Future Health Spending Forecast in Leading Emerging BRICS Markets in 2030 - Health Policy Implications

Introduction: BRICS leading Emerging Markets are increasingly shaping the landscape of global health sector demand and supply for medical goods and services. BRICS’ share of global health spending and future projections will play a prominent role during upcoming 2020s. The purpose of current research was to examine decades long, underlying historical trends in BRICS’ nations health spending and explore these data as the grounds for reliable forecasting of their health expenditures up to 2030.Methods: BRICS’ health spending data spanning 1995 - 2017 were extracted from IHME’s Financing Global Health 2019 database. Total health expenditure, government, prepaid private and out-of-pocket spending per capita and GDP share of total health spending, were forecasted 2018 - 2030. The ARIMA (Autoregressive Integrated Moving Average) models were used to obtain future projection based on time series analysis.Results: Per capita health spending in 2030 is projected to be: Brazil: $1767 (95% PI: 1615, 1977) ; Russia: $1933 (95% PI: 1549, 2317); India: $468 (95% PI: 400.4, 535) ; China: $1707 (95% PI: 1079, 2334); South Africa $1379 (95% PI: 755, 2004). Health spending %GDP shares in 2030 are projected to be: Brazil: 8.4% (95% PI: 7.5, 9.4) ; Russia: 5.2% (95% PI: 4.5, 5.9) ; India: 3.5% (95% PI: 2.9%,4.1%) ; China: 5.9% (95% PI: 4.9, 7.0) ; South Africa: 10.4% (95% PI: 5.5, 15.3).Conclusions: All BRICS expose long term trend to increase their per capita spending in PPP (purchase power parity) terms. India and Russia are highly likely to maintain stable total health spending GDP% share until 2030. China, as the major driver of global economic growth will be capable of significantly expanding its investment into the health sector across an array of indicators. Brazil is the only large nation whose GDP% share of health expenditure is about to contract substantially during the third decade of the 21st century. The steepest curve of increase in per capita spending until 2030 seems to be attributable to India while Russia should achieve the highest values in absolute terms. Health policy implications of long term trends in health spending indicate the need for Health Technology Assessment dissemination among BRICS ministries of health and national health insurance funds. Matters of cost-effective allocation of limited resources shall remain the core challenge in 2030 as well.

Prevalence-adjusted trends in U.S. healthcare spending on upper gastrointestinal cancers, 1996 to 2016.

e16064 Background: Upper gastrointestinal cancers are rising in prevalence and associated with high healthcare costs. We estimated trends in the US healthcare spending in patients with esophageal and stomach cancer between 1996 and 2016. Methods: We used data on national healthcare spending developed by the Institute for Health Metrics and Evaluations Disease Expenditure Project. Corresponding prevalence of esophageal and stomach cancer was estimated from the Global Burden of Diseases Study. Prevalence-adjusted, temporal trends in the US healthcare spending in patients with upper gastrointestinal cancer, stratified by age and setting of care (ambulatory, inpatient, emergency department, pharmaceutical prescriptions, nursing care and government administration) were calculated using joinpoint regression, expressed as annual percent change (APC) with 95% confidence intervals. Results: Overall, annual US healthcare spending on esophageal cancer increased from $0.76 billion (95% CI 0.68-0.86) in 1996 to $1.06 billion (95% CI 0.88-1.29) in 2016, although after adjusting for increasing prevalence, there was a significant decrease in per capita spending of -0.4%/year (95% CI -0.7%, -0.1%). Annual US healthcare spending on stomach cancer increased from $1.23 billion (95% CI $1.14 billion - $1.34 billion) in 1996 to $1.49 billion (95% CI $1.20 billion - $2.03 billion) in 2016. Per capita spending increased by 1.8%/year (95% CI 1.4%, 2.1%) between 1996 and 2011, followed by a decrease in gastric cancer-related per capita spending after 2011 (APC -4.4%/year [95% CI -5.8%, -2.9%]). Inpatient care was the largest contributor to total cost of both cancers between 1996-2016: 61.9% for esophageal cancer and 73.1% in gastric cancer in 2016. The rising price and intensity of care (defined as the cost per encounter) was the largest driver of change from 1996-2016 for both cancers, accounting for $0.28 billion (95% CI 0.12-0.41) for esophageal cancer and $0.95 billion (95% CI 0.41-1.39) for stomach cancer. Conclusions: After adjusting for rising prevalence, US per capita healthcare spending on esophageal cancer has decreased significantly since 1996, while per capita spending on gastric cancer has remained stable. Inpatient care was the most significant contributor to costs for both cancers over the time period studied.

