Health Economics Review最新文献

Background: Improving efficiency is one of the high-potential options for expanding fiscal space for health. During the pandemic, as health systems' financial challenges intensify, the importance of utilizing resources efficiently also increases. Therefore, this study was conducted to estimate the efficiency of Iran's public hospitals in treating COVID-19 inpatient cases.

Methods: This descriptive-analytical study was based on administrative claims data from the Iran Health Insurance Organization and included 439,327 COVID-19 inpatient cases across 493 public hospitals in 2021. Epidemic waves were first identified using time-series data on daily admissions, and each patient was assigned to the corresponding wave. A logistic regression model was then fitted to estimate the probability of death based on age, sex, ICU admission, and epidemic wave. From this, a risk-adjusted survival variable (RA_surv) was calculated at the individual level and subsequently aggregated at the hospital level. Hospital efficiency was assessed using input-oriented data envelopment analysis (DEA) under variable returns to scale, with total inpatient billed charges for COVID-19 as the input and RA_surv as the output. Finally, to account for structural and contextual differences, DEA efficiency scores were adjusted using a fractional logit regression model that incorporated teaching status, specialty type, hospital size, and province fixed effects.

Results: The mean of per-patient charge for COVID-19 treatment was estimated at USD 236.46 (SD = 234.48; median = 185.73), and the mean daily hospital charge was USD 46.34 (SD = 26.41; median = 41.62). These figures varied considerably across provinces, with the highest per-patient charge observed in Tehran (USD 364.98) and the lowest in South Khorasan (USD 171.37). Overall hospital efficiency scores before contextual factors adjustment ranged from 0.083 to 1.00. After adjustment, the national mean remained 0.49, although the distribution and ranking of hospitals shifted. A strong positive correlation was found between non-adjusted and adjusted efficiency scores (Spearman's rho = 0.707, p < 0.001).

Conclusion: This study indicated significant variation in hospital charges in COVID-19 inpatient bills in Iran's public hospitals, and there was a relatively significant potential to save resources during the financial difficulties of Iran's health system during the pandemic. Adopting appropriate strategies to reduce variation in clinical practice, for example, promoting the use of clinical guidelines, can significantly help reduce variation in hospital charges and subsequently improve the system's efficiency.

Purpose: Vaccine hesitancy among the population raises concern for health policymakers because it threatens the attainment of herd immunity, which is necessary to keep the society healthy and manage public health spending. However, a problem arises when there is hesitancy by economic agents and their dependents, even when the resource is freely available. This policy problem is analyzed in the context of Ghana's major urban area, Accra, where a cross-section of urban parents are surveyed regarding vaccine hesitancy and whether it extends to their children, with special reference to the COVID-19 vaccine.

Methodology: Data on preferences of residents regarding the choice for their dependents to receive the vaccine gathered in 2022. The data was obtained through a cross-sectional online survey of 2000 urban parents in Accra, Ghana. The paper estimates logit and probit regression models and their associated marginal effects to examine the willingness of respondents to allow their children to take the vaccine and the extent of influence of attitudinal and demographic characteristics of respondents.

Findings: The results first show that urban respondents who had tested for COVID-19, taken the vaccine and were willing to pay for the COVID-19 vaccine are more likely to allow their children to take the vaccine. More so, urban respondents concerned about age group vulnerability of their children, not suffering permanently health conditions, and being infected by others are also more likely to allow their children to take the COVID-19 vaccine.

Practical implications: Based on the findings, this paper recommends to policymakers to strengthen education efforts, with special encouragement for parents to get their children vaccinated. Vaccines are meant to provide immunity to the populace and its hesitancy among the population sets back the public health objective of achieving herd immunity and building a robust pharmaceutical industry while increasing the risk of poor public services and higher public health spending.

Originality/value: This paper offers a novel lens on the sustainability of public health expenditure by examining vaccine hesitancy during a pandemic that caught populations unprepared and distrustful. Using evidence from urban Ghana, it shows how reluctance to accept free vaccines reveals the hidden social costs and governance gaps in public health delivery-an overlooked dimension in discussions of health financing in developing countries.

Background: COVID - 19 has had a profound impact on the economy, health systems within countries, and individuals around the world. To provide insight that may enhance the preparedness for future pandemics, a comprehensive cost assessment is vital. This study aims to estimate the direct cost of illness (CoI), as well as the national burden of treating hospitalised COVID-19 patients.

Methods: This study is prevalence-based retrospective study containing all patients admitted to a single designated hospital in Kuwait for the treatment of COVID-19. Micro (bottom-up) and macro (top-down) costing methods were used to evaluate direct medical CoI from a hospital perspective. Cost components were grouped as consumables, equipment, and human resources, and sensitivity analysis was used to account for uncertainty of inputs. The cost per admission was reported in local currency and international dollars (PPP$).

Results: Data on 7569 patients was analysed, 52.8% of whom were male, 69.2% were above 41 years, 22% had previously vaccinated for COVID-19, 22% were admitted to the ICU, and 18% had ≥ 3 pre-existing comorbidities. The mean CoI per admission was 12,063 PPP$, with overheads accounting for 45% of this figure, while consumables, human resources, and equipment accounted for 30%, 19%, and 7%, respectively. The sensitivity analysis demonstrated that overall cost uncertainty was primarily driven by variations in human resource costs rather than by uncertainties related to personal protective equipment (PPE) or ventilator use.

Conclusion: The substantial economic impact of COVID-19 on Kuwait's healthcare system has emphasised the significant role human resource costs has on overall expenditure. These findings provide valuable insights for future pandemic preparedness.

