Healthcare Spending: The Role of Healthcare Institutions from an International Perspective
Keywords:healthcare systems, healthcare spending, healthcare expenditure, healthcare institutions, international comparison, regression analysis, private, public, health insurance
AbstractHealthcare systems differ greatly across the world, however, it appears that the extent of public insurance (publicly/government funded healthcare) is the only institutional characteristic that plays a significant role in accounting for the large disparities in total healthcare spending. Other factors, such as whether healthcare services are provided by the private or public sector, play much less of a role, highlighting the important distinction between how services are provided and how those services are funded. A regression analysis is conducted utilising an existing categorisation of the predominately high-income countries of the OECD in 2009. It is found that more public insurance and less private insurance is associated with significantly lower spending after controlling for differences in income through GDP and healthcare quality/outcomes through life expectancy. This result is robust to the inclusion of additional controls for lifestyle factors and the proportion of the population aged 65 and over, as well as the inclusion or exclusion of the US that could otherwise be seen as some kind of outlier. A typical country relying largely on private provision and insurance, such as the Netherlands, Germany or the US, could reduce total healthcare spending by around a third by moving to a system with extensive public insurance whilst retaining extensive private provision of services, a situation typical of some countries such as Austria, Greece and Japan.
Anderson, G. F., Hurst, J., Hussey, P. S., & Jee-Hughes, M. (2000). Health spending and outcomes: trends in OECD countries, 1960-1998. Health Affairs, 19(3), 150-157. doi:10.1377/hlthaff.19.3.150
Anderson, G. F., Reinhardt, U. E., Hussey, P. S., & Petrosyan, V. (2003). It’s the prices, stupid: why the United States is so different from other countries. Health Affairs, 22(3), 89-105. doi:10.1377/hlthaff.22.3.89
Basu, S., Andrews, J., Kishore, S., Panjabi, R., & Stuckler, D. (2012). Comparative performance of private and public healthcare systems in low-and middle-income countries: a systematic review. PLoS medicine, 9(6), e1001244. doi:10.1371/journal.pmed.1001244
Frank, R. G. (2001). Prescription drug prices: why do some pay more than others do? Health Affairs, 20(2), 115-128. doi:10.1377/hlthaff.20.2.115
Hashimoto, H., Ikegami, N., Shibuya, K., Izumida, N., Noguchi, H., Yasunaga, H., . . . Reich, M. R. (2011). Cost containment and quality of care in Japan: is there a trade-off? The Lancet, 378(9797), 1174-1182. doi:10.1016/S0140-6736(11)60987-2
Joumard, I., André, C., & Nicq, C. (2010). Health care systems: efficiency and institutions. OECD Economics Department Working Papers, No. 769. doi:10.1787/5kmfp51f5f9t-en
Motta, M. (2004). Competition Policy: Theory and Practice. Cambridge: Cambridge University Press.
Naderi, P. S., & Meier, B. D. (2010). Privatization within the Dutch context: A comparison of the health insurance systems of the Netherlands and the United States. Health, 14(6), 603-618. doi:10.1177/1363459309360790
OECD. (2014). OECD Health Statistics 2014 - Frequently Requested Data. Retrieved May 4, 2015, from OECD: http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequently-requested-data.htm
OECD. (n.d.). Health Expenditure - OECD. Retrieved May 3, 2015, from OECD: http://www.oecd.org/els/health-systems/health-expenditure.htm
OECD. (n.d.). OECD Statistics. Retrieved May 10, 2015, from OECD: http://stats.oecd.org/
Paris, V., Devaux, M., & Wei, L. (2010). Health systems institutional characteristics: a survey of 29 OECD Countries. OECD Health Working Papers. doi:10.1787/5kmfxfq9qbnr-en
Phelps, C. E. (2012). Health Economics (5th ed.). Pearson.
Reinhardt, U. E., Hussey, P. S., & Anderson, G. F. (2004). US health care spending in an international context. Health Affairs, 23(3), 10-25. doi:10.1377/hlthaff.23.3.10
Squires, D. A. (2012). Explaining high health care spending in the United States: an international comparison of supply, utilization, prices, and quality. Issue brief (Commonwealth Fund), 10, 1-14.
Stabile, M., Thomson, S., Allin, S., Boyle, S., Busse, R., Chevreul, K., . . . Mossialos, E. (2013). Health care cost containment strategies used in four other high-income countries hold lessons for the United States. Health Affairs, 32(4), 643-652. doi:10.1377/hlthaff.2012.1252