsidies have on dietary habits and obesity. Prominent researchers in the field have concluded that US farm subsidies have had a negligible impact on obesity. However, even small increases in obesity rates are associated with higher health care expenditures. The primary intent of this study is to break down the linkages from farm subsidy to health expenditure and shed light on the unintended implications of the farm subsidy program. We find that agricultural subsidies have the potential to influence health care expenditures.
文摘It is widely recognized that developed countries have been spending more than developing countries on health care. Objective of the study is to examine determinants of health expenditure and what factors influence it. Fifteen Asian countries and 30 OECD countries were chosen to explore the difference of their health expenditure structures. Model of health expenditure per person was estimated to be dependent on market demand, market supply, and other exogenous factors. A model with country specific and time effects of health expenditure was used and estimated. The study found a negative but insignificant relationship between price and health expenditure and a positive and significant relationship between GDP and health expenditure. Urban population density as proxy of urbanization was found to induce the health expenditure in the OECD. Out-of-pocket payment was also found to induce health expenditure for both the Asian and the OECD countries. A net effect of improvement in the health status or a lower mortality rate and a higher life expectancy caused an increase in the health expenditure among the Asian countries studied but decreased health expenditure in the OECD countries. In terms of income elasticity, it was found to be smaller than one in both groups of the countries. Since the income has changed faster than the other factors, the net effect of changes of all factors over period of time will cause rising in health care expenditure. Finally, the model indicated that both the Asian and OECD countries will continue to have a rising health expenditure per person over a period of time.
文摘<strong>Background:</strong> Despite having one of the most successful health systems in the world, annual medical expenditures in Japan have been increasing year to year. We sought to clarify regional differences in medical expenditures by analyzing the relationship between the specific health examination coverage and medical care expenditure by prefecture of Japan. <strong>Methods:</strong> We used data from the National Database of Health Insurance Claims and Specific Health Checkups (NDB) Open Data Japan (2015) and Overview of 2015 National Medical Expenses to compare medical care expenditure per capita and proportions of persons receiving specific health examination between Japan nationally and individual prefectures. <strong>Results: </strong>National medical expenditures were 42.3 trillion Japanese yen (JPY) (3851 hundred million dollars), with a national per capita rate of JPY347,219 (USD3156). Per capita medical expenditure rates by prefecture ranged from JPY290,900 (USD2645) in Saitama Prefecture to JPY 444,000 (USD4036) in Kochi Prefecture. The proportion of persons receiving specific health examinations was 49.0% for Japan overall and ranged from 39.3% in Hokkaido Prefecture to 63.4% in Tokyo Prefecture. We observed a significant negative correlation between per capita medical expenditures and the proportion of persons receiving specific health examinations (R = 0.553, p < 0.001).<strong> Conclusion: </strong>We found a significant negative correlation between per capita medical expenditures and the proportion of persons receiving health examinations: prefectures with lower expenditures tended to have higher rates of medical examinations. Interventions to increase the proportion of persons receiving specific health examinations by prefecture could reduce per capita medical expenditures and reduce prefectural disparities in expenditures.
文摘Using data from 60th round of the National Sample Survey, this study attempts to measure the incidence and intensity of ‘catastrophic’ maternal health care expenditure and examines its socio-economic correlates in urban and rural areas separately. Additionally, it measures the effect of maternal health care expenditure on poverty incidence and examines the factors associated with such impoverishment due to maternal health care payments. We found that maternal health care expenditure in urban households was almost twice that of rural households. A little more than one third households suffered catastrophic payments in both urban and rural areas. Rural women from scheduled tribes (ST) had more catastrophic head counts than ST women from urban areas. On the other hand, the catastrophic head count was greater among illiterate women living in urban areas compared to those living in rural areas. After adjusting for out-of-pocket maternal health care expenditure, the poverty in urban and rural areas increased by almost equal percentage points (20% in urban areas versus 19% in rural areas). Increasing education level, higher consumption expenditure quintile and higher caste of women was associated with increasing odds of impoverishment due to maternal health care expenditure. To reduce maternal health care expenditure induced poverty, the demand-side maternal health care financing programs and policies in future should take into consideration all the costs incurred during prenatal, delivery and postnatal periods and focus not only on those women who suffered catastrophic expenditure and plunged into poverty but also those who forgo maternal health care due to their inability to pay.
