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Household health expenditures in Nepal: implications for health care financing reform

HEALTH POLICY AND PLANNING 1998年第4期13卷 371-383页

作者： Hotchkiss, DR Rous, JJ Karmacharya, K Sangraula, P Tulane Univ Sch Publ Hlth & Trop Med Dept Int Hlth & Dev New Orleans LA 70012 USA Univ N Texas Dept Econ Denton TX 76203 USA

His Majesty's Government of Nepal has embarked on an ambitious social welfare programme of increasing the accessibility of primary education and health care services in rural communities. The implications on the financing of health care services are substantial, as the number of health posts has increased twelve-fold from 1992 to 1996, from 200 to 2597. To strengthen health care financing, government policy-makers are considering a number of financing strategies that are likely to have a substantial impact on household health care expenditures. However, more needs to be known about the role of households in the current structure of the health economy before the government designs and implements policies that affect household welfare. This paper uses the Nepal Living Standards Survey, a rich, nationally-representative sample of households from 1996, to investigate the level and distribution of household out-of-pocket health expenditures. Utilization and expenditures for different types of providers are presented by urban/rural status and by socioeconomic status. In addition, the sources of health sector funds are analyzed by contrasting household out-of-pocket expenditures with expenditures by the government and donors. The results indicate that households spend about 5.5% of total household expenditures on health care and that households account for 74% of the total level of funds used to finance the health economy. In addition, rural households are found to spend more on health care than urban households, after controlling for income status. Distributing health care expenditures by type of care utilized indicates that the wealthy, as well as the poor, rely heavily on services provided by the public sector. The results of this analysis are used to discuss the feasibility of implementing alternative health care financing policies.

关键词：发展中国家/经济学筹资政府/方法筹资个人/统计学和数值数据卫生保健改革/经济学卫生经费支出/统计学和数值数据卫生服务易得程度卫生服务研究尼泊尔乡村卫生服务/经济学乡村卫生服务/组织和管理农村人口市区人口

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Private health care provision in developing countries: a preliminary analysis of levels and composition

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HEALTH POLICY AND PLANNING 1998年第3期13卷 195-211页

作者： Hanson, K Berman, P Univ London London Sch Hyg & Trop Med Hlth Policy Unit London WC1E 7HT England Harvard Univ Sch Publ Hlth Dept Populat & Int Hlth Boston MA 02115 USA

While the importance of the private sector in providing health services in developing countries is now widely acknowledged, the paucity of data on numbers and types of providers has prevented systematic cross-country comparisons. Using available published and unpublished sources, we have assembled data on the number of public and private health care providers for approximately 40 countries. This paper presents some results of the analysis of this database, looking particularly at the determinants of the size and structure of the private health sector. We consider two different types of dependent variable: the absolute number of private providers (measured here as physicians and hospital beds), and the public-private composition of provision. We examine the relationship between these variables and income and other socioeconomic characteristics, at the national level. We find that while income level is related to the absolute size of the private sector, the public-private mix does not seem to be related to income. After controlling for income, certain socioeconomic characteristics, such as education, population density, and health status are associated with the size of the private sector, though no causal relationship is posited. Further analysis will require more complete data about the size of the private sector, including the extent of dual practice by government-employed physicians. A richer story of the determinants of private sector growth would incorporate more information about the institutional structure of health systems, including provider payment mechanisms, the level and quality of public services, the regulatory structure, and labour and capital market characteristics. Finally, a normative analysis of the size and growth of the private sector will require a better understanding of its impact on key social welfare outcomes.

关键词：发展中国家卫生保健调查卫生经费支出/统计学和数值数据卫生资源卫生服务研究收入/统计学和数值数据私人开业/统计学和数值数据私营部门/经济学私营部门/统计学和数值数据社会经济因素

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Dental services: Use, expenditures and sources of payment, 1987

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JOURNAL OF THE AMERICAN DENTAL ASSOCIATION 1999年第4期130卷 500-508页

作者： Manski, RJ Moeller, JF Maas, WR Univ Maryland Sch Dent Dept Oral Hlth Care Delivery Baltimore MD 21201 USA

Background This article pro rides per capita estimates of dental care utilization, expenditures mix of services and sources of payment for each of several socioeconomic and demographic categories. Methods. The focus of the analyses presented here is on dental cafe utilization by the U.S, population during 1987. Specifically, national estimates are provided for dental visits, expenditures, sources of payment and procedure type for each of several socioeconomic and demographic categories using household data from the 1987 National Medical Expenditure Survey, or NMES. Results. During 1987, less that 50 percent of Americans visited a dental office. Americans made approximately 292 million dental visits and received approximately $30 billion worth of dental care, of which $10 billion was paid by insurers, $17 billion was paid out of pocket and $1.6 billion was not reimbursed. Conclusions. These analyses establish the magnitude of the dental care market and the amounts paid by individual patients, private insurance companies and Medicaid. They also reveal that the type of care received varies among people in distinct socioeconomic and demographic groups. Practice Implications. Although the dental care market is substantial, many Americans do not visit a dentist. By understanding these analyses. practitioners will be better positioned to meet the dental needs of all Americans.

