1HEALTHCARE SYSTEM EXPENDITURE Introduction Healthcare expenditure is referred to as the amount of money spent on the primary and predominant causes that can improve the quality of life by improving health1. The amount of the healthcare expenditure is one of the most important indicators of the overall development. All the developing countries need to make policies that can have a future impact on the health and the surrounding environment of the people2.Health is a resource for the sustainable development of a country and along with that it is also an important outcome for the sustainable development of the country. These goals cannot be achieved when there is high prevalence and risk of debilitating illness in any country and thus, in order to consider overall development of any country there has to be increase in the healthcare expenditure3. This essay is going to discuss about the rapid growth of healthcare expenditure due to aging of population, longer expectancy of life in an individual, unhealthy lifestyle of the individuals and also the epidemiology of the diseases. This essay is also going to discuss the impact of increasing risk of cardiovascular diseases among the people that demands proper care and risk management among the people. As there is increased development in the field of science and medicine that have increased the demand among the individuals about longer life expectancy and this expectancy causes increases healthcare expenditure4. 1Bedir, Serap. "Healthcare expenditure and economic growth in developing countries."Advances in Economics and Business4, no. 2 (2016): 76-86. 2Samadi, Alihussein, and Enayatollah Homaie Rad. "Determinants of Healthcare Expenditure in Economic Cooperation Organization (ECO) Countries: Evidence from Panel Cointegration Tests."International journal of health policy and management1, no. 1 (2013): 63. 3Sturm, Roland, Ruopeng An, Josiase Maroba, and Deepak Patel. "The effects of obesity, smoking, and excessive alcohol intake on healthcare expenditure in a comprehensive medical scheme."South African Medical Journal103, no. 11 (2013): 840-844. 4Geue, Claudia, Andrew Briggs, James Lewsey, and Paula Lorgelly. "Population ageing and healthcare expenditure projections: new evidence from a time to death approach."The European Journal of Health Economics15, no. 8 (2014): 885-896.
2HEALTHCARE SYSTEM EXPENDITURE Discussion The development goals for the new generation means that the developmental goals offer a way of measuring the overall progress across the economic, social, and environmental causes of sustainability. At the same time, better healthcare conditions is also a major determinant of development in many countries5.This has led to the overall increase in the healthcare expenditure and it is expected to increase in the coming years. As the healthcare expenditure is increasing when the individuals are at their last years of life it is expected to increase as a result of the changes in the demographic factors. All across the globe there has been comparison of the national healthcare data compiled by the World Health Organization (WHO) and the World Bank6. When the data has been analyzed it was seen that it consisted of national sources that spend on the health issues along with the expenditures made by normal individual.This data gives the information from the public, private and external sources that can have many implications for the health systems7. Drivers of healthcare expenditure Thereisincreasedprevalenceofchronicdiseasesthatincludescardiovascular diseases that is putting increased burden on the healthcare expenditure in many countries. Analysis was done to know the cost of illness that can have the potential in the healthcare expenditure and it was seen that the total cost of the healthcare expenditure was more than the 5Callander, Emily J., Lisa Corscadden, and Jean-Frederic Levesque. "Out-of-pocket healthcare expenditure and chronic disease–do Australians forgo care because of the cost?."Australian Journal of Primary Health23, no. 1 (2017): 15-22. 6Khan, Jahangir AM, Sayem Ahmed, and Timothy G. Evans. "Catastrophic healthcare expenditure and poverty related to out-of-pocket payments for healthcare in Bangladesh—an estimation of financial risk protection of universal health coverage."Health policy and planning32, no. 8 (2017): 1102-1110. 7Bernard, Didem Minbay, Patrik Johansson, and Zhengyi Fang. "Out-of-pocket healthcare expenditure burdens among nonelderly adults with hypertension."The American journal of managed care20, no. 5 (2014): 406-413.
