Healthcare financing in Egypt: a systematic literature review.

Background The Egyptian healthcare system has multiple stakeholders, including a wide range of public and private healthcare providers and several financing agents. This study sheds light on the healthcare system’s financing mechanisms and the flow of funds in Egypt. It also explores the expected challenges facing the system with the upcoming changes. Methods We conducted a systematic review of relevant papers through the PubMed and Scopus search engines, in addition to searching gray literature through the ISPOR presentations database and the Google search engine. Articles related to Egypt’s healthcare system financing from 2009 to 2019 were chosen for full-text review. Data were aggregated to estimate budgets and financing routes. Results We analyzed the data of 56 out of 454 identified records. Governmental health expenditure represented approximately one-third of the total health expenditure (THE). Total health expenditure as a percent of gross domestic product (GDP) was almost stagnant in the last 12 years, with a median of 5.5%. The primary healthcare financing source is out-of-pocket (OOP) expenditure, representing more than 60% of THE, followed by government spending through the Ministry of Finance, around 37% of THE. The pharmaceutical expenditure as a percent of THE ranged from 26.0 to 37.0%. Conclusions Although THE as an absolute number is increasing, total health expenditure as a percentage of GDP is declining. The Egyptian healthcare market is based mainly on OOP expenditures and the next period anticipates a shift toward more public spending after Universal Health Insurance gets implemented.

Determinants of China’s health expenditure growth: based on Baumol’s cost disease theory

Background During the past four decades, China’s total health expenditure and health expenditure per capita have both experienced a dramatic increase in growth rate. This study aims to explore the determinants of health expenditure growth and the influencing mechanism of these determinants, with considering the productivity efficiency represented by Baumol’s cost disease. Methods Based on the longitudinal data of 30 provincial-level administrative regions in China, from 2010 to 2017, multi-variates regression models were constructed to assess the determinants, including demography, income, Baumol’s cost disease, technology, their effects on per capital total health expenditure growth and the three financing sources: government, society and out-of-pocket health expenditure. Moreover, the Spatial Durbin Model was used to analyze the influence mechanism of determinants on the increase of health expenditure across provinces. Results Among 210 province-year growth rate observations, all of the average growth rate of total health expenditure (12.78%) was much higher than the growth rate of per capita GDP (8.06%). According to the statistical analysis, we found that:(1) Income and Baumol’s cost disease have a significant positive impact on health expenditure growth(P < 0.01). The impact of technical factors on government health expenditure is significantly positive. (2) The determinants affected the growth of health costs in different regions variably; the eastern region is mainly driven by Baumol’s cost disease and technical factors, while the central and western regions are mainly affected by income factors and Baumol’s cost disease. (3) There is a significant spatial spillover effect on the health expenditure growth between regions. The income factor and Baumol’s cost disease have a positive impact on the health expenditure growth in its own region as well as in other regions. Conclusions Income and Baumol’s cost disease significantly contributed to China health expenditure growth. The health expenditure determinants showed spatial varies effect and space spillover effect on the neighborhood areas. Which indicates that a reasonable salary system should be contrasted to meet the changeling from the Baumol’s cost disease, and the necessity of equity in health resource allocation among provinces in China.

Regular Home Health Care Visits Reduce Health Expenditure Among Home Care Patients: A Retrospective Cohort Study in a Community Hospital in Northern Taiwan

Background: In response to the rapidly aging population with anticipated growth of chronic disabling diseases, the National Health Insurance program in Taiwan has established home health care services since 1995. Medically and functionally compromised elders with multiple chronic conditions, tend to have increased need for home health care (HHC) and higher medical costs. Our study aimed to identify health expenditure and its influencing factors among home care patients and to clarify whether regular HHC visits reduce health expenditure.Methods: A retrospective observational cohort study on individuals receiving HHC was conducted at National Taiwan University Hospital Bei-Hu Branch from 2010 to 2015. Patients aged < 20 years, did not receive HHC for at least 6 months, or did not receive regular hospital care at our healthcare system were excluded. The patient characteristics, health service utilization, and health expenditure were collected. Total health expenditure was defined as the sum of outpatient clinic, emergency department and hospitalization cost. Considering the distribution of costs data was highly skewed, a generalized linear model was applied to estimate the impact patient factors on healthcare expenditure.Results: A total of 1,285 home care patients, mean age 79.4±12.9 years and males 50.9%, were enrolled. The majority (85%) of the study population were totally dependent in daily activities with Barthel index 0-20, and had Charlson comorbidity index score≥4. The median monthly total expenditure per person was US$737 (IQR, 229-1,935), which broke down to US$414 (IQR,56-1,234) for hospitalization, US$170 (IQR,73-369) for outpatient clinic, and US$60 (IQR, 9-150) for emergency department. Home care patients with higher need for nursing services utilization (p<0.05), indwelling tracheostomy tube (p<0.05), underlying neoplasm (p<0.05), or registry of catastrophic illness certificate (p<0.001), had higher health expenditure. On the other hand, regular HHC visits significantly lowered total health expenditure (p<0.001).Conclusions: Patient characteristics that incurred higher health expenditure were identified, whereas regular HHC visits have a potential role to reduce expenditure in the disabled homebound population. The visit number and frequency of HHC should be taken into account when making reimbursement policy in order to provide a sustainable and cost-effective HHC program.

