Charting the course:India's health expenditure projections for 2035

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.

The twisted path from farm subsidies to health care expenditures

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.

Regional Differences in Specific Health Examination Utilization and Medical Care Expenditures in Japan

Background: 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. Methods: 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. Results: 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). Conclusion: 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.

Maternity or catastrophe: A study of household expenditure on maternal health care in India

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.

Health Care Expenditure Inequality Associated With Pollution in China

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.

The Pattern of Government Health Expenditure in China

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.

Social Expenditure on Health Service and Its Macro Estimation

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

A Study of the Impact of Fiscal Decentralization on the Efficiency of Public Health Expenditure

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.

Medical expenditures for colorectal cancer diagnosis and treatment: A 10-year high-level-hospital-based multicenter retrospective survey in China, 2002-2011

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.

Assessing the Impact of Health Insurance on Household Financial Protection in Togo

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.

健康中国背景下的“看病贵”与政府支出——基于资源配置结构性失衡视角的分析

“看病贵”意味着医疗卫生资源转化为医疗卫生服务的成本高,有限资源下医疗卫生服务供给的数量和质量难以满足公众健康需求,从而直接影响健康中国建设。同时,人口快速老龄化带来的医疗卫生需求爆发式增长,将形成医疗卫生体系的额外压力,加剧供求矛盾。基于医疗卫生资源配置结构性失衡视角研究“看病贵”与政府支出之间的关系发现:政府增加卫生支出会通过加剧人力资源配置的结构性失衡而加剧“看病贵”问题;只有将增加政府卫生支出与深化医疗卫生体制改革相结合,才能真正缓解全社会“看病贵”问题。因此,应深化公立医院改革,优化政府对医疗卫生资源的配置方式,加强基层医疗卫生体系建设,重塑医疗卫生服务治理模式,构建专业化治理模式,系统性重构中国医疗卫生领域人才建设。

北京市综合医改前后社区卫生服务机构治疗费用的受益人群分析

背景厘清社区卫生服务机构主要服务的人群特点,对下一步社区卫生服务机构的精准改革具有十分重要的意义。目的通过分析综合改革前后北京市社区卫生服务机构治疗费用的受益人群特征,为下一步改革政策制定和调整提供精准的数据支持。方法本研究基础数据来源于2016—2019年北京市卫生总费用核算基础数据库,其他数据来源于2016—2019年《北京市卫生健康统计年鉴》《北京市卫生财务统计年报》《北京市卫生费用核算报告》等。采用多阶段分层整群抽样的方案选取社区卫生服务机构,从HIS系统纳入全年的门诊数据、住院患者的数据。采用卫生费用核算体系2011(SHA2011)核算、分析社区卫生服务机构治疗费用的受益人群状况。结果2016—2019年北京市社区卫生服务机构治疗费用从121.81亿元增长至222.45亿元,年均增长19.07%。40岁以上中老年患者治疗费用历年占比均在92%以上,60~岁、80~岁两个年龄组患者治疗费用增长较快,年均增速分别为24.08%、25.84%;治疗费用中内分泌、营养和代谢疾病,症状、体征和检验异常、循环系统疾病占比最高,内分泌、营养和代谢疾病,神经系统疾病,症状、体征和检验异常疾病治疗费用增长较快,年均增速分别为40.11%、48.40%和32.43%。结论综合改革后分级诊疗成效初显,社区医疗服务资源主要由中老年患者、内分泌、循环系统等慢性非传染性疾病患者所消耗,改革引导更多中老年和慢性病患者流向社区,社区卫生服务机构应该从服务能力、人才队伍、慢性病管理、医联体建设等多方面着手,提升其服务能力,巩固和维持改革的效果。

人工智能与财政预算支出管理——基于公共卫生预算的分析

通过将人工智能运用于公共卫生预算分配,本文实证检验了人工智能方法在财政预算支出管理中的有效性。本文以2014—2022年广东21个地级市为研究样本,构建人工智能模型探讨公共卫生预算支出与人口死亡率、甲乙类传染病发病数量和人均地区生产总值等多目标的联系。研究发现:第一,提高卫生监督机构、突发公共卫生应急处理以及疾病预防控制机构预算水平是降低人口死亡率的有效途径;第二,优化基本公共卫生服务、城市社区卫生机构和老龄卫生健康事务的预算分配是控制甲乙类传染病发病数量的关键;第三,疾病预防控制机构、突发公共卫生事件应急处理和采供血机构的预算支出是保障劳动力健康和经济增长的基石;第四,控制传染病发病数量与提高人均地区生产总值存在一定程度的目标冲突,而降低人口死亡率与提高生产总值的目标则较为一致。