3HEALTHCARE SYSTEM EXPENDITURE socio-economic statusof the individualswho were admitted for the treatmentof the cardiovascular diseases8.Cardiovascular diseases thus, provide an insight on the healthcare system expenditure from a financial perspective. The private health insurance has increased rapidly over the last decade and that is due to the faster spending in many services such as physician, dietician, clinical services and also the prescription drugs. Thus, the increase is due to the faster use of the drugs consistently by the patients who are suffering from the chronic diseases to treat their diseases9. CVD: Cause for expenditure CVD is a term that is used in Australia to describe various conditions that affect the blood vessels and heart diseases. Among all this, coronary heart diseases and stroke are the most serious and most common type of CVD10.The main causes that can lead to CVD is atherosclerosis that leads to deposition of fat, cholesterol and other substances that is built up in the inner lining of the arteries and this can cause plaque. There are a number of factors that can increase the risk of CVD that includes tobacco smoking, overweight, high blood pressure, high blood cholesterol level, obesity, inadequate physical activity along with poor nutrition and diabetes11. Decrease in mortality rate 8Rasu, Rafia S., Walter Agbor Bawa, Richard Suminski, Kathleen Snella, and Bradley Warady. "Health literacy impact on national healthcare utilization and expenditure."International journal of health policy and management4, no. 11 (2015): 747. 9Samadi, Alihussein, and Enayatollah Homaie Rad. "Determinants of Healthcare Expenditure in Economic Cooperation Organization (ECO) Countries: Evidence from Panel Cointegration Tests."International journal of health policy and management1, no. 1 (2013): 63. 10Bedir, Serap. "Healthcare expenditure and economic growth in developing countries."Advances in Economics and Business4, no. 2 (2016): 76-86. 11Geue, Claudia, Andrew Briggs, James Lewsey, and Paula Lorgelly. "Population ageing and healthcare expenditure projections: new evidence from a time to death approach."The European Journal of Health Economics15, no. 8 (2014): 885-896.
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4HEALTHCARE SYSTEM EXPENDITURE In Australia, there has been a decrease in the mortality rate of the individuals that have CVD. This can be due to the improved diagnosis and treatment facility that includes a marked increase in the use of statins, anti-thrombolytic facilities and anti-hypertensive medications. This is supported by the reduction in smoking and improvement in the rate of blood pressure12.As CVD is a common disease that is strongly related to the age of the individual thus, the decline or decrease in the mortality rate has resulted in the increase in the number of older people where the per person expenditure is the highest. This combination consisting of the older people along with improved CVD survival and increased expenditure has put a pressure on the overall expenditure of CVD13. CVD expenditure is represented by the age, sex and type of cardiovascular disease and the expenditure that is primarily based on the expenditure of the healthcare services used by an individual that includes he services that is availed by the patient at the time of hospital admission, out-of hospital expenses that covers medicines and other pharmaceutical expenses14. Characteristics of Participants With Dietary Data Number of Ideal Life's Simple 7 FactorsaPTrendb 0 to 1 N=1079 (17.2%) 2 N=1947 (31.1%) 3 N=1814 (29.0%) 4 N=1024 (16.4%) 5 to 7 N=398 (6.4%) Age, y (SE)71.8 (0.17)72.0 (0.13)72.6 (0.14)73.0 (0.20)72.6 (0.30)<0.001 12Lahiri, Bibudh, and Nitin Agarwal. "Predicting healthcare expenditure increase for an individual from medicare data." InProceedings of the ACM SIGKDD Workshop on Health Informatics. 2014. 13Watkins, David A., Zachary D. Olson, Stéphane Verguet, Rachel A. Nugent, and Dean T. Jamison. "Cardiovascular disease and impoverishment averted due to a salt reduction policy in South Africa: an extended cost-effectiveness analysis."Health policy and planning31, no. 1 (2015): 75-82. 14Tapia Granados, José A., and Edward L. Ionides. "Population health and the economy: Mortality and the Great Recession in Europe."Health economics26, no. 12 (2017): e219-e235.
