Tobacco use in the European region.

This paper presents comparable tobacco use prevalence estimates for the WHO European region for two common definitions of tobacco use: current smoker (occasional and daily) and daily smoker. Data collections held in the WHO Global InfoBase (www.who.int/infobase) were used to examine patterns of tobacco use at the country level, in the region as a whole and for specific subregional groups. Data from 275 sources presenting tobacco use prevalence by age and sex and representing 46 out of 52 countries in the WHO European region met the inclusion criteria. Regression models were used to adjust country-reported prevalence to a standard set of definitions and age groups. Estimates were projected to a set of standard reporting years, 2002, 2005 and 2015. The prevalence of current smoking and daily smoking was 33.2 and 28.4%, respectively in 2002. Male smokers had overall higher prevalence of daily smoking, 37.7% and current smoking, 43.1% in 2002. The corresponding rates for female smokers were 19.3% for daily smokers and 23.4% for current smokers in 2002. The overall prevalence declines slightly by 2015 for male daily smokers to 33.5% but increases for female daily smokers to 20.1%. The increase in female smokers is most apparent in the eastern, southern and western parts of Europe.

Do drugs reduce utilisation of other healthcare resources?

BACKGROUND: Drug expenditures per capita have drastically increased over the last quarter century in Canada, with a share of overall healthcare costs rising from 8.8% in 1980 to 16.8% in 2002. Pressure to curb expenditure on drugs has increased accordingly, but containing drug expenditure might increase costs elsewhere in the healthcare sector. OBJECTIVE: To measure substitution patterns between drugs and other healthcare resources over the last 25 years and thus assess whether containing drug costs might result in higher expenditure elsewhere in the healthcare system. METHODS AND DATA: A production function approach was used, in which life expectancy was modelled as a function of per capita drugs and non-drug healthcare resources, among other factors. Estimates are used to calculate a marginal rate of substitution, or trade-off, between drugs and non-drug healthcare resources, for a given level of life expectancy in the population. The model is estimated from a societal perspective, with panel data techniques using Canadian provincial-level data on health expenditure and spending on physicians per capita for the period 1980-2002, as well as individual survey data on lifestyle habits such as cigarette consumption and body mass index. RESULT: Using life expectancy at birth for males as the production function, increasing drug spending by Can 1.00 dollars (constant 2003 values) was accompanied by a decrease of Can 1.48 dollars in non-drug, non-physician healthcare resources over the study period, without affecting life expectancy at birth. Results using life expectancy at birth for females as the production function showed a decrease of Can 1.05 dollars in non-drug, non-physician healthcare resources over the same period. CONCLUSION: Using life expectancy as a general health indicator, results suggest that increases in drug spending could be more than offset by decreases in other healthcare spending without affecting the health of the population. This suggests that better access to drugs may be an effective strategy to decrease overall healthcare costs. Freeing up healthcare dollars by reallocating spending towards drugs could provide opportunities for overall healthcare cost savings without negatively impacting the health of the population.

Public and private pharmaceutical spending as determinants of health outcomes in Canada.

Canadian per capita drug expenditures increased markedly in recent years and have become center stage in the debate on health care cost containment. To inform public policy, these costs must be compared with the benefits provided by these drugs. This paper measures the statistical relationship between drug spending in Canadian provinces and overall health outcomes. The analysis relies on more homogenous data and includes a more complete set of controls for confounding factors than previous studies. Results show a strong statistical relationship between drug spending and health outcomes, especially for infant mortality and life expectancy at 65. This relationship is almost always stronger for private drug spending than for public drug spending. The analysis further indicates that substantially better health outcomes are observed in provinces where higher drug spending occurs. Simulations show that if all provinces increased per capita drug spending to the levels observed in the two provinces with the highest spending level, an average of 584 fewer infant deaths per year and over 6 months of increased life expectancy at birth would result.