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Managed care, deficit financing, and aggregate health care expenditure in the United States: A cointegration analysis

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  • N.R. Murthy
  • Albert Okunade

Abstract

We applied a battery of cointegration tests comprising those of Johansen and Juselius [19], Phillips and Hansen [35], and Engle and Granger [6], to model aggregate health care expenditure using 1960–96 US data. The existence of a stable long-run economic relationship or cointegration is confirmed, in the United States, between aggregate health care expenditure and real GDP, population age distribution, managed care enrollment, number of practicing physicians, and government deficits. The evidence of cointegration among these variables, chosen on the theoretical basis of prior studies, implies that while they are individually non-stationary in levels, together they are highly correlated and move, in the long run to form an economic equilibrium relationship of US aggregate health care expenditure. More specifically, and for the first time in this line of inquiry, (i) managed care enrollment is found to be negatively associated with the level of health care spending, (ii) supply disinduced demand effects of physicians tend to moderate health expenditure, and (iii) government deficit financing is positively related to health care spending. The observed sign and magnitude of the income coefficient are consistent with health care being a luxury good. Copyright Kluwer Academic Publishers 2000

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  • N.R. Murthy & Albert Okunade, 2000. "Managed care, deficit financing, and aggregate health care expenditure in the United States: A cointegration analysis," Health Care Management Science, Springer, vol. 3(4), pages 279-285, September.
    • Handle: RePEc:kap:hcarem:v:3:y:2000:i:4:p:279-285
    DOI: 10.1023/A:1019066012984
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    Cited by:

    1. Murthy, Vasudeva N.R. & Okunade, Albert A., 2009. "The core determinants of health expenditure in the African context: Some econometric evidence for policy," Health Policy, Elsevier, vol. 91(1), pages 57-62, June.
    2. Xiaocang Xu & Haoran Yang & Chang Li, 2022. "Theoretical Model and Actual Characteristics of Air Pollution Affecting Health Cost: A Review," IJERPH, MDPI, vol. 19(6), pages 1-14, March.
    3. Samia Nasreen & Aviral Kumar Tiwari & Mehr‐un Nisa & Faryal Ishtiaq, 2024. "Evaluating the Role of GDP Per Capita, Air Pollution and Non‐Economic Factors in Determining Health Expenditure: Evidence from Asian Region Using Instrumental Variables Techniques," Economic Papers, The Economic Society of Australia, vol. 43(1), pages 63-90, March.
    4. Moheddine Younsi & Marwa Bechtini, 2024. "Financing Health Systems in Developing Countries: the Role of Government Spending and Taxation," Journal of the Knowledge Economy, Springer;Portland International Center for Management of Engineering and Technology (PICMET), vol. 15(3), pages 13182-13210, September.
    5. Joan Costa‐Font & Marin Gemmill & Gloria Rubert, 2011. "Biases in the healthcare luxury good hypothesis?: a meta‐regression analysis," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 174(1), pages 95-107, January.
    6. Abbas, Faisal & Hiemenz, Ulrich, 2011. "Determinants of Public Health expenditures in Pakistan," Discussion Papers 118422, University of Bonn, Center for Development Research (ZEF).
    7. Vasudeva N. R. Murthy & Natalya Ketenci, 2017. "Is technology still a major driver of health expenditure in the United States? Evidence from cointegration analysis with multiple structural breaks," International Journal of Health Economics and Management, Springer, vol. 17(1), pages 29-50, March.
    8. Fabio Pammolli & Massimo Riccaboni & Laura Magazzini, 2012. "The sustainability of European health care systems: beyond income and aging," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(5), pages 623-634, October.
    9. Nilgun Yavuz & Veli Yilanci & Zehra Ozturk, 2013. "Is health care a luxury or a necessity or both? Evidence from Turkey," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(1), pages 5-10, February.
    10. Shanshan Liu & Jiaoling Huang & Jincheng Fan & Hong Liang & Jiquan Lou & Yimin Zhang, 2019. "Fluctuating operation development index of community health service centres in the Pudong new area of Shanghai: A continuous investigation," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 679-693, January.
    11. Paresh Kumar Narayan & Seema Narayan, 2008. "The role of permanent and transitory shocks in explaining international health expenditures," Health Economics, John Wiley & Sons, Ltd., vol. 17(10), pages 1171-1186, October.
    12. Vasudeva Murthy, 2012. "A Time-Series Investigation of the U.S. Real Health Expenditure: Evidence from Nonlinear Unit Root Tests," International Advances in Economic Research, Springer;International Atlantic Economic Society, vol. 18(4), pages 429-438, November.
    13. Okunade, Albert A. & Murthy, Vasudeva N. R., 2002. "Technology as a 'major driver' of health care costs: a cointegration analysis of the Newhouse conjecture," Journal of Health Economics, Elsevier, vol. 21(1), pages 147-159, January.
    14. Faisal Abbas & Ulrich Hiemenz, 2013. "What determines public health expenditures in Pakistan? Role of income, urbanization and unemployment," Economic Change and Restructuring, Springer, vol. 46(4), pages 341-362, November.
    15. Di Matteo, Livio, 2005. "The macro determinants of health expenditure in the United States and Canada: assessing the impact of income, age distribution and time," Health Policy, Elsevier, vol. 71(1), pages 23-42, January.
    16. Kazeem Bello Ajide & Risikat Oladoyin Dauda & Olorunfemi Yasiru Alimi, 2023. "Electricity access, institutional infrastructure and health outcomes in Africa," Environment, Development and Sustainability: A Multidisciplinary Approach to the Theory and Practice of Sustainable Development, Springer, vol. 25(1), pages 198-227, January.
    17. Murthy, Vasudeva N.R. & Okunade, Albert A., 2016. "Determinants of U.S. health expenditure: Evidence from autoregressive distributed lag (ARDL) approach to cointegration," Economic Modelling, Elsevier, vol. 59(C), pages 67-73.
    18. Genevieve E O'Connor, 2016. "Investigating the significance of insurance and income on health service utilization across generational cohorts," Journal of Financial Services Marketing, Palgrave Macmillan, vol. 21(1), pages 19-33, March.
    19. Muhammad Arshad Khan & Muhammad Iftikhar Ul Husnain, 2019. "Is health care a luxury or necessity good? Evidence from Asian countries," International Journal of Health Economics and Management, Springer, vol. 19(2), pages 213-233, June.
    20. Olorunfemi Yasiru Alimi & Kazeem Bello Ajide, 2021. "The role of institutions in environment–health outcomes Nexus: empirical evidence from sub-Saharan Africa," Economic Change and Restructuring, Springer, vol. 54(4), pages 1205-1252, November.
    21. Narayan, Paresh Kumar & Narayan, Seema, 2008. "Does environmental quality influence health expenditures? Empirical evidence from a panel of selected OECD countries," Ecological Economics, Elsevier, vol. 65(2), pages 367-374, April.
    22. Olorunfemi Yasiru Alimi & Kazeem Bello Ajide & Wakeel Atanda Isola, 2020. "Environmental quality and health expenditure in ECOWAS," Environment, Development and Sustainability: A Multidisciplinary Approach to the Theory and Practice of Sustainable Development, Springer, vol. 22(6), pages 5105-5127, August.

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