The Determinants of Public Health Expenditures: Comparing Canada and Spain

Di Matteo, Livio and Cantarero-Prieto, David (2018): The Determinants of Public Health Expenditures: Comparing Canada and Spain.

Abstract

The determinants of public health care expenditure are examined in two of the most decentralized countries in the world (Canada and Spain) for two partly overlapping time-spans of data availability: Canada, 1981 to 2013 and Spain, 2002 to 2013. While Canada generally spends more per capita on health care than Spain, over time Spain’s macro level health indicator performance has surpassed Canada’s. Using regression analysis, we find the key determinants of public health care spending include time trend, income, physician numbers and regional fixed effects. Physician numbers are a significant driver of real per capita public health expenditures in Canada but not Spain despite the greater per capita number of physicians in Spain. Differences in the growth and performance of real per capita income explain much of the gap between public health spending between these two countries with some contribution from differences in per capita physician numbers. The differential health indicator outcomes raise the question of what Canada might do to be more efficient.

• Item Type: MPRA Paper
• Language: English
• Keywords: H51, I1, I18, I3
• Subjects: H - Public Economics > H5 - National Government Expenditures and Related Policies > H51 - Government Expenditures and Health; I - Health, Education, and Welfare > I1 - Health > I11 - Analysis of Health Care Markets

References

References

[1] Di Matteo, L. and R. Di Matteo (1998) Evidence on the Determinants of Canadian Provincial Government Health Expenditures: 1965-1991,”Journal of Health Economics, 17 (2), 211-228.

[2] Di Matteo, L. (2010). The sustainability of public health expenditures: evidence from the Canadian federation. European Journal of Health Economics 11 (6): 569-584.

[3] Di Matteo, L. (2014) “Physician numbers as a driver of provincial government health spending in Canadian health policy,” Health Policy, 115, 18-35.

[4] Cantarero Prieto, D. and Lago Peñas, S. (2010) The determinants of health care expenditure in Spain: a reexamination. Applied Economics Letters, 17(7-9), 723-726.

[5] Regidor, E., Barrio, G., Bravo, M.J. & de la Fuente L. Has health in Spain been declining since the economic crisis? Journal of Epidemiology and Community Health 2014; 68(3): 280–2.

[6] González López-Valcárcel, B., & Barber, P. Economic Crisis, Austerity Policies, Health and Fairness: Lessons Learned in Spain. Applied Health Economics and Health Policy 2017; 15(1): 13-21.

[7] IMF World Economic Outlook Database, October 2017.

[8] OECD. OECD Health Statistics 2015, 2016 and 2017

[9] Canadian Institute for Health Information. National Health Expenditure Trends 2017, 1975 to 2017.

[10] Marchildon, G.P. and L. Di Matteo, eds. (2015). Bending the Cost Curve in Health Care: Canada’s Provinces in International Perspective, Toronto: University of Toronto Press.

[11] Blanco-Moreno Á, Urbanos-Garrido RM, Thuissard-Vasallo IJ. (2013), Public healthcare expenditure in Spain: measuring the impact of driving factors, Health Policy, Jun; 111(1), 34-42.

[12] González López-Valcárcel, B., & Barber, P. (2017). Economic Crisis, Austerity Policies, Health and Fairness: Lessons Learned in Spain. Applied Health Economics and Health Policy, 15(1), 13-21.

[13] Gerdtham, U.G. and B. Jonsson. 2000. “International Comparisons of Health Expenditure: Theory, Data and Econometric Analysis,” Handbook of Health Economics, Vol. 1, eds. A.J. Culyer & J.P. Newhouse. Elsevier Science.

[14] Gerdtham, U.G., J. Sogaard, F. Andersson and B. Jonsson. 1992. “An econometric analysis of health care expenditure: A cross-section study of the OECD countries,” Journal of Health Economics 11: 63-84.

[15] Gerdtham, U.G., B. Jonsson, M. MacFarlan and H. Oxley. 1998. “The Determinants of Health Expenditure in the OECD Countries: A Pooled Data Analysis,” P. Zweifel, ed. Health, The Medical Profession and Regulation. Developments in Health Economics and Public Policy 6: 113-134.