基金supported in part by the Humanities and Social Science Project of Chinese Ministry of Education (Grant No. 11YJC790233)
文摘For a while since the inception of economic system reform programs in 1980s,China's government investment in health was weakened.This resulted in healthcare provider's increasing reliance on user charges for their income,poorer access to healthcare for the vulnerable population groups,and increasing socioeconomic disparities in health and healthcare.To address these problems,China initiated a series of health sector reforms since late 1990s.Our comprehensive review study has found that indeed Chinese government spending on health has been increasing in recent years,especially since 2009,when the new Healthcare Reform Plan was announced.Still,China needs to both further strengthen government investment in health and address the structural imbalances in government health financing,in order to make the overall Chinese health system more equitable and more efficient.
基金support from the US National Institutes of Health D43 TW009595 and P30 AI064518 programsCharles Muiruri was supported by the National Heart,Lung,And Blood Institute of the National Institutes of Health trader Award U01HL142099.
文摘Background:Missed clinic appointments negatively impact clinic patient flow and health outcomes of people living with HIV(PLHIV).PLHIV likelihood of missing clinic appointments is associated with direct and indirect expenditures made while accessing HIV care.The objective of this study was to examine the relationship between out-of-pocket(OOP)health expenditures and the likelihood of missing appointments.Method:Totally 618 PLHIV older than 18 years attending two HIV care and treatment centres(CTC)in Northern Tanzania were enrolled in the study.Clinic attendance and clinical characteristics were abstracted from medical records.Information on OOP health expenditures,demographics,and socio-economic factors were self-reported by the participants.We used a hurdle model.The first part of the hurdle model assessed the marginal effect of a one Tanzanian Shillings(TZS)increase in OOP health expenditure on the probability of having a missed appointment and the second part assessed the probability of having missed appointments for those who had missed an appointment over the study period.Results:Among these 618 participants,242(39%)had at least one missed clinic appointment in the past year.OOP expenditure was not significantly associated with the number of missed clinic appointments.The median amount of OOP paid was 5100 TZS per visit,about 7%of the median monthly income.Participants who were separated from their partners(adjusted odds ratio[AOR]=1.83,95%confidence interval[CZ]:1.11-8.03)and those aged above 50 years(AOR=2.85,95%CI:1.01-8.03)were significantly associated with missing an appointment.For those who had at least one missed appointment over the study period,the probability of missing a clinic appointment was significantly associated with seeking care in a public CTC(P=0.49,95%CI:0.88-0.09)and aged between>25-35 years(P=0.90,95%CI:0.11-1.69).Conclusion:Interventions focused on improving compliance to clinic appointments should target public CTCs,PLHIV aged between>25-35 years,above 50 years of age and those who are separated from their partners.
文摘This research builds an index to describe the inequality in health care expenditure related to pollution,and the measurement with Chinese provincial data set suggests that health care expenditure inequality related to pollution is obvious negative,which confirms that residents located in high-polluted areas cannot get the better health care resources.Meanwhile,the absolute value of health care expenditure inequality related to pollution is even larger than that related to income,which suggests the inequality related to pollution cannot be ignored.
文摘Turkey launched a project in 2003 known as "Health Transformation Programme" (HTP), which enabled Turkey to make considerable progress and radical changes to the health care system. The programme in 2003 included the effectiveness and the efficiency factors within the process by setting them as the primary objectives to increase the health status of the population (effectiveness) and to use resources in the best possible manner and at the lowest possible cost (efficiency). Accessing services according to the need of patients and state benefits according to their ability to pay would be viable under these objectives. In this study, initially, Turkish National Health System will be articulated on a literature-study basis approach to measure the efficiency of public expenditure on health. Then, the measured level of the efficiency will be analysed in Turkey, The paper serves a purpose to analyse the efficiency based on the outcomes of heath service such as satisfaction with public health services over the period of 2003-2013. A simple linear regression was employed to test the degree of statistical relation between public health expenditure and satisfaction with public health care services.
文摘By social expenditure on health service(SEHS)we refer to the sum total of money paid by thewhole society during a certain period of year for the sake of preventing and treating diseases andof protecting and improving the people’s health.It reflects objectively the total level of SEHSduring a certain period;the levels of health service expenditures on the parts of the whole society,enterprises,and individuals;the ratio between SEHS and total social expenditure;and the ratiosof SEHS to gross national product and to national income.The article discussed and
基金supported by the Foshan Social Science Planning Project in 2022,based on“How to Improve the Enterprise Service System and Promote the Reform of the Foshan Business Enabling Environmental System”(Project Number:2022-ZDA01)Foshan Social Science Planning Major Project in 2022,Foshan Social Science Federation,2022(5)the Student Academic Foundation of Foshan University in 2022,based on“Cultivating a Refreshing‘Soft Environment’to Build‘Hard Power’for Development:A Study on the Influencing Factors and Enhancement of Business Environment in Foshan Oriented on Entrepreneurial Satisfaction”(Project Number:xsjj202214zsa02),Communist Youth League Foshan University Committee,2022(6).