Treating Young and Old as Equals

This chapter brings the whole framework developed in previous chapters together: it summarizes its key components and examines potential conflicts between the principles. The chapter then goes back to the examples of inequalities between young and old with which this book began (unequal exposure to environmental risks, unequal benefit ratios, unequal per-capita spending, unequal respect, unequal political power, and unequal labor market vulnerabilities), and offers a final take on whether (or under which conditions) they are unjust. The chapter ends with an examination of the recommendations that can be derived from the framework for what counts as treating young adults, specifically, as equals.

Don’t You Want My Help? Volunteer Involvement and Management in Local Government

The global COVID-19 health pandemic has put extraordinary pressure on already fiscally strapped local governments. As local jurisdictions search for strategies to meet rising service expectations with declining resources, use of volunteers would seem to offer significant advantages. This study examines the involvement of volunteers to deliver services in all county governments in one U.S. state, as well as the factors that explain the extent of use of this service approach. Our analysis is based on information collected from a survey of county government officials working in 10 service domains, supplemented by demographic and other data drawn from a variety of sources. To arrive at valid estimates of volunteer involvement in the delivery of county services, we introduce a novel methodology that corrects our survey data for possible sample and response biases based on a calibration estimator using auxiliary information. The results of our inquiry reveal a higher use of volunteers to deliver services by county governments than suggested by the literature. The findings show, moreover, that counties with higher per capita income, greater percentage of residents attaining a bachelor’s degree or higher formal education, and lower unemployment are likely to involve volunteers in the delivery of more services, as are those county governments with greater per capita spending and per capita property tax revenues. These results have important implications in regard to the capacity of local governments to use volunteers, which we treat in the Discussion.

Trends in Pediatric Private Insurance and Medicaid Spending: A Repeated Cross-Sectional Analysis of Data from 2002 to 2014

Given increased focus on health spending, this investigation aims to compare trends in pediatric Medicaid and private insurance spending on type of service from 2002 to 2014 in order to inform policy and research. A repeated cross-sectional analysis of 2002 to 2014 National Health Expenditure Accounts data was conducted. Total spending, per capita spending, and compounded annual growth rates for type of service were determined for children ages 0 to 18 at the national level. Per capita spending growth was higher for private insurance than for Medicaid, and the areas of high per capita spending growth differed for private insurance and Medicaid. While Medicaid spent more per capita on hospital care than private insurance, private insurance demonstrated greater per capita spending growth on hospital care than Medicaid (8.49% vs 1.99%, respectively). Conversely, per capita spending on home health care grew more for Medicaid (6.79%) than for private insurance (3.18%). Trends in private insurance and Medicaid overall and per capita spending differ. Medicaid experienced higher annual growth in total spending than per capita spending, while private insurance had greater annual growth in per capita spending than total spending. Growth in private insurance per capita spending was higher than growth in Medicaid per capita spending, but growth in Medicaid total spending was higher than growth in private insurance total spending. These data suggest that Medicaid and private insurance may have different drivers of spending growth, highlighting the need for policy makers to examine spending patterns by payer. Further research to determine why such differences in spending growth exist will better inform efforts to increase health care value.

Association of Medicare Advantage Penetration With Per Capita Spending, Emergency Department Visits, and Readmission Rates Among Fee-for-Service Medicare Beneficiaries With High Comorbidity Burden

Rapid growth of Medicare Advantage (MA) plans has the potential to change clinical practice for both MA and fee-for-service (FFS) beneficiaries, particularly for high-need, high-cost beneficiaries with multiple chronic conditions or a costly single condition. We assessed whether MA growth from 2010 to 2017 spilled over to county-level per capita spending, emergency department visits, and readmission rates among FFS beneficiaries, and how much this varied by the comorbidity burden of the beneficiary. We also examined whether the association between MA growth and per capita spending in FFS varied in beneficiaries with specific chronic conditions. MA growth was associated with decreased FFS spending and emergency department visits only among beneficiaries with six or more chronic conditions. MA growth was associated with decreased FFS spending among beneficiaries with 11 of the 20 chronic conditions. This suggests that MA growth may drive improvements in efficiency of health care delivery for high-need, high-cost beneficiaries.

