A discussion of this argument is presented in Sundin, Jan, and Sam Willner. (2007) Social change and health in Sweden: 250 years of politics and practice. Swedish National Institute of Public Health.
For concrete instances see “Evolution of Health-Care Reforms“, CESifo DICE Report 2 (4), 2004, 74-77
See (a) Tanzi, Vito, and Ludger Schuknecht. Public spending in the 20th century: A global perspective. Cambridge University Press, 2000; and (b) Lindert, Peter H. “The rise of social spending, 1880-1930.” Explorations in Economic History 31, no. 1 (1994): 1-37.
Estimates from OECD – Health Expenditure and Financing Dataset; and Schoenman, Julie A. “The concentration of health care spending.” NIHCM Foundation Data Brief, National Institute of Health Care Management, Washington, DC (2012).
Estimates from WHO – Global Health Expenditure Database from the World Health Organization
Estimates from Institute for Health Metrics and Evaluation. Financing Global Health 2014: Shifts in Funding as the MDG Era Closes. Seattle, WA: IHME, 2015. Available online from www.healthdata.org
We present evidence of this result in the section about Correlates and Determinants. For a technical discussion see Chapter 1 in Culyer, A. J., & Newhouse, J. P. (Eds.). (2000). Handbook of health economics. Elsevier.
That healthcare should be considered a human right is nevertheless still subject of much debate. For an academic discussion of the principle of health care as a human right, see Smith, Richard, et al. “Shared ethical principles for everybody in health care: a working draft from the Tavistock Group.” British Medical Journal 318.7178 (1999): 248.
For instance, concrete cases of successful interventions aimed at curbing the spread of the plague are recorded in Marseille and Provence 1720–1722.
Sundin, Jan, and Sam Willner. (2007) Social change and health in Sweden: 250 years of politics and practice. Swedish National Institute of Public Health.
The National Health Service (NHS) was established in 1948 with the aim of providing health services to all UK citizens, financed by general taxation and free at the point of use.
Medicare Payment Assessment Commission. (2011) A Data Book: Health Care Spending and the Medicare Program.
Figure published in Schoenman, Julie A. “The concentration of health care spending.” NIHCM Foundation Data Brief, National Institute of Health Care Management, Washington, DC (2012). Original source data comes from the Medical Expenditure Panel Survey – a nationally representative longitudinal survey that collects information on healthcare utilization and expenditure, health insurance, and health status, as well sociodemographic and economic characteristics for civilian non-institutionalized population. According to the source, the data refers to ‘non-institutionalized civilian population’, in the sense that it excludes care provided to residents of institutions, such as long-term care facilities and penitentiaries, as well as care for military and other non-civilian members of the population. The data corresponds to ‘personal healthcare services’, in the sense that they exclude administrative costs, research, capital investments and many other public and private programs such as school health and worksite wellness.
The source given for the data corresponds to Figure 1 in ILO, (2011), Social Protection Floor for a Fair and Inclusive Globalization. Report of the Advisory Group chaired by Michelle Bachelet convened by the ILO with the collaboration of the WHO. Geneva: International Labour Office. Available online here.
For the list of countries considered as ‘developing’ in this visualization see the appendix A in IHME DAH Database 1990-2015 – User Guide
Institute for Health Metrics and Evaluation. Financing Global Health 2013:Transition in an Age of Austerity. Seattle, WA: IHME, 2014. Available online from www.healthdata.org
In middle-income countries, also receiving some of such development assistance funds, the weight is much lower – external funding accounts for less than 5% of spending in these countries.
Snapshot from IHME interactive visualization available at http://vizhub.healthdata.org/fgh
Institute for Health Metrics and Evaluation. Financing Global Health 2014: Shifts in Funding as the MDG Era Closes. Seattle, WA: IHME, 2015. Available online from www.healthdata.org
The official WHO definition of external funding is: “The sum of resources channeled towards health by all non-resident institutional units that enter into transaction with resident units, or have other economic links with resident units, explicitly labelled or not to health, to be used as a means of payments of health goods and services by financing agents in the government or private sectors. Includes donations and loans, in cash and in-kind resources.”