5HEALTHCARE SYSTEM EXPENDITURE Characteristics of Participants With Dietary Data Number of Ideal Life's Simple 7 FactorsaPTrendb 0 to 1 N=1079 (17.2%) 2 N=1947 (31.1%) 3 N=1814 (29.0%) 4 N=1024 (16.4%) 5 to 7 N=398 (6.4%) Women64.2%57.8%52.3%51.9%47.7%<0.001 Black race44.9%36.2%29.2%20.9%12.8%<0.001 Annual income <$2000031.7%22.6%20.8%18.0%14.0%<0.001 Less than a high school education 21.2%15.2%10.6%8.9%5.3%<0.001 Unmarried50.7%44.4%42.7%38.4%39.3%<0.001 Table -1: Effect of various factors on health expenditure (Source:Aaron et al., 2017) Out- of-pocket expenditure There are certain expenditures that cannot be assigned to any particular disease that includes capital expenditure, over-the counter drugs, community healthcare service expenses, and non-admitted patient hospital services15. The conduction of various healthcare awareness programs, buying of health aids and appliances and the cost of ambulance also counts 15Bhatnagar, Prachi, Kremlin Wickramasinghe, Julianne Williams, Mike Rayner, and Nick Townsend. "The epidemiology of cardiovascular disease in the UK 2014."Heart101, no. 15 (2015): 1182-1189.
6HEALTHCARE SYSTEM EXPENDITURE towards the total healthcare expenditure. The expenditure that is based on the patients who are being admitted to the hospital is based on the various diagnosis and treatment process that isspecifictoeachindividual16.Theout-ofhospitalandprescriptionpharmaceutical expenditure includes a large number follow-up services that are required by a patient once he or she is discharged from the hospital. The cost of the drugs that are being used to treat the disease is also increasing that in ultimately having an impact on the overall cost for the treatment of the disease17. Research has shown that despite improvements in the healthcare services CVD still remains the leading cause of disability and death. Thus, most of the growth in the healthcare sector is linked to the increased expenditure done on the factors that are associated with the risk factors of CVD18. There are a number of factors that can be related to the increase in the health service utilization. These factors include primary care that consists of regular visits from the general physician along with the visit of the general practitioner to the patient’s house. The other factors are the out-patient care that involves consultation taking place in the outpatient wards or even in the patient’s home or clinic19. The patient who stay at the hospital the expenditure or cost is defined by the duration of their stay during the treatment of the disease. The patients thus have to pay a lot of money at the time of their admission to the 16Schofield, Deborah, Rupendra Shrestha, Richard Percival, Megan Passey, Emily Callander, and Simon Kelly. "The personal and national costs of CVD: impacts on income, taxes, government support payments and GDP due to lost labour force participation."International journal of cardiology166, no. 1 (2013): 68-71. 17de Meijer, Claudine, Owen O’Donnell, Marc Koopmanschap, and Eddy Van Doorslaer. "Health expenditure growth: looking beyond the average through decomposition of the full distribution."Journal of Health Economics32, no. 1 (2013): 88-105. 18Muka, Taulant, David Imo, Loes Jaspers, Veronica Colpani, Layal Chaker, Sven J. van der Lee, Shanthi Mendis et al. "The global impact of non-communicable diseases on healthcare spending and national income: a systematic review."European Journal of Epidemiology30, no. 4 (2015): 251-277. 19Waters, Anne‐Marie, Lany Trinh, Theresa Chau, Michael Bourchier, and Lynelle Moon. "Latest statistics on cardiovascular disease in A ustralia."Clinical and Experimental Pharmacology and Physiology40, no. 6 (2013): 347-356.
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7HEALTHCARE SYSTEM EXPENDITURE hospital and also during the time of discharge and thus it is having an impact on the healthcare system20. Research has shown that there has been considerable increase in the expenditure of medicine as there is increasing demand in the number of medicines and the supply by the pharmaceutical companies is not that much. This gap has created a scope for the increase in thecostofthemedicinesandthathasimpactedtheoverallriseinthehealthcare expenditure21. The healthcare expenditure is also related to the cost of informal care, patient travel cost, and out-of pocket expenses that include child care, over-the counter medicines and home aids that also involves nursing, residential care and the primary or community healthcare services22. Age,sexandethnicityshouldnothaveanyimpactontheprevalenceof