Ambiguous no more: Time to de-mystify the Barnett Formula

This paper sets out to de-mystify the effects of the Barnett Formula – the mechanism which has delivered the bulk of the funding for Scottish domestic services over the past forty years. There has always been considerable ambiguity about the effects of the formula: with some holding that it is a mechanism which would eventually deliver converging levels of per capita spending in the different countries of the UK: while others held that it protected expenditure differentials. The paper explains why, partly because of the effects of relative population change, both views were correct at different times in the period up to 2015. In particular, at times of austerity, the formula operated to protect relative per capita spending levels in Scotland. Largely by accident, the Barnett Formula delivered some of the features expected in a properly functioning monetary union. After 2015, however, with the introduction of the post referendum fiscal settlement, the position is quite different. While Barnett still plays a part, the overall effect of the new funding system is to place Scotland in a vulnerable position, where it is at much greater risk of falling into a cycle of economic decline relative to the rest of the UK.

Financiación y modelo económico

Spain is a country made up with a multilevel structure of government. The Autonomous Communities are the institutions responsible for providing education services, health and social services. However, taxes collection is mainly done by the national administration. The current system of financing this multi-level government is not completely satisfactory. For instance, there are large disparities in per capita funding among the 17 regions. Some communities can fund basic services using just 55% of the resources that they are transferred, whereas others need to invest up to 80%. The case of the Valencian Region is the most dramatic, because, despite being in the queue of per capita spending on essential public services, it suffers a structural deficit by insufficient income. This article discusses the causes of this situation and outlines a fair reform of the current system, which also enables correct the anomaly that represents that the Valencian Region being the only region of Spain that having a per capita income below the average (12%) be a net contributor to the system

O papel da administração pública municipal no enfrentamento à Covid-19 no Brasil

Resumo O presente artigo trata acerca da distribuição desigual dos recursos no enfretamento à Covid-19 e interpreta o papel da administração pública municipal no combate à doença. Para isso, analisamos os dados disponibilizados pelo Instituto Brasileiro de Geografia e Estatística (IBGE) a respeito dos recursos básicos usados no combate à Covid-19, considerando as desigualdades regionais. Por conseguinte, aplicamos o método de Mínimos Quadrados Ordinários (MQO) para estimar a influência da despesa per capita e do investimento per capita com saúde no número de mortes causadas pela Covid-19. Adotamos como variável proxy para o investimento no sistema de saúde, as Transferências ao SUS para o bloco de investimentos. Em síntese, nosso estudo indica que municípios com maiores dispêndios em saúde em relação ao tamanho da população, tendem a apresentar menos mortes pela doença. Dessa forma, podemos dimensionar a influência dos recursos destinados à saúde no número de mortes causadas pela Covid-19. Concluímos que a situação crítica em que o país se encontra é, em parte, resultado da aplicação ineficiente dos recursos públicos Abstract This article deals with the unequal distribution of resources before Covid19 and interprets the role of the municipal public administration in combating the disease. For this, we analyzed the data provided by the Brazilian Institute of Geography and Statistics (IBGE) and respected the basic resources used to combat Covid-19, considering regional inequalities. Therefore, we apply the method of Ordinary least Squares (OLS) to estimate the influence of per capita spending and per capita investment in health on the number of deaths caused by Covid-19. We adopted as a proxy variable for investment in the health system, the Transfers to SUS for the investment block. In summary, our study indicates that municipalities with higher health expenditures in relation to the size of the population, tend to have fewer deaths from the disease. In this way, we can measure the influence of resources involved in health on the number of deaths caused by Covid-19. It concludes that a critical situation in the country it finds is, in part, the result of the inefficient use of public resources.