Suchergebnisse

This study aims to determine and analyze the level of technical cost efficiency, technical systems and improvement strategies that need to be done for inefficient areas in 30 districts / cities in East Java Province. This study uses secondary data from 30 districts / cities in East Java Province. The variables used include APBD expenditure variables according to health function as input, variable total of puskesmas, posyandu, puskesmas medical personnel, and government hospitals as intermediate outputs, as well as life expectancy, Maternal Mortality Rate (MMR), Infant Mortality Rate (IMR), and Morbidity Rate variables as outcomes. The research method uses Data Envelopment Analysis (DEA) with the assumption of Variable Return to Scale (VRS) and input-oriented. The results obtained on average technical efficiency costs during 2012-2016 were only 26.67%, while for technical efficiency the system reached 53.34% which was already efficient so that there were indications of waste in the allocation of health spending and an improvement strategy based on potential improvement for the regions was needed. which is still inefficient so that the proportion of inputs and outputs can be efficient according to the needs in each of these regions.

During the 1990s, growth in health care costs slowed considerably, helping to lessen the spending strain on business, government, and households. Although cost growth has slowed, the Federal Government continues to pay an ever-increasing share of the total health care bill. This article reviews important health care spending trends, and for the first time, provides separate estimates of the employer and employee share of the premium costs for employer-sponsored private health insurance. This article also highlights some of the emerging trends in the employer-sponsored insurance market, including managed care, cost-sharing, and employment shifts.

Surprisingly little is known about long-term spending patterns in the under-65 population. Such information could inform efforts to improve coverage and control costs. Using the MarketScan claims database, we characterize the persistence of health care spending in the privately insured, under-65 population. Over a 6-year period, 69.8% of enrollees never had annual spending in the top 10% of the distribution and the bottom 50% of spenders accounted for less than 10% of spending. Those in the top 10% in 2003 were almost as likely (34.4%) to be in the top 10% five years later as one year later (43.4%). Many comorbid conditions retained much of their predictive power even 5 years later. The persistence at both ends of the spending distribution indicates the potential for adverse selection and cream skimming and supports the use of disease management, particularly for those with the conditions that remained strong predictors of high spending throughout the follow-up period.

Purpose
This paper aims to analyze the relationship between public health spending and health outcome using time series data in Nigeria over the period 1980 to 2017, taking into account the role of governance by assessing how the quality of governance directly affects health status and indirectly as a mediator for the effectiveness of public health spending.


Design/methodology/approach
Using the Hausman statistical tests to check for the existence of endogeneity, the proper method for estimating the model for this study is the two-stage least square regression model. The two-stage least squares regression model addresses the problem of endogeneity using instrumental variables. The mediating role of governance on the effectiveness of public health spending on health was considered by an interaction of governance indicators with public health spending.


Findings
The results showed that public health spending had no significant effect on health outcome except when interacted with governance quality. The interaction of government health spending with governance effectiveness as well as that for control of corruption improved health by inducing a fall in maternal deaths, whereas government health expenditure interacted with rule of law raised maternal mortality. Public health spending interacted with regulatory quality improved life expectancy while that for political stability with public health spending induced a fall in life expectancy, poor maternal and infant health. Political stability and the control of corruption had direct influence on maternal health.


Practical implications
Given the predominance of public health spending in promoting access to health care and population health status for developing economies, the effectiveness of such spending should be top priority in policy makers' agenda. This again is important because for developing economies, government revenue is generated from a small tax base due to their highly informal nature. To improve health status from public intervention in the health sector, there is indeed need for improvement in the overall state of governance in Nigeria.


Originality/value
This paper is one of the few country case studies which uses time series data to examine the role of governance on the efficacy of public health spending with extension of findings to maternal health and covering more measures of governance quality. The results fundamentally illuminate the importance of governance in fostering development in health and consequently enhancing economic development and growth.

Health policies seek to achieve conflicting objectives. We argue that the objective of saving lives is best served by a careful balancing of fairness and efficiency considerations. Open, fair, and equitable access to health care for all citizens will lower overall mortality rates by enabling the very poor and chronically ill to satisfy their demand for necessary health care. But it will also result in higher costs, not least by also increasing demand for irrelevant, unnecessary, and inefficient health care. This undesirable demand and its associated costs can be reduced by increasing out-of-pocket contributions paid for by patients. Such payments are unpopular, though, as they are regarded as regressive and damaging to health of the relatively poor. We argue that properly enacted, no such apparent trade-offs exist. If the freed-up resources are used for more life-saving measures, then higher out-of-pocket contributions will lower overall mortality rates. However, this beneficial effect is conditional on what happens to total health spending. Ironically, out-of-pocket payments are most effective as health policies if they are not or only hardly used as a means of reducing total health expenditures. Our theoretical arguments are confirmed by an econometric analysis of aggregate mortality rates in OECD countries over the period 1984 to 2007. Adapted from the source document.

Inequality in access and utilization of health services because of socioeconomic status is unfair, and it should be monitored and corrected with appropriate remedial action. Therefore, this study aimed to estimate the distribution of benefits from public spending on health care across socioeconomic groups in Ethiopia using a benefit incidence analysis. We employed health service utilization data from the Living Standard Measurement Survey, recurrent government expenditure data from the Ministry of Finance and health services delivery data from the Ministry of Health's Health Management Information System. We calculated unit subsidy as the ratio of recurrent government health expenditure on a particular service type to the corresponding number of health services visits. The concentration index (CI) was applied to measure inequality in health care utilization and the distribution of the subsidy across socioeconomic groups. We conducted a disaggregated analysis comparing health delivery levels and service types. Furthermore, we used decomposition analysis to measure the percentage contribution of various factors to the overall inequalities. We found that 61% of recurrent government spending on health goes to health centres (HCs), and 74% was spent on outpatient services. Besides, we found a slightly pro-poor public spending on health, with a CI of −0.039, yet the picture was more nuanced when disaggregated by health delivery levels and service types. The subsidy at the hospital level and for inpatient services benefited the wealthier quintiles most. However, at the HC level and for outpatient services, the subsidies were slightly pro-poor. Therefore, an effort is needed in making inpatient and hospital services more equitable by improving the health service utilization of those in the lower quintiles and those in rural areas. Besides, policymakers in Ethiopia should use this evidence to monitor inequity in government spending on health, thereby improving government resources allocation to target the disadvantaged ...