Civil Servants and Non-Western Migrants’ Perceptions on Pathways to Health Care in Serbia—A Grounded Theory, Multi-Perspective Study

(1) Background: Informal patient payments continue to persist in the Serbian health care system, exposing vulnerable groups to private spending on health care. Migrants may in particular be subject to such payments, as they often experience barriers in access to health care. Little is known about migrants paying informally to access health care in Serbia. The study aims to explore pathways of accessing health care, including the role of informal patient payments, from the perspectives of civil servants and non-western migrants in Serbia. (2) Methods: Respondents (n = 8 civil servants and n = 6 migrants) were recruited in Belgrade in 2018, where semi-structured interviews were conducted. The interviews were analysed applying the grounded theory methodological steps. (3) Results: Data reveal different pathways to navigate the Serbian health care system, and ultimately whether paying informally occurs. Migrants appear less prone to paying informally and receive the same or better-quality health care. Locals experience the need to pay informal patient payments, quasi-formal payments and to bring medicine, materials or equipment when in health facilities. (4) Conclusions: Paying informally or using private care in Serbia appear to have become common. Despite a comprehensive health insurance coverage, high levels of out-of-pocket payments show barriers in accessing health care. It is highly important to not confuse the cultural beliefs with forced spending on health care and such private spending should be reduced to not push people into poverty.

Confidence and the Propagation of Demand Shocks

We revisit the question of why shifts in aggregate demand drive business cycles. Our theory combines intertemporal substitution in production with rational confusion, or bounded rationality, in consumption and investment. The first element allows aggregate supply to respond to shifts in aggregate demand without nominal rigidity. The second introduces a “confidence multiplier,” that is, a positive feedback loop between real economic activity, consumer expectations of permanent income, and investor expectations of returns. This mechanism amplifies the business-cycle fluctuations triggered by demand shocks (but not necessarily those triggered by supply shocks); it helps investment to comove with consumption; and it allows front-loaded fiscal stimuli to crowd in private spending.

Assessing the Role of Sentiment in the Propagation of Fiscal Stimulus

This paper studies the dynamic effects of the fiscal policy shock on private activity using an array of vector autoregressive models for the post-war U.S. data. We are particularly interested in the role of consumer sentiment in the transmission of fiscal stimulus. Our major findings are as follows. Private spending fails to rise persistently in response to government spending shocks, while they exhibit persistent and significant increases when the sentiment shock occurs. Employing not only linear but also nonlinear state-dependent VAR model estimations, we show that the government spending shock generates consumer pessimism in all phases of business cycle resulting in subsequent decreases in private activity, which ultimately weakens the effectiveness of the fiscal policy. Our counterfactual simulation exercises confirm the important role of sentiment in propagating fiscal stimulus to private spending.

Healthcare in Saudi Arabia

Saudi Arabia is a large state located on the Arabian Peninsula; this country is considered the birthplace of Islam. The population of Saudi Arabia is approaching 35 million. About 7% of GDP is allocated annually for the maintenance of the healthcare system, while about 1,500 US dollars is spent on medical care for each resident of the country (according to this indicator, the country ranks 41st in the world). The share of private spending on health care is 37.6%. The average life expectancy in Saudi Arabia was 74.4 years in 2019. According to Healthcare Index 2021, the assessment of the effectiveness of the healthcare system, Saudi Arabia was ranked 54th out of 93 countries, while gaining 60.7 points out of 100 possible. A feature of this country is the fact that it is here that the largest annual mass event in the world is held - the Hajj, or pilgrimage to Mecca, which puts a very serious burden on the healthcare system.

Toward Innovation-Driven Competitiveness Across African Countries: An Analysis of Efficiency of R&D Expenditures

The main goal of this paper is to determine whether R&D funds are used efficiently in African countries. The innovativeness of a country’s economy is nowadays one of the key factors stimulating the economic growth and competitiveness. Becoming more innovative is important in particular for developing countries, whose governments are developing national innovation strategies (NIS) and assuming a steady increase in research and development spending. Efficient innovation policies are creating conditions for enterprise development and the increase of competitiveness of the country. A calculation of R&D spending efficiency for selected African economies for the years 2009-2017 was carried out using Data Envelopment Analysis methodology, which allows the evaluation of input-output efficiency. Public and private spending on R&D as % of GDP was the selected inputs indicator. The model examines three output indicators: the number of patent applications (per million inhabitants), high-technology exports (% of export), and number of technical and scientific journal articles (per million inhabitants). Among the analyzed countries, those on the efficiency frontier regarding the use of CRS methodology are South Africa and Tunisia. According to VRS methodology, the most efficient nations are South Africa, Tunisia, and Madagascar. The performed analysis has not confirmed our hypothesis regarding the non-proportional relation between higher R&D spending and innovation outputs. Considering limited innovation capacities across African countries, it appears to be reasonable to increase R&D expenditures gradually to achieve better results on the path toward innovationdriven growth and development.