文摘In this present-day global pandemic that has not been completely resolved,health is a major concern among people,and correspondingly,people are demanding higher standards for public health products and services provided by the government.In this paper,we measure the technical efficiency of public health expenditure in each province by using the data envelopment analysis(DEA)model,and examine the impact of decentralization on the efficiency of public health expenditure under the fiscal decentralization system using the panel data from 31 provinces from 2012-2019 in a panel model subject to fixed effects.
基金co-supported by the National Natural Science Foundation of China (No. 81773521)CAMS Innovation Fund for Medical Sciences (No. 2017-I2M-1006, No. 2016-12M-2-004)+4 种基金the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (No. 2018RC330001)the National Key Projects of Research and Development of China (No. 2018 YFC1315000)China Scholarship Council (No. 201908110180)the Sanming Project of Medicine in Shenzhen (No. SZSM201911015)the Cancer Screening Program in Urban China funded by National Health Commission of People’s Republic of China
文摘Objective: Colorectal cancer(CRC) causes a substantial burden of disease in China and the evidence of economic burden triggered is fundamental for priority setting. The aim of this survey was to quantify medical expenditures and the time trends for CRC diagnosis and treatment in China.Methods: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 13 provinces across China. For each eligible CRC patient diagnosed from 2002 to 2011, clinical information and expenditure data were extracted using a uniform questionnaire. All expenditure data were reported in Chinese Yuan(CNY)using 2011 values.Results: Of the 14,536 CRC patients included, the average age at diagnosis was 58.2 years and 15.8% were stageI cases. The average medical expenditure per patient was estimated at 37,902 CNY [95 % confidence interval(95%CI): 37,282-38,522], and the annual average increase rate was 9.2% from 2002 to 2011(P for trend <0.001), with a cumulative increase of 2.4 times(from 23,275 CNY to 56,010 CNY). The expenditure per patient in stages Ⅰ, Ⅱ, Ⅲ and Ⅳ were 31,698 CNY, 37,067 CNY, 38,918 CNY and 42,614 CNY, respectively(P<0.001). Expenditure significantly differed within various subgroups. Expenses for drugs contributed the largest proportion(52.6%).Conclusions: These conservative estimates illustrated that medical expenditures for CRC diagnosis and treatment in tertiary hospitals in China were substantial and increased rapidly over the 10 years, with drugs continually being the main expense by 2011. Relatively, medical expenditures are lower for CRC in the earlier stages. These findings will facilitate the economic evaluation of CRC prevention and control in China.
文摘AIM To evaluate the association between mortality-to-incidence ratios(MIRs) and health disparities.METHODS In this study, we used the GLOBOCAN 2012 database to obtain the cancer incidence and mortality data for 57 countries, and combined this information with the World Health Organization(WHO) rankings and total expenditures on health/gross domestic product(e/GDP). The associations between variables and MIRs were analyzed by linear regression analyses and the 57 countries were selected according to their data quality. RESULTS The more developed regions showed high gastric cancer incidence and mortality crude rates, but lower MIR values than the less developed regions(0.64 vs 0.80, respectively). Among six continents, Oceania had the lowest(0.60) and Africa had the highest(0.91) MIR. A good WHO ranking and a high e/GDP were significantly associated with low MIRs(P = 0.001 and P = 0.001, respectively).CONCLUSION The MIR variation for gastric cancer would predict regional health disparities.
文摘Objective:This study aimed to estimate the out-of-pocket expenditure of families on the health care of children younger than 5 years in a rural area of Kancheepuram district.Methods:A cross-sectional descriptive study was performed in a rural area of Kancheepuram district for 5 months.All households with at least one child younger than 5 years were eligible for the study,and 153 households were selected for the fi nal study.A semistructured and pretested schedule was used to obtain information about various study variables during home visits.Ethics approval was obtained before the start of the study.Data were entered into Microsoft Excel,and statistical analysis was done with IBM SPSS Statistics version 23.Frequency distributions were calculated for all the variables.Results:The fi ndings indicate that most children younger than 5 years were males(62.7%).The maximum out-of-pocket expenditure was for accidents/trauma and in cases of fever/malaria.Further,96 households(53.1%)preferred private-sector health care for their ailments.Conclusion:The fi ndings indicate that 93 of the children younger than 5 years(60.8%)had experienced one episode of illness in the previous 3 months.Further,the maximum out-of-pocket expenditure was for accident/trauma cases,and overall the largest share was for buying medica-tions for the treatment.
