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This technical note analyzes the health care spending issues in advanced economies. Both public and total health spending have increased substantially in advanced countries. Total health spending increased by more than 6 percentage points of GDP in the Organization for Economic Cooperation and Development countries between 1970 and 2007. This note examines the recent trends in health care spending in advanced countries. It discusses the main challenges for advanced countries over the medium term. Policy options for containing health care costs are also described.

Insurance --- Public Finance --- Health Policy --- National Government Expenditures and Health --- Health: Government Policy --- Regulation --- Public Health --- Analysis of Health Care Markets --- Insurance Companies --- Actuarial Studies --- Health: General --- National Government Expenditures and Related Policies: General --- Public finance & taxation --- Health systems & services --- Insurance & actuarial studies --- Health economics --- Health care spending --- Health care --- Health --- Expenditure --- Financial institutions --- Expenditures, Public --- Medical care --- United States

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This paper exploits the staggered adoption of major concurrent health reforms in countries in Europe and Central Asia after 1990 to estimate their impact on public health expenditure, utilization, and avoidable deaths. While the health systems all derived from the same paradigm under central planning, they have since introduced changes to policies regarding cost-sharing, provider payment, financing, and the rationalization of hospital infrastructure. Social health insurance is predicted to increase this share, although the leads of both social health insurance and primary care fee-for-service suggest endogeneity may be an issue with the outpatient share regressions. Provider payment reforms produce the largest impact on spending, with fee-for-service increasing spending and patient-based payment reducing it. The impact on avoidable deaths is generally negligible, but there is some evidence of improvements due to fee-for-service. Considering the corresponding relative reduction in inpatient admissions and the incentives fee-for-service provides to deliver additional services, perhaps there is an overprovision of services in the primary care setting and an underutilization of more specialized hospital services.

Health care reform --- Health care reorm --- Health planning --- Medical policy --- Comprehensive health planning --- Health care planning --- Health services planning --- Medical care --- Medical care planning --- Public health --- Planning --- Health services administration --- Health reform --- Health system reform --- Healthcare reform --- Medical care reform --- Reform of health care delivery --- Reform of medical care delivery --- Health insurance --- Health care policy --- Health policy --- Medicine and state --- Policy, Medical --- Public health policy --- State and medicine --- Science and state --- Social policy --- Government policy --- Insurance --- Personal Finance -Taxation --- Public Finance --- National Government Expenditures and Health --- National Government Expenditures and Related Policies: General --- Personal Income and Other Nonbusiness Taxes and Subsidies --- Insurance Companies --- Actuarial Studies --- Health: General --- Public finance & taxation --- Insurance & actuarial studies --- Health economics --- Health care spending --- Expenditure --- Tax allowances --- Health --- Expenditures, Public --- Income tax --- Czech Republic

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This paper provides estimates of the changes in premiums, average or expected out of pocket payments, and the sum of premiums and out of pocket payments (total expected price) for a sample of consumers who bought individual insurance in 2010 to 2012, comparing total expected prices before the Affordable Care Act with estimates of total expected prices if they were to purchase silver or bronze coverage after reform, before the effects of any premium subsidies. We provide comparisons for purchasers of self only coverage in California and in 23 states with minimal prior state premium regulation before the ACA now using federally managed exchanges. Using data from the Current Population Survey, we find that the average prices increased by 14 to 28 percent, with similar changes in California and the federal exchange states; we attribute the increase primarily to higher premiums in exchanges associated with insurer expectations of a higher risk population being enrolled. The increase in total expected price is similar for age-gender population subgroups except for a larger than average increases for older women. A welfare calculation of the change in risk premium associated with moving from coverage that prevailed before reform to bronze or silver coverage finds small changes.

Zonder onderwerpscode: economie

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Government spending on health has grown as a percent of GDP over the last 40 years in industrialized countries. Widespread decentralization of healthcare systems has often accompanied this increase in spending. In this paper, we explore the effect of soft budget constraints on subnational health spending in a sample of OECD countries. We find countries where subnational governments rely primarily on central government financing and enjoy large borrowing autonomy have higher healthcare spending than those with more restrictions on subnational government borrowing.

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We examine whether the least educated population groups experienced the worst mortality trends during the 21st century by measuring changes in mortality across education quartiles. We document sharply differing gender patterns. Among women, mortality trends improved fairly monotonically with education. Conversely, male trends for the lowest three education quartiles were often similar. For both sexes, the gap in average mortality between the top 25 percent and the bottom 75 percent is growing. However, there are many groups for whom these average patterns are reversed - with better experiences for the less educated - or where the differences are statistically indistinguishable.