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Watching the bottom line: Enhancing the role and impact of infection control in a managed care environment

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AMERICAN JOURNAL OF INFECTION CONTROL 2000年第1期28卷 25-29页

作者： Rhinehart, E AIG Consultants Inc Healthcare Management Div Qual Management Serv Atlanta GA 30328 USA

Health care expenditures exceeded $1 trillion in 1997, with projections for $2.2 trillion in expenditures by 2008. Decreasing organizational revenues and efforts to reduce operating costs have had a direct impact on infection control programs. Senior managers in hospitals and other provider organizations are focusing on achieving and maintaining revenues while controlling costs. Infection control professionals must align themselves and their programs with these organizational goals by (1) identifying areas in which the infection control program can support and enhances revenues, (2) facilitating the avoidance of excess costs for care, especially those related to nosocomial infection, (3) identifying opportunities for cost reduction through value analysis, and (4) participating in efforts to measure and prevent other adverse outcomes of care.

关键词：费用控制筹资组织/组织和管理卫生经费支出/统计学和数值数据卫生经费支出/发展趋势感染控制/组织和管理管理医疗规划/组织和管理模型经济计量学结果评价(卫生保健)/组织和管理风险分担财政/组织和管理美国利用情况审核/组织和管理人类

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Medicare spending by beneficiaries with various types of supplemental insurance

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MEDICAL CARE RESEARCH AND REVIEW 1999年第2期56卷 137-155页

作者： Khandker, RK McCormack, LA Res Triangle Inst Res Triangle Pk NC 27709 USA

The authors analyzed Medicare spending by elderly noninstitutionalized Medicare beneficiaries with and without supplemental insurance such as Medigap, employer-sponsored plans, and Medicaid. Use of a detailed survey of Medicare beneficiaries and their Medicare health insurance claims enabled the authors to control for health status, chronic additions,functional limitations, and other factors that explain spending variations across supplemental insurance categories. The authors found that supplemental insurance was associated with a higher probability and level of Medicare spending, particularly for Part B services. Beneficiaries with both Medigap and employer plans had the highest levels of spending ceteris paribus, suggesting a possible moral hazard effect of insurance. Findings from this study are discussed in the context of the overall financing of health care for the elderly.

关键词：卫生经费支出/统计学和数值数据健康状况收入保险赔偿费保险 Medigap/经济学保险 Medigap/统计学和数值数据保险 Medigap/利用似然函数 Logistic模型 Medicaid/经济学 Medicaid/统计学和数值数据 Medicaid/利用 Medicare/经济学 Medicare/统计学和数值数据 Medicare/利用统计学非参数美国人类男(雄)性

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What we say and what we do: County-level public spending for health care

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JOURNAL OF RURAL HEALTH 1999年第4期15卷 421-430页

作者： Zimmerman, MK McAdams, R Univ Kansas Dept Hlth Policy & Management Overland Pk KS 66213 USA

The purpose oft his study is to examine county-level public spending for health care services in Kansas and to explain variation in spending levels with a model composed of population density population age and per capita income. Data are abstracted from budget documents for all 105 counties in Kansas for the years 1994, 1995 and 1996. Health care expenditures are defined as county tax revenues spent for ambulance, hospitals, ambulatory care, home health services, nursing homes, and mental health and substance abuse services. Results show that Kansas counties spent between 12.1 percent and 13.6 percent of their budgets to fund local health care services between 1994 and 1996, spending more than $133 million in 1996 alone. In 10 counties, one-quarter to one-third of the budget went for health services. Low population density and relatively high per capita income explained nearly one-third of the variation in how much counties spent and an even greater proportion when analysis was limited to the most rural counties. Findings from this study suggest there may be a significant local commitment in the United States to publicly supported health care services, more support than typically recognized and perhaps more than is estimated in national health care spending data. Future research on the economic effects of the health sector on local communities should take account of local spending for health care, especially at the county level.