文摘The health inequities remain high in India with government and private health expenditures clearly favoring the rich, urban population and organized sector workers and the Out Of Pocket (OOP) spending as high as 80%, afflicting the poor in the worst manner. The focus of the paper is to examine the potential Community Based Health Insurance (CBHI) offers to improve the healthcare access to rural, low-income population and the people in unorganized sector. This is done by drawing empirical evidence from various countries on their experiences of implementing CBHI schemes and its potential for applications to India, problems and challenges faced and the policy and management lessons that may be applicable to India. It can be concluded that CBHI schemes have proved to be effective in reducing the Catastrophic Health Expenditure (CHE) of people. But success of such schemes depends on its design, benefit package it offers, its management, economic and non-economic benefits perceived by enrollees and solidarity among community members. Collaboration of government, NGO’s and donor agencies is very crucial in extending coverage;similarly overcoming the mistrust that people have from such schemes and subsidizing the insurance for the many who cannot pay the premiums are important factors for success of CBHI in India. One of the biggest challenges for the health system is to address the piecemeal approach of CBHI schemes in extending health insurance and inability of such schemes to cover a large number of poor and the unorganized sector workers. Also, there is a need for a stronger policy research to demonstrate: 1) how such schemes can create a larger risk pool, 2) how such schemes can enroll a large number of people in the unorganized sector, 3) the interaction of CBHI schemes with other financing schemes and its link to the health system.
文摘Context: To facilitate financial access to care for the population, health insurance mechanisms have been established, in particular the National Health Insurance Institute, which covers civil servants and their dependents. In addition, other voluntary and community mechanisms have been developed. After several years of implementation, the level of catastrophic health expenditures among insured individuals shows that there is still a considerable level of financial risk associated with health care. This study aims to assess the impact of health insurance in Togo on insured populations. Methodology: The data used in this study come from the harmonized survey on household living conditions carried out in 2018 by the National Institute of Statistics, Economic and Demographic Studies. The propensity score matching method was used according to the following steps: estimation of propensity scores, verification of the conditional independence hypothesis (balancing property) and estimation of the average treatment effect on treated. Stata V14.2 software was used. Findings: The average effect of health insurance on household financial protection is −0.012 for the nearest neighbor method, −0.013 for the matching radius method, −0.015 for the Kernel and −0.016 for the stratification method. Results showed that health insurance contributes to reducing catastrophic health expenditures, but their effect remains very limited. This could be explained by the level of care package covered and the cost covered. Conclusion: Health insurance contributes to the reduction of catastrophic health expenses for households. However, it is important to widen the range of care covered and the cost covered. In addition, measures to extend this coverage to a larger proportion of the population will make it possible to have a greater impact.
文摘With the advancement of technology and health sciences,health care delivery costs are steadily increasing.This affects both households and governments.Unfortunately,the present truth is that health has become an essential but unaffordable commodity.This is very concerning.Quality,up-to-date,costeffective health care delivery is one of the prime objectives,and focuses on administration and health care authority.As the per capita spent on health from public/government funds is very poor in developing countries,the responsibility of cost-effective health care delivery falls primarily on the shoulder of the treating physicians.Anesthesiologists are becoming an indispensable part of health care delivery,having a diverse role in the emergency,critical care,pain,and perioperative care of patients.As the population ages,the need for surgical care is also increasing.Therefore,the anesthesiologist can also play a more significant role in delivering cost-effective health care,and minimize the cost without affecting the quality.This brief narrative review analyzes the current practice of anesthesiologists in two prime areas in the context of cost-savings:Preoperative investigation and low/minimal flow anesthesia.
文摘Norwegian authorities recommend that adults and elderly people be physically active for at least 30 min every day at moderate to high levels of intensity. This is equivalent to approximately 10,000 steps a day. This research study seeks to determine whether golf is beneficial to individual health as defined by the governmental recommendations. The study included 29 participants, whose heart rate, playing time, and walked distance were measured as they carried a GPS (global position system) receiver. Male players walked on average 11,256 + 830 m while female players walked on average 10,000 ~ 595 m. Thus, men tended to walk 1.98 times the course length while women walked 2.13 times the course length. The duration of the golf round averaged 269 ~ 25.4 rain (i.e., 4 h 29 min); for men, the mean duration was 271 rain, and for women, it was 267 rain. The average heart rate was 104.1 ~ 14.5 bpm for male players and 110.8 ~ 16.9 bpm for the female players. Based on the energy expenditure in kcal on the golf course, male players used 2,467 kcal on average while female players used 1,587 kcal on average during a round of golf. Comparing the hilliness of two different golf courses, it indicated that golf playing could be a form of interval training. Our results strongly indicate that golf is beneficial to health as defined in the governmental recommendations.