Robust analysis of the determinants of healthcare expenditure growth: evidence from panel data for low-, middle- and high-income countries.

This paper examines the determinants of healthcare expenditure for low-, middle- and high-income countries, and it quantifies their influences in order to assess policies for achieving universal health coverage. We elaborate two models, a fixed-effect model and the dynamic panel model, to estimate the factors associated with the total health expenditure growth as well as its major components for 167 countries over the period of 1993-2013. The panel data on total health expenditure per capita and its components were taken from the World Development Indicators. Overall, our results showed that total health expenditure per capita is rising in all countries over time as a result of rising incomes. However, our estimates showed that the income elasticity of health expenditure ranged from 0.75 to 0.96 in the fixed-effect static panel model, while in the dynamic panel model, it was smaller and ranged from 0.16 to 0.47. Our empirical findings indicate that development assistance for health reduced government domestic spending on health but increased total government health spending. Our results also indicate that the trend in health expenditure growth is significantly depending with the country's economic development. In addition, out-of-pocket expenditure is powerfully influenced by a country's capacity to increase general government revenues and social insurance contributions. Knowledge of factors associated to health expenditure might help policy makers to make wise judgments, plan health reforms and allocate resources efficiently. Copyright © 2016 John Wiley & Sons, Ltd.

Health-Related Quality-of-Life Measures: Evidence from Tunisian Population Using the SF-12 Health Survey.

OBJECTIVE: To explore reporting differences related to sociodemographic characteristics affecting different health status indicators to assess their impact on the measurement of self-reported health status among the Tunisian population using the Tunisian version of the 12-item Short-Form Health Survey (SF-12). METHODS: Psychometric properties of the SF-12 were validated for a random sample of individuals (N = 3864) aged 18 years and older. The SF-12 summary scores were derived using the standard US algorithm. The principal-component analysis was used to confirm the hypothesized component structure of the SF-12 items. RESULTS: "Known-subgroup" comparisons showed that the SF-12 discriminated well between groups of respondents on the basis of sex, age, education, and socioeconomic status, providing evidence of construct validity. The results suggest the existence of reporting differences related to the sociodemographic characteristics affecting the health status indicators. For a given latent health status, women and oldest people are more likely to report physical activity limitations and chronic diseases. Mental health problems are overreported by divorced people and underreported by the oldest people. In addition, highly educated and socially advantaged people more often report social activities limitations due to the problems of physical and mental health. CONCLUSIONS: The findings showed that the Tunisian version of the SF-12 is a reliable and valid measure, and suggest its potential for measuring health-related quality of life in large-scale studies, specifically when overall physical and mental health are the outcomes of interest instead of the typical eight-scale profile.

Measuring health-related quality of life: psychometric evaluation of the Tunisian version of the SF-12 health survey.

BACKGROUND: The 12-item short-form health survey (SF-12) was developed as a shorter alternative to the SF-36 for use in large-scale studies as an applicable instrument for measuring health-related quality of life. The main purpose of this study was to evaluate the psychometric properties of the Tunisian version of the SF-12. METHODS: A stratified representative sample (N = 3,582) of the general Tunisian population aged 18 years and over was interviewed. SF-12 summary scores were derived using the standard US algorithm. Factor analysis was used to confirm the hypothesized component structure of the SF-12 items. Reliability was estimated using internal consistency, and construct validity was investigated with "known groups" validity testing and via convergent and divergent validity. RESULTS: SF-12 summary scores distinguished well, and in the expected manner, between groups of respondents on the basis of gender, age, education and socioeconomic status, thus providing evidence of construct validity. Mean scores in the total sample were 50.11 (SD 8.53) for the physical component summary (PCS) score and 47.96 (SD 9.82) for the mental component summary (MCS) score. The results showed satisfactory internal consistency and acceptable convergent validity for both summary scores. Cronbach's α coefficient for PCS-12 and MCS-12 was 0.73 and 0.72, respectively. Known groups comparison showed that the SF-12 discriminated well between groups of respondents on the basis of gender, age, education and socioeconomic status. In addition, no floor or ceiling effects at baseline were observed. The PCA confirmed the two-factor structure of the SF-12 items. Items belonging to the physical component correlated more strongly with the PCS-12 than those with the MCS-12. Similarly, items belonging to the mental component correlated more strongly with the MCS-12 than those with the PCS-12. CONCLUSION: The findings suggest that the SF-12 appears to be a valid and reliable measure that can be used for measuring of population health status. However, for optimal measurement, modifications to traditional scoring methods for the SF-12 should be considered.