[16] Hitiris, T. and J. Posnett, (1992), The determinants and effects of health expenditure in developed countries, Journal of Health Economics, 11, 173-181.

[17] Barros, P.P. (1998). “The Black Box of Health Care Expenditure Determinants.” Health Economics 7: 553-544.

[18] Culyer, A.J., (1988), Health care expenditures in Canada: Myth and reality; Past and Future, Canadian Tax Paper No. 82 (Canadian Tax Foundation, Toronto.)

[19] Sen, A. (2005) Is Health Care a Luxury? New Evidence from OECD Data, International journal of Health Care Finance and Economics, June, 5, 2, 147-164.

[20] Getzen, T.E. (2000) Health care is an individual necessity and a national luxury: applying multilevel decision models to the analysis of health care expenditures, Journal of Health Economics, 19, 2, 259-270.

[21] Leu, Robert E., (1986), The public-private mix and international health care costs, in A.J. Culyer and B. Jonsson (eds.), Public and Private Health Services (Basil Blackwell, Oxford.).

[22] Parkin, D., A. McGuire and B. Yule (1987), Aggregate health care expenditures and national income: Is health care a luxury good, Journal of Health Economics, 6, 109-27.

[23] Brown, M.C.,(1987), Caring for profit: Economic dimensions of Canada’s health industry (Fraser Institute, Vancouver.).

[24] Gbesemete, K.P. and U-G. Gerdtham, (1992), Determinants of health care expenditure in Africa: A cross-sectional study, World Development, 20, 303-308.

[25] Hitiris, T. (1997) Health care expenditure and integration in the countries of the European Union, Applied Economics, 29, 1-6.

[26] Di Matteo, L. (2003) The income elasticity of health care spending: A comparison of parametric and nonparametric approaches, European Journal of Health Economics, 4, 20-29.

[27] Di Matteo, L. (2005) The macro determinants of health expenditure in the United States and Canada: assessing the impact of income, age distribution and time, Health Policy, 71, 23-42.

[28] Bilgel, F. and K.C. Tran (2013) The determinants of Canadian provincial health expenditures: evidence from a dynamic panel, Applied Economics, 45,2, 201-212.

[29] Lopez-Casasnovas, G., Saez, M. (2007). A multilevel analysis on the determinants of regional health care expenditure: a note, European Journal of Health Economics, 8(1), 59-65.

[30] Wang, Z. (2009) The determinants of health expenditures: evidence from US state-level data, Applied Economics, 41,4, https://doi.org/10.1080/00036840701704527.

[31] Hartwig, J. and J-E Sturm (2014) “Robust determinats of health care expenditure growth,” Applied Economics, 46, 36, 4455-4474.

[32] Ang, J.B. (2010) “The determinants of health care expenditure in Australia,” Applied Economics Letters, 17, 7, 639-644.

[33] Mills, T.C., (1994), Time series techniques for economists (Cambridge University Press, Cambridge.).

[34] Hendry DF. (1986) Econometric modelling with cointegrated variables: an overview. Oxford Bulletin of Economics and Statistics; 48: 201–27.

[35] Davidson, R. and J.G. Mackinnon (1993) Estimation and inference in econometrics (Oxford University Press, Oxford.).

[36] Muscatelli VA, Hurn S. (1992) Cointegration and dynamic time series models. Journal of Economic Surveys; 6: 1–43.

[37] Hansen, P. and A. King, (1996), The determinants of health care expenditure: A cointegration approach, Journal of Health Economics, 15, 127-137.

[38] Blomqvist, A.G. and R.A.L. Carter (1997) "Is health care really a luxury?" Journal of Health Economics, 16, 207-229.

[39] Roberts J. Spurious regression problems in the determinants of health care expenditures: comment on Hitiris. Applied Economics Letters 2000; 7: 279–83.

[40] McKoskey SK and Seldon TM. (1998) Health care expenditure and GDP: panel data unit root test results. Journal of Health Economics; 17: 369–76.

[41] Murthy, N.R. Vasudeva and V. Ukpolo, (1994), Aggregate health care expenditure in the United States: Evidence from cointegration tests, Applied Economics, 26, 797-802.