Maternal mortality ratio in China from 1990 to 2019: trends, causes and correlations

Background Maternal mortality ratio is an important indicator to evaluate the health status in developing countries. Previous studies on maternal mortality ratio in China were limited to certain areas or short periods of time, and there was a lack of research on correlations with public health funding. This study aimed to assess the trends in the maternal mortality ratio, the causes of maternal death, and the correlations between maternal mortality ratio and total health financing composition in China from 1990 to 2019. Methods Data in this longitudinal study were collected from the China Health Statistics Yearbooks (1991–2020) and China Statistical Yearbook 2020. Linear regression analysis was used to assess the trends in the maternal mortality ratio in China. Pearson correlation analysis was used to assess the correlations between national maternal mortality ratio and total health financing composition. Results The yearly trends of the national, rural and urban maternal mortality ratio were − 2.290 (p < 0.01), − 3.167 (p < 0.01), and − 0.901 (p < 0.01), respectively. The gap in maternal mortality ratio between urban and rural areas has narrowed. Obstetric hemorrhage was the leading cause of maternal death. The mortalities ratios for the main causes of maternal death all decreased in China from 1990 to 2019. The hospital delivery rate in China increased, with almost all pregnant women giving birth in hospitals in 2019. Government health expenditure as a proportion of total health expenditure was negatively correlated with the maternal mortality ratio (r = − 0.667, p < 0.01), and out-of-pocket health expenditure as a proportion of total health expenditure was positively correlated with the maternal mortality ratio (r = 0.516, p < 0.01). Conclusion China has made remarkable progress in improving maternal survival, especially in rural areas. The maternal mortality ratio in China showed a downward trend over time. To further reduce the maternal mortality ratio, China should take effective measures to prevent obstetric hemorrhage, increase the quality of obstetric care, improve the efficiency and fairness of the government health funding, reduce income inequality, and strengthen the medical security system.

Living Longer with Disability: Economic Implications for Healthcare Sustainability

This work focuses on the economic implications of the relationship between life expectancy, the number of years lost to disability and per-capita total health expenditure. The primary goal of the paper is to identify and plot the correlation between healthcare expenditure and the global increase in life expectancy, in order to assess if, and how, the way longer average lifespans are achieved affects healthcare sustainability. Datasets regarding the United States, the European Union and the five largest emerging healthcare systems (i.e., Brazil, the Russian Federation, India, China and South Africa) were obtained from the Institute for Health Metrics and Evaluation and the WHO Health Expenditure Statistics Repository. All analysis was performed on 2017 data. The results of the analysis showed the number of years lost to disability to be a linear function of life expectancy at birth (male R2 = 0.61; female R2 = 0.47), and per-capita total health expenditure to be an exponential function of the number of years lost to disability (male R2 = 0.60; female R2 = 0.65). This implies that improving life expectancy via social policies bears negative consequences in terms of healthcare sustainability, unless the number of years lost to disability is reduced too. Further studies should narrow the sample of countries and causes of years lost due to disability, to better inform future policy efforts.

Determinants of China's Health Expenditure Growth: Based on Baumol’s Cost Disease Theory

Background During the past four decades, China's total health expenditure and health expenditure per capita have both experienced a dramatically increase in growth rate. It is essential to understand the driven force of this growth with the new economic context. This study aims to explore the determinants of health expenditure growth and the influencing mechanism of these determinants, with considering the productivity efficiency represented by Baumol's cost disease. Methods Based on the longitudinal data of 30 provincial-level administrative regions in China, from 2010 to 2017, multi-variates regression models were constructed to assess the determinants, including demography, income, Baumol's cost disease, technology, their effects on per capital total health expenditure growth and the three financing sources: government, society and out-of-pocket health expenditure. Moreover, the Spatial Durbin Model was used to analyze the influence mechanism of each factor on the increase of health expenditure across provinces.Results Among 210 province-year observations, all of the average growth rate of total health expenditure (12.78%) was much higher than the growth rate of per capita real GDP (8.06%). According to the statistical analysis, we found that:(1) Income and Baumol’s cost disease have significant positive impact on health expenditure growth(P<0.01). The impact of technical factors on government health expenditure is significantly positive. (2) The determinants affected the growth of health costs in different regions variably, the eastern region is mainly driven by Baumol's cost disease and technical factors, while the central and western regions are mainly affected by income factors and Baumol's cost disease. (3) There is a significant spatial spillover effect on the health expenditure growth between regions. The income factor and Baumol’s cost disease have a positive impact on the health expenditure growth in its own region as well as in other regions.Conclusions Income and Baumol's cost disease significantly contributed to China health expenditure increase growth. The health expenditure determinants showed spatial varies effect and space spillover effect on the neighborhood areas. Which indicates that a reasonable salary system should be contrasted to meet the changeling from the Baumol's cost disease, and the necessary of equity in health resource allocation among provinces in China.