The source for this chart is WHO (2017) World Health Statistics: Monitoring Health for the SDGs. World Health Organization. Available online from the WHO’s Global Health Observatory.
Jamison, Dean T., et al. “Global health 2035: a world converging within a generation.” The Lancet 382.9908 (2013): 1898-1955
Jamison, Dean T., et al. “Global health 2035: a world converging within a generation.” The Lancet 382.9908 (2013): 1898-1955
See White, C. (2010). The health care reform legislation: an overview. The Economists’ Voice, 7(5) for a non-specialist overview of the ACA’s major provisions, their logic, and the federal budgetary implications.
Obama, B. (2016). United States health care reform: progress to date and next steps. JAMA.
Newhouse, J.P. (1977), “Medical care expenditure: a cross-national survey”, Journal of Human Resources 12:115–125.
Interestingly, there are important institutional variables that are also significantly correlated with healthcare expenditure after controlling for income. For example, the use of primary care “gatekeepers” seems to result in lower health expenditure. And lower levels of health expenditure also appear to occur in systems where the patient first pays the provider and then seeks reimbursement, compared to other systems. For more information see page 46 in Culyer, A. J., & Newhouse, J. P. (Eds.). (2000). Handbook of health economics. Elsevier.
Culyer, A. J., & Newhouse, J. P. (Eds.). (2000). Handbook of health economics. Elsevier.
Lu, C., Schneider, M. T., Gubbins, P., Leach-Kemon, K., Jamison, D., & Murray, C. J. (2010). Public financing of health in developing countries: a cross-national systematic analysis. The Lancet, 375(9723), 1375-1387.
Reeves, A., Gourtsoyannis, Y., Basu, S., McCoy, D., McKee, M., & Stuckler, D. (2015). Financing universal health coverage—effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries. The Lancet, 386(9990), 274-280.
One has to be cautious when interpreting these results causally. Bear in mind that the fixed-effect approach used by Reeves et al. (2015) does not solve problems associated with time varying unobservables, or potential simultaneity of variables in the model.
Whether healthcare spending is highly responsive to price changes in other contexts is still the subject of academic discussion. We reference here empirical evidence from developing countries, focusing on price changes in the form of user fees. Other studies focusing on other populations find different results. For an interesting (technical) discussion about estimates of price elasticity of healthcare in the U.S. see Kowalski, Amanda. “Censored quantile instrumental variable estimates of the price elasticity of expenditure on medical care.” Journal of Business & Economic Statistics 34.1 (2016): 107-117.
JPAL Bulleting 2011, “The Price is Wrong”, Poverty Action Lab.
Culyer, A. J., & Newhouse, J. P. (Eds.). (2000). Handbook of health economics. Elsevier.
Conditional Cash Transfers (CCTs) are increasingly common in the developing world. There is substantial evidence suggesting that CCTs have a significant impact on the intended outcomes, typically schooling, health, infant mortality, child labor, and poverty reduction. For an overview of CCTs and their impacts in Latin America – the region that pioneered large-scale CCTs – see Handa, S., & Davis, B. (2006). The experience of conditional cash transfers in Latin America and the Caribbean. Development policy review, 24(5), 513-536.
A recent report commissioned by The Lancet, using evidence similar to what we discuss here, concludes that “[a] unique characteristic of our generation is that collectively we have the financial and the ever-improving technical capacity to reduce infectious, child, and maternal mortality rates to low levels universally by 2035, to achieve a “grand convergence” in health. With enhanced investments to scale up health technologies and systems, these rates in most low-income and middle-income countries would fall to those presently seen in the best-performing middle-income countries.” (Jamison, Dean T., et al. “Global health 2035: a world converging within a generation.” The Lancet 382.9908 (2013): 1898-1955).
IHME collects budget, revenue, and expenditure data for 39 global health channels in order to estimate flows of development assistance for health. They use WHO estimates to then calculate how these flows compare to total expenditure in source and recipient countries.
Lu, C., Schneider, M. T., Gubbins, P., Leach-Kemon, K., Jamison, D., & Murray, C. J. (2010). Public financing of health in developing countries: a cross-national systematic analysis. The Lancet, 375(9723), 1375-1387.
See, for instance, the report Guidelines to improve estimates of expenditure on health administration and health insurance
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