[42] Ariste, R. and J. Carr (2003) "New considerations on the Empirical Analysis of Health Expenditures in Canada: 1966-1998" Health Canada, Health Policy Research Working Paper Series, Working Paper 02-06.

[43] Murthy, N.R. Vasudeva and A.A. Okunade (2016) Determinants of U.S. health expenditure: Evidence from autoregressive distributed lag (ARDL) approach to cointegration, Economic modelling, 59, December, 67-73.

[44] Jewell, T., J. Lee, M. Tieslau and M.C. Strazicich (2003) Stationarity of health expenditures and GDP: evidence from panel unit root tests with heterogeneous structural breaks. Journal of Health Economics, 22, 313-323.

[45] Newhouse, J.P., (1977) Medical care expenditure: A cross-national survey, The Journal of Human Resources, 12, 115-125.

[46] Newhouse, J.P. (1987) Cross-national differences in health spending: what do they mean? Journal of Health Economics, 6, 159-162.

[47] Newhouse, J.P. (1992) Medical Care costs: How much welfare loss? Journal of Economic Perspectives, 6(3):3-21.

[48] Davidson W, Molloy W, Bédard M. (1995) Physician characteristics and prescribing for elderly people in New Brunswick: Relation to patient outcomes. Canadian Medical Association Journal; 152(8):1227-1234.

[49] Evans R.G, McGrail K.M, Morgan S.G, Barer M.L, Hertzman C. (2001) Apocalypse no. Population aging and the future of health care systems. Canadian Journal on Aging, 20(suppl 1):160– 91

[50] Robson W. (2001) Will the baby boomers bust the health budget? Demographic change and health care financing reform. Commentary 148. C.D. Howe Institute.

[51] Lubitz J, Riley G. (1993) Trends in medicare payments in the last year of life. New England Journal of Medicine;328:1092–6.

[52] Seshamani M,. Gray A.M. (2004) A longitudinal study of the effects of age and time to death on hospital costs. Journal of Health Economics, 23:217–35. [53] Reinhardt, U.E. (2003) Does the Aging of the Population Really Drive the Demand for Health Care? Health Affairs, 22, 6, 27-39.

[54] Morgan, S. and C. Cunningham (2011) Population Aging and the Determinants of Healthcare Expenditures: The Case of Hospital, Medical and Pharmaceutical Care in British Columbia, 1996 to 2006, Healthcare Policy, 7,1,68-79.

[55] Brinda, E.M., P. Kowal, J. Attermann and U. Enemark (2015) Health service use, out-of-pocket payments and catastrophic health expenditure among older people in India: The WHO Study on Global Ageing and Adult health (SAGE), Journal of Epidemiol Community Health, 0, 1-6.

[56] Gopffarth, D., T. Kopetsch and H. Schmitz (2016) Determinants of Regional Variation in Health Expenditures in Germany, Health Economics, 25,7,July, 801-815.

[57] Pammolli, F., Riccaboni, M. and Magazzini, L. (2008) The sustainability of European health care systems: beyond income and aging, European Journal of Health Economics, 13, 623–34.

[58] Blazquez-Fernandez, C., Cantarero Prieto, D. and Perez, P. (2014). Disentangling the heterogeneous income elasticity and dynamics of health expenditure. Applied Economics, 46(16), 1839-1854.

[59] Kumar, S. (2013) “Systems GMM estimates of the health care spending and GDP relationship: a note, European Journal of Health Economics, 12, 503–6.

[60] Cantarero Prieto, D. and Lago Peñas, S. (2012). Decomposing the determinants of health care expenditure: the case of Spain. The European Journal of Health Economics, 13, 19-27.

[61] Di Matteo, L. and C. Busby (2016) Hold the Applause: Why Provincial Restraint on Healthcare Spending Might Not Last. CD Howe No. 455.

[62] Martin, J.J.M., M.P.L. del Amo Gonzalez, M.D.C. Garcia (2011) Review of the Literature on the determinants of healthcare expenditure,”Applied Economics, 2011, 43, 19-46.