健康公平视角下的城乡居民医疗支出不平等研究——基于生命周期模型

促进健康公平是中国医疗体制改革的重要目标之一。建立居民医疗支出内生决策的生命周期模型,根据实际数据采用模拟矩估计法估计城乡居民偏好参数,通过模型求解揭示居民的医疗支出行为特征及城乡差异,并讨论相关政策对城乡医疗支出不平等的影响。研究表明:城乡居民的生命周期最优医疗支出均呈现倒U型,但医疗支出水平具有明显差异;收入差距、主观偏好差异和基本医疗保险制度差异是造成该现象的重要原因且重要性依次降低;增加农村居民收入、提高农村居民医疗保险保障水平、提升医疗技术以及引入普惠型健康保险可以有效缩小城乡居民医疗支出差距。因此,应增强城乡居民医疗保险制度的福利性,积极在农村地区推广惠民保等普惠型健康保险,进一步增加农村居民收入,以缩小城乡医疗支出差距。

迁移对中老年人医疗费用支出的影响研究

本文使用2018年中国健康与养老追踪调查数据研究迁移对中老年人医疗费用支出的影响。结果表明,无论是门诊治疗还是住院治疗,参保地和居住地不同的中老年人都有更少的医疗费用支出,这种差异不仅体现在医疗总费用上,也表现在报销之后的自付费用上。但是,对于过去一个月内有门诊治疗经历的人,以及过去一年内有住院治疗经历的人,迁移中老年人在就医过程中要支付更高的费用。机制分析表明,迁移中老年人在门诊和住院方面的就医行为更少,同时在就医中的报销比例也更低。最后,本文从持续推动基本医疗保险异地就医直接结算、建立全国统筹的医疗保险制度、加强对迁移中老年人的健康服务、提升健康治理水平等方面提出了政策建议。

政府卫生支出、财政压力与居民医疗服务利用机会不平等分析

目的:分析政府卫生支出与居民医疗服务利用机会不平等之间的关系及其作用机制,为完善相关政策提供理论依据。方法:基于机会平等理论,利用CFPS2014—2020年数据测算居民医疗服务利用的机会不平等程度。结果:2014—2020年,我国居民医疗服务利用的机会不平等上限均值为0.781,下限均值为0.264,机会不平等的相对程度均值为0.337,即总不平等中有33.7%是机会不平等造成的;每增加1个单位的政府卫生支出,机会不平等程度增加4.6%,说明我国政府卫生支出存在一定的结构性问题;财政压力作为调节变量,能够削弱政府卫生支出对机会不平等的影响。结论:增加政府卫生支出能够改善欠发达地区医疗服务利用机会不平等问题,同时应从报销比例、地域、财政压力等方面,提升医疗服务利用公平性。

家庭教育支出与身心健康——对“双减”政策的效果评估

本文研究2021年实施的教育“双减”政策对中小学校内外负担、家庭教育支出以及身心健康等的影响。基于在全国范围内针对“双减”政策开展的家庭微观调查数据,我们发现学生的学习负担在“双减”政策实施后显著减少了四分之一,家庭教育支出及家长的时间投入降低了约15%,学生和家长的多项身心健康指标也得到了显著改善。异质性分析发现,家长具有本科及以下学历的家庭在教育投入上的降幅相对更大,而这些学生和家长在身心健康方面的获益也更多。进一步的机制探索发现,家长在认知和信念上的差异影响了其实际的教育投入。

基于灰色系统理论的我国卫生总费用之预测

利用我国2008—2020年卫生总费用及相关统计数据分别建立了GM(1,1)、FHGM(1,1)、DGM(1,1)和OFHGM(1,1)4种灰色预测模型。利用平均绝对百分比误差研究了这些模型的性能,结果表明:与GM(1,1)、FHGM(1,1)和DGM(1,1)模型相比,OFHGM(1,1)模型的预测精度最高。