Total Health Expenditure and Its Driving Factors in China: A Gray Theory Analysis

The continuous growth in total health expenditure (THE) has become a social issue of common concern in most countries. In China, the total health expenditure (THE) is maintaining a rapid growth trend that is higher than that of the economy, which has become increasingly obvious in the 21st century and has brought a heavy burden to the government and residents. To analyze the main driving factors of THE in China in the 21st century and establish a predictive model, gray system theory was employed to explore the correlation degree between THE and nine hot topics in the areas of the economy, population, health service utilization, and policy using national data from 2000 to 2018. Additionally, a New Structure of the Multivariate Gray Prediction Model of THE was established and compared with the traditional grey model and widely used BP neural network to evaluate the prediction effectiveness of the model. We concluded that the Chinese government and society have played a crucial role in reducing residents’ medical burden. Besides this, the improved economy and aging population have increased the demand for health services, leading to the continual increase in THE. Lastly, the improved NSGM(1,N) model achieved good prediction accuracy and has unique advantages in simulating and predicting THE, which can provide a basis for policy formulation.

Total Health Expenditure and Its Driving Factors in China: A Gray Theory Analysis

Background: The continuous growth in total health expenditure (THE) has become a social issue of common concern in most countries. In China, THE is maintaining a rapid growth trend that is faster than that of the economy, and this trend has become increasingly obvious in the 21st century and has placed a heavy burden on the government and residents. Therefore, the aims of this paper are to analyze the main driving factors and establish a predictive model of the growth of THE in China in the 21st century.Methods: Gray system theory was employed to explore the correlation degree between THE and 9 hot topics in the areas of the economy, population, health service utilization, and policy using national data for China from 2000 to 2018. Additionally, a New Structure of the Multivariate Gray (NSGM) prediction model of health expenditure was established and compared with the traditional grey model and widely used Back Propagation (BP) neural network.Results: General government expenditures on health, the economy, and out-of-pocket health expenditures were highly correlated with THE, with all correlation degrees greater than 0.8. The correlation degrees between health institutions, population and THE were 0.6-0.8, whereas infant mortality rate and THE was only 0.573. The average of the residual percentage of the training data of the NSGM(1,10) model is 0.36%, and that of the test data is 1.85%, which is better than the results of the other models.Conclusion: The Chinese government and society have played a crucial role in reducing residents’ medical burden, whereas the improved economy and aging population have increased the demand for health services, leading to the continual increase in THE. The improved NSGM(1,N) model achieved good prediction accuracy and has unique advantages in simulating and predicting THE, which can provide a basis for policy formulation.

The usage of enzyme replacement treatments, economic burden, and quality of life of patients with four lysosomal storage diseases in Shanghai, China

Background Lysosomal storage diseases (LSDs) are a group of rare diseases that caused progressive physical dysfunction and organ failure, which significantly affected patients’ quality of life. Enzyme replacement treatments (ERTs) are now acknowledged as the advanced therapies for LSDs while cost millions per patient per year. Previous studies seldom reported the usage of ERTs and disease burden of patients with LSDs in China. The objective of this study was to explore the characteristics and usage of ERTs of patients with the four different LSDs (Gaucher, Fabry, Pompe disease and Mucopolysaccharidosis) in Shanghai and then evaluate the economic burden and quality of life of these patients. Methods The study used data extracted from a large survey of living conditions of patients with rare diseases in Shanghai, which was conducted from April to August 2020. A total of 31patients, involving 5, 14, 4 and 8 patients with Gaucher, Fabry, Pompe disease and Mucopolysaccharidosis, respectively, was included in analysis. Descriptive statistics was used to describe the socio-demographic information (age, gender, education and etc.), economic burden caused by LSDs (direct medical and non-medical costs, and indirect cost in 2019), the treatment (usage of drugs) and the patients’ quality of life. Results Five Gaucher disease patients in Shanghai used Imiglucerase in 2019, while the other 26 patients with the other three LSDs didn’t receive ERTs. The total health expenditure of Gaucher disease patients was 2,273,000CNY on average mainly resulted by the high cost of Imiglucerase. The total health expenditure of the other 26 patients was 37,765CNY on average. The average total disease burdens of Gaucher disease patients and the patients with the other three LSDs were 164,301CNY and 58,352CNY, respectively. The mean EQ-VAS score of GD patients was 76.4 ± 15.5, which was higher than that of the other three LSDs. All the patients with LSDs in this study reported poor quality of life, which was significantly worse than the Chinese general population. Conclusion Few patients with LSDs in Shanghai could have access to available ERTs without a high reimbursement level. Though the cost-sharing mechanism of basic medical insurance, charity fund and patients had been explored for Gaucher disease in Shanghai, the Out-of-pocket part still laid a heavy economic burden on the patients and their families. The scope of drug reimbursement list and the reimbursement level should be further expanded and raised to help improve the quality of life of patients with LSDs.