关键词：预算筹资政府/经济学卫生卫生经费支出/统计学和数值数据卫生服务/经济学收入堪萨斯模型经济计量学人口密度问卷调查居住特征/统计学和数值数据人类

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Growing importance of capitation in Switzerland

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Health Care Management Science 2000年第2期3卷 111-119页

作者： Beck, Konstantin CSS Insurance CH-6002 Lucerne Switzerland

Since its liberalisation the Swiss health insurance market has shown risk selection activities of the insurance funds, which call for risk adjustment. Because risk selection continues to be profitable under the current risk adjustment formula, fast growing HMO and PPO plans are (mis)used to attract good risks rather than to contain costs. For fear of being replaced by one centralised fund, social health insurers are themselves proposing improvements of the risk adjustment formula, to be applied to funds. The revised formula proposed in this paper, applicable among funds for risk adjustment and to gatekeeping models to calculate fair capitation, explains 12.4% of the variance of health care expenditure, halves profits from risk selection, and uses only the (few) data that are available in Switzerland. © Baltzer Science Publishers BV.

关键词：方差分析按人收费/发展趋势卫生经费支出/统计学和数值数据保险选择偏倚管理医疗规划/发展趋势卫生服务使用研究国家卫生规划/发展趋势政治转诊和会诊/组织和管理风险调节/发展趋势风险分担财政/发展趋势瑞士青少年成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Out of pocket expenditures by family caregivers of dementia patients residing in the community

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Home Health Care Services Quarterly 1992年第4期12卷 29-43页

作者： Collins, Clare Stommel, Manfred Clare Collins is affiliated with the College of Nursing Michigan State University MI 48824 United States College of Nursing Michigan State University Research Associate of the Sovial Science Research Bureau at Michigan State University MI 48824 United States

Out of pocket expenditures by families (N = 182) of relatives with dementia residing in the community were examined. Average expenditures for a three month period were $1,149. The relationship between illness variable... 详细信息

关键词：阿尔茨海默病/经济学医疗护理提供者/经济学社区卫生服务/经济学数据收集家庭筹资个人/统计学和数值数据卫生经费支出/统计学和数值数据家庭护理(非专业)/经济学密执安女(雌)性人类男(雄)性

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Academic internal medicine: Challenges and opportunities - Part I

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AMERICAN JOURNAL OF MEDICINE 2000年第6期108卷 525-529页

作者： Ibrahim, T

At the beginning of the 21st century, the US health-care system presents a challenging contradiction to politicians and policy makers, providers and patients. By most comparisons, the United States offers superior care, while leading the world in innovation, technology, and training. Paradoxically, the United States also has the most expensive, complex, and inadequate health-care system in the world.

关键词：费用控制卫生保健提供/组织和管理全体教工医学院校/组织和管理诈骗/预防和控制卫生经费支出/统计学和数值数据卫生经费支出/发展趋势医院教学/组织和管理内科学/教育内科学/组织和管理未参加医疗保险者/统计学和数值数据组织改革人员选用院校医学/组织和管理美国人类

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Reform follows failure: I. Unregulated private care in Lebanon

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HEALTH POLICY AND PLANNING 1997年第4期12卷 296-311页

作者： Van Lerberghe, W Ammar, W El Rashidi, R Sales, A Mechbal, A Inst Trop Med Dept Publ Hlth B-2000 Antwerp Belgium World Bank Washington DC 20433 USA WHO Beirut Lebanon

This first of two papers on the health sector in Lebanon describes how unregulated development of private care quickly led to a crisis situation. Following the civil war the health care sector in Lebanon is characterized by (i) ambulatory care provided by private practitioners working as individual entrepreneurs, and, to a small extent, by NGO health centres;and (ii) by a fast increase in hi-tech private hospitals. The latter is fuelled by unregulated purchase of hospital care by the Ministry of Health and public insurance schemes. Health expenditure and financing patterns are described. The position of the public sector in this context is analyzed. In Lebanon unregulated private care has resulted in major inefficiencies, distortion of the health care system, the creation of a culture that is oriented to secondary care and technology, and a non-sustainable cost explosion. Between 1991 and 1995 this led to a financing and organizational crisis that is the background for growing pressure for reform.

关键词：门诊医疗/组织和管理门诊医疗/统计学和数值数据发展中国家效率组织设施的规章和管理卫生保健改革卫生保健部门卫生经费支出/统计学和数值数据医院私立/组织和管理黎巴嫩未参加医疗保险者国家卫生规划私营部门公营部门战争

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