Background: While out-of-pocket health expenses continue to rise, households' coping strategies remain largely unexplored. When individuals and families rely on unsustainable mechanisms such as borrowing, they may face heightened financial vulnerability, which can be particularly severe among certain socio-economic groups. This study examined the determinants of medical borrowing and the associated inequalities in Saudi Arabia.

Methods: Nationally representative data from the 2021 World Bank Global Financial Inclusion (Global Findex) database were analysed. Descriptive statistics summarized respondents' characteristics, and Chi-squared tests assessed bivariate associations between socio-economic factors and medical borrowing. Multivariate logistic regression models were then estimated to identify independent determinants of medical borrowing. Socioeconomic inequalities were further evaluated using concentration curves and concentration indices.

Results: Approximately 16.3% of the 1019 respondents from the KSA reported borrowing money for medical purposes within the preceding 12 months. Medical borrowing was less common among higher-income and more educated individuals [Model 3 odds ratio = 0.561; 95% confidence interval: 0.391-0.807; p < 0.01). Borrowing incidence was slightly lower for males than for females. Across all models, government employees showed consistently higher odds of borrowing for medical expenses. Inequality analysis showed a negative education-based concentration index (-0.117, p ˂ 0.01), indicating that medical borrowing was disproportionately concentrated among individuals with lower educational attainment.

Conclusion: Socio-economic inequalities in borrowing for medical purposes exist in Saudi Arabia, highlighting the need to curb distress financing, particularly among lower-income groups, less-educated individuals, and public sector employees. These findings underscore the importance of expanding equitable insurance coverage and reducing reliance on out-of-pocket spending. Strengthening public healthcare quality and aligning reforms with Vision 2030 goals will be critical to curbing medical indebtedness and enhancing financial protection for all in Saudi Arabia.

Background: Relatively little is known about subnational life expectancy disparities in low and middle-income countries (LMICs). We construct indicators of subnational disparities in life expectancy, offering critical insights into health inequalities within countries. Moreover, we investigate the factors that account for cross-country and over-time variations in subnational life expectancy in less developed countries.

Methods: We measure subnational disparities in life expectancy within a country by way of a population-weighted coefficient of variation indicator. Our sample covers 101 LMICs during the period 2000-2021 and we consider overall, male and female health disparities. We employ regression analysis to identify important drivers of subnational disparities in life expectancy and focus on the role of subnational disparities in income and education.

Results: The findings reveal that subnational disparities in life expectancy are markedly higher in Sub-Saharan Africa compared to other LMIC world regions. Moreover, while subnational disparities in life expectancy have decreased in most regions, Sub-Saharan Africa stands out as an exception, with persistently high disparities alongside rising average life expectancy. A gender-specific analysis highlights that, while women generally live longer than men, subnational disparities are greater for women. Regression analysis identifies a range of factors influencing life expectancy disparities. Variables such as good governance and public health spending help reduce subnational disparities, while decentralization, country size, geographic diversity and ethnic fractionalization tend to increase them. Subnational disparities in income and education emerge as the most significant drivers, with disparities in female education playing a particularly critical role.

Conclusions: Subnational life expectancy disparities in some LMICs, especially in Sub-Saharan Africa, are high and persistent. Reducing subnational disparities in female education emerges as a key strategy.

Background: Health expenditure is influenced by complex interactions between economic, demographic, social factors, with significant variations across countries. This study aims to investigate the determinants of health expenditures employing robust regression methods offering a more flexible and reliable approach to dealing with outliers and high data variation.

Methods: This study employs robust regression methods, Weighted Least Squares (WLS) and MM-estimator regression, to examine the determinants of health expenditures. The analyses were conducted using data from 179 countries for the year 2021 with the R Studio.

Results: The findings indicate that income and ageing are significant determinants of health expenditures, and sixteen outliers were identified. In contrast, education level, public health expenditure, disease patterns showed no significant effect.

Conclusion: This study fills gap in the literature by using robust regression methods to account for outliers and provides new insights into the role of economic and demographic factors in health expenditures.

Background: Diagnosis-related group (DRG) payment methods are increasingly being used to decrease the costs of healthcare worldwide. However, the effectiveness of cost controls varies from region to region. This study aimed to analyze the impacts of DRG payments on medical costs in China and provide theoretical support for the promotion of DRG payments in other countries.

Methods: Patients from City Wuxi in China was selected, which underwent a reform from fee-for-service (FFS) payment to DRG payment during the study period. Ordinary least regression analysis (OLS) and propensity-score-matching (PSM) were used to analyze the effects of DRG, Causal Forest (CF) of machine learning algorithm was used to analyze the underlying reasons for the results.

Results: The OLS model revealed that personal total medical costs decreased by 28.3% after the DRG reform and the total personal out-of-pocket payment (OPP) decreased by 21.3% after the DRG reform, but the personal out-of-pocket ratio increased by 15% after the DRG reform. The PSM-OLS model regression and the DRG reform results indicated decreases of 29.4% and 24.2% in personal total cost and OPP costs, respectively. The proportion of OPP costs increased by 9%. The causal forest model suggested that age and the number of surgeries played a significant role in the impact of DRG reform on patients' medical burden (total medical expenses, OPP costs, and OPP Ratio). Results indicate that the impacts of the DRG reform was associated with a 27% reduction in patients' medical burden (SE = 0.007), a 19.4% reduction in out-of-pocket expenses (SE = 0.012), and a 1.4% increase in utilization costs (SE = 0.002).

Conclusions: DRG payment can control the growth of medical expenses and ease the burden on the medical insurance fund. However, the current rules may increase the OPP ratio and the economic burden on patients. A regulatory model in line with China's national conditions still must be explored.