Fiscal Decentralization and Local Public Health Expenditure: Empirical Analysis Based on Different Caliber Indicators and Provincial Panel Data / 中国卫生经济

Objective:To conduct empirical analysis on the impact mechanism of local public health expenditure based on fiscal decentralization.Methods:Using panel data of China's 31 provinces from 2010 to 2015,through static panels,FGLS,GMM estimation methods,the influence of different fiscal decentralization indexes on local public health expenditure in China were analyzed.Results:Different fiscal decentralization indexes had different effects on public health expenditure.Local governments with bigger fiscal autonomous income fight might increase public health expenditure effectively.Conclusion:It needed to further differentiate fiscal powers of the central and local governments reasonably,clear responsibility boundary,build the central and local public health expenditure hard constraint mechanism and improve the enthusiasm of local governments to provide unproductive public products.

Análisis de Beneficio de Incidencia: Implante coclear infantil en el Hospital Barros Luco Trudeau período 2003 a 2011 / Benefit/Incidence Analysis: cochlear implants in children at Barros Luco Trudeau Hospital, period 2003-2011

Introducción: La hipoacusia sensorioneural infantil es una causa frecuente de discapacidad en la infancia. Si bien la intervención ha demostrado ser costo efectiva, un alto porcentaje no accede al implante coclear por problemas de cobertura de los servicios de salud. Objetivo: Conocer el uso y distribución del gasto público de salud en el programa piloto de implantes cocleares del Hospital Barros Luco Trudeau. Material y método: Se realizó un Análisis de Beneficio de Incidencia, que permite conocer la distribución y el uso del gasto público en salud entre los distintos grupos socioeconómicos. Resultados: Durante el período del estudio se realizaron 73 implantes cocleares en menores de 15 años, correspondiendo a 35 niñas y 38 hombres. El 56,1% de los menores con implante coclear se ubicaban en el primer quintil de ingresos, el 27,5% al segundo quintil, 15,1% en el tercer quintil, y un caso pertenecía al cuarto quintil, no registrándose ningún niño en el quinto quintil de ingresos según los datos de la encuesta CASEN 2009. Discusión: Al evaluar el programa se deduce que en este caso específico los recursos públicos se encuentran focalizados hacia la población con menores ingresos económicos y con menor acceso a los servicios sanitarios.

Introduction: Childhood sensorineural hearing loss is a common cause of disability in children, with harmful consequences for individuals, family and society if it is not detected and treated early in life. While the intervention has proven to be cost effective, a high percentage does not access the cochlear implant coverage because of problems of health care. Aim: To determine the use and distribution of public expenditure in health in the pilot program of cochlear implants of the Barros Luco Trudeau Hospital. Material and method: We conducted a Benefit/Incidence Analysis, that is a model that evaluate the distribution and use of public expenditure on health between different socioeconomic groups. Results: During the study period there were performed 73 cochlear implants in children under 15years, corresponding to 35 girls and 38 men. The 56.1% of children with cochlear implants belonged to the lowest income quintile, 27.5% to the second quintile, 15.1% belonged to the third quintile, and one case belonged to the fourth quintile. There were no child of the fifth quintile of income according to the data of the 2009 CASEN survey. Discussion: When evaluating the program, in this specific case we can establish that public resources are targeted to people with lower incomes and less access to health services.

Trends in Scale and Structure of Korea's Health Expenditure over Last Three Decades (1980-2009): Financing, Functions and Providers

This paper introduces statistics related to the size and composition of Korea's total health expenditure. The figures produced were tailored to the OECD's system of health accounts. Korea's total health expenditure in 2009 was estimated at 73.7 trillion won (US$ 57.7 billion). The annual per capita health expenditure was equivalent to US$ PPP 1,879. Korea's total health expenditure as a share of gross domestic product was 6.9% in 2009, far below the OECD average of 9.5%. Korea's public financing share of total health expenditure increased rapidly from less than 50% before 2000 to 58.2% in 2009. However, despite this growth, Korea's share remained the fourth lowest among OECD countries that had an average public share of 71.5%. Inpatient, outpatient, and pharmaceutical care accounted for 32.1%, 33.0%, and 23.7% of current health expenditure in 2009, respectively. A total of 41.1% of current health expenditure went to hospitals, 28.1% to providers of ambulatory healthcare (15.9% on doctor's clinics), and 17.9% to pharmacies. More investment in the translation of national health account data into policy-relevant information is suggested for future progress.

The Incidence of Thyroid Cancer Is Affected by the Characteristics of a Healthcare System

The aim of this study was to investigate the associations between the incidence of thyroid cancer and the characteristics of healthcare systems in OECD countries and to demonstrate that the increasing incidence of thyroid cancer is mainly due to overdiagnosis. We used a random effects panel model to regress the incidence of thyroid cancer on the characteristics of healthcare systems (i.e., share of public expenditure on health, mode of health financing, existence of referral system to secondary care, mode of payment to primary care physicians), controlling for macro context variables (i.e., GDP per capita, educational level) on a country level. Data were derived from 34 OECD countries for 2002 and 2008. The share of public expenditure on health was negatively associated with the incidence of thyroid cancer. However, it had no statistically significant effect on the mortality of thyroid cancer and on the incidence of stomach and lung cancer. In the case of colorectal cancer, it had a positive effect on the incidence rate. The upward trend of the incidence of thyroid cancer is closely related to the healthcare system that permits overdiagnosis. Increases in the proportion of public financing may help reduce the overdiagnosis of thyroid cancer.