Investimento, internações e óbitos por câncer de boca na cidade de Feira de Santana, Bahia

INTRODUCTION: oral cancer is a chronic disease with a high social cost that requires specialized methods and expensive hospitalizations for its diagnosis and treatment. OBJECTIVE: to describe the financial investment, frequency and length of hospital stay and profile of deaths from oral cancer in the municipality of Feira de Santana, state of Bahia, in 2020. METHODS AND MATERIALS: a descriptive study that analyzed the data of the Hospital Information System of the Unified Health System (SIH / SUS) on public and private spending, hospitalizations and deaths due to cancer of the lip, mouth and pharynx in the municipality of Feira de Santana, Bahia, from January to October 2020. RESULTS: in the period analyzed, the municipality reported 206 admissions for oral cancer, with a total of 726 days of hospital stay, adding up to a total investment of R $ 421,019.42. The male gender (85.7%), the brown color (64.2%) and the age group of 30 to 59 years (57.1%) presented the highest frequency of deaths due to the disease. The death rate for the city was 5.6. CONCLUSION: the analysis of this study showed that, in the municipality of Feira de Santana, there was a higher frequency of deaths related to oral cancer in men, young adults and browns. Hospitalizations due to the disease added up to more than 700 days of stay in hospitals located in the municipality, which can contribute to increased hospital costs.

Abstract 14164: Trends in U.S. Spending on Diabetes Therapies by Insurance Payer From 2007 to 2017

Importance: Diabetes mellitus is an important cardiovascular risk factor, and diabetes therapies are among the most commonly prescribed medications in the U.S. While the introduction of new, high-cost therapies has increased costs, recent trends in national spending on diabetes medications by insurance payer have not been examined. Understanding the burden of costs amongst all payers may help inform strategies to optimize drug expenditures in the US. Objective: To produce nationally representative estimates of US spending on diabetes therapies from 2007 to 2017, stratified by insurance payers (Medicare, Medicaid, Private, VA, and TRICARE—a program for civilian health benefits for US Armed Forces). Trends in out-of-pocket costs were also examined. Design/Setting: Retrospective analysis of patient-level data from the Medical Expenditure Panel Survey, a nationally representative survey that is the most complete source of data on healthcare costs in the US, from 2007 to 2017. Participants: All patients receiving one or more classes of diabetes therapies. Outcomes: Inflation-adjusted total national expenditures on all diabetes therapies. Results: There were substantial increases in total expenditures on diabetes therapies for all payers during the study period, ranging from +165.6% for VA & TRICARE ($380.6 million to $1.0 billion) to +460.4% for Medicaid ($1.1 to $6.1 billion). Private insurers increased spending by +346.6% ($5.7 to $25.5 billion), and Medicare increased spending by +389.9% ($5.4 to $25.2 billion). Out-of-pocket spending increased more modestly (+15.7%, from $4.7 to $5.7 billion). Conclusions/Relevance: Spending on diabetes therapies increased dramatically between 2007-2017, with Medicare spending increasing by 389.9%. In contrast, increases in out-of-pocket costs have been more modest. Reasons for the rapid rate of rise in Medicare and private spending compared to out-of-pocket spending should be examined in future studies.

Marginal Income Tax Rates, Economic Growth, and Primary Fiscal Deficits

Economic theory suggests that variations in marginal tax rates are more important for consumption and investment decisions than the average rates commonly studied. This article analyzes the aggregate implications of the statutory tax code, using a new times series on annual marginal tax rates, which decomposes the federal income tax code into its “level” and “progressive” (or spread) components. Robust results from a vector autoregression model show that increasing the spread of the marginal income tax rates has a positive impact on private spending growth, leading to an indirect, negative impact on the primary deficit ratio. Contrary to the political narrative, our findings suggest that the general level of these tax rates does not significantly impact growth rates or the primary deficit ratio.