[63] BBVA Foundation and Ivie (Instituto Valenciano de Investigaciones Económicas). Gasto sanitario público en España. 2013 and 2015. Database available on: http://www.fbbva.es

[64] Constant, A., S. Peterson, C.D. Mallory and J. Major. 2011. Research Synthesis on cost Drivers in the Health Sector and Proposed Policy Options. Ottawa, ON: Canadian Health Services Research Foundation, Reports on Cost Drivers and Health System Efficiency: Paper 1.

[65] Cutler, D.M., M. McClellan, J.P. Newhouse and D. Remler (1998) Are Medical Prices Declining? Evidence from Heart Attack Treatments, Quarterly Journal of Economics, 113(4), 991-1024.

[66] Shain, M. and M.I. Roemer (1959) Hospital Costs Relate to the Supply of Beds. Modern Hospital, 92:71.

[67] Roemer (1961) " Bed Supply and Hospital Utilization: A National Experiment," Hospitals, J.A.H.A., 35, 988-993.

[68] Evans, R.G. (1974) Supplier-Induced Demand: Some empirical Evidence and Implications, In The Economics of Health and Medical Care, ed., Mark Perlman, London: MacMillan and Co.

[69] Folland, S., A.C. Goodman and M. Stano (2010) The Economics of Health and Health Care, 6th Edition,(New Jersey: Princeton).

[70] Escarce, J.J. (1993) Would Eliminating Differences in Physician Practice Style Reduce Geographic Variation in Cataract Surgery Rates, Medical Care, 12, 1106-1118.

[71] Norregaard, J.C., P. Bernth-Peterson, J. Alonsi. E. Dunn, C. Black, T.F. Anderson, M. Espallargues, L. Belland, G.F. Anderson (1998) Variations in indications for cataract Surgery in the United States, Denmark, Canada and Spain: Results from the International Cataract Surgery Outcomes Study, British Journal of Ophthalmology, 1998, 82, 1107-1111.

[72] Delattre, E., Dormont, B. L. (2003). “Fixed fees and physician-induced demand: a panel data study on French physicians ” Health Economics 12(9): 741-754.

[73] Filippini, M. G. Masiero, K. Moschetti (2006) Socioeconomic determinants of regional differences in outpatient antibiotic consumption: Evidence from Switzerland, Health Policy, 78, 1, 77-92.

[74] Crivellei, L., M. Filippini and I. Mosca (2006) Federalism and regional health care expenditures: an empirical analysis for the Swiss cantons, Health Economics, 15, 5, 535-541.

[75] Contandriopoulos, D., and M. Perroux, (2013). Fee Increases and Target Income Hypothesis: Data from Quebec on Physicians’ Compensation and Service Volumes. Healthcare Policy, 9(2), 30–35.

[76] Kantarevic J., B. Kralj B., and D. Weinkauf (2008) “Income Effects and Physician Labour Supply: Evidence from the Threshold System in Ontario.” Canadian Journal of Economics 41(4): 1262–84.

[77] Thursby, J.G. (1987) OLS or GLS in the Presence of Specification Error, Journal of Econometrics, 35, 359-374.

[78] Breitung, J. and M.H. Pesaran (2005). Unit Roots and Cointegration in Panels,”CESIFO Working Paper No. 1565. October.

[79] Palangkaraya, A. and J. Yong . (2009). Population Ageing and its implications on aggregate health care demand: empirical evidence from 22 OECD countries, International Journal of Health Care Finance Economics, March.

[80] Bryant, J. and A. Teasdale, M. Tobias, J. Cheung and M. McHugh. (2004). Population Ageing and Government Health Expenditures in New Zealand, 1951-2051, New Zealand Treasury Working Paper, 04/14.

[81] Spillman, B. C., & Lubitz, J. (2000). The effect of longevity on spending for acute and long-term care. The New England Journal of Medicine, 342(19), 1409–1415.

[82] Béland,D., A. Lecours, G. Marchildon, H. Mou and M. R. Offert (2017) Fiscal Federalism and Equalization Policy in Canada:Political and Economic Dimensions. University of Toronto Press.