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Health expenditure growth: Looking beyond the average through decomposition of the full distribution

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  • de Meijer, Claudine
  • O’Donnell, Owen
  • Koopmanschap, Marc
  • van Doorslaer, Eddy

Abstract

Explanations of growth in health expenditures have restricted attention to the mean. We explain change throughout the distribution of expenditures, providing insight into how expenditure growth and its explanation differ along the distribution. We analyse Dutch data on actual health expenditures linked to hospital discharge and mortality registers. Full distribution decomposition delivers findings that would be overlooked by examination of changes in the mean alone. The growth rate of hospital expenditures is greatest at the middle of the distribution and is driven mainly by changes in the distributions of determinants. Pharmaceutical expenditures increase most rapidly at the top of the distribution and are mainly attributable to structural changes, including technological progress, making treatment of the highest cost cases even more expensive. Changes in hospital practice styles make the largest contribution of all determinants to increased spending not only on hospital care but also on pharmaceuticals, suggesting important spill over effects.

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  • de Meijer, Claudine & O’Donnell, Owen & Koopmanschap, Marc & van Doorslaer, Eddy, 2013. "Health expenditure growth: Looking beyond the average through decomposition of the full distribution," Journal of Health Economics, Elsevier, vol. 32(1), pages 88-105.
    • Handle: RePEc:eee:jhecon:v:32:y:2013:i:1:p:88-105
    DOI: 10.1016/j.jhealeco.2012.10.009
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    11. Norton, E.C., 2016. "Health and Long-Term Care," Handbook of the Economics of Population Aging, in: Piggott, John & Woodland, Alan (ed.), Handbook of the Economics of Population Aging, edition 1, volume 1, chapter 0, pages 951-989, Elsevier.
    12. Jonas Krämer & Jonas Schreyögg, 2019. "Demand-side determinants of rising hospital admissions in Germany: the role of ageing," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(5), pages 715-728, July.
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    14. Kolodziej, Ingo W.K. & García-Gómez, Pilar, 2017. "The causal effects of retirement on mental health: Looking beyond the mean effects," Ruhr Economic Papers 668, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
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    17. Beata Gavurova & Samer Khouri & Viliam Kovac & Michaela Ferkova, 2020. "Exploration of Influence of Socioeconomic Determinants on Mortality in the European Union," IJERPH, MDPI, vol. 17(13), pages 1-21, June.
    18. Sungchul Park & Anirban Basu, 2018. "Alternative evaluation metrics for risk adjustment methods," Health Economics, John Wiley & Sons, Ltd., vol. 27(6), pages 984-1010, June.
    19. Nigel Rice & Maria Jose Aragon, 2018. "The determinants of health care expenditure growth," Working Papers 156cherp, Centre for Health Economics, University of York.
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    Keywords

    Health care expenditure; Decomposition; Ageing; Pharmaceuticals; The Netherlands;
    All these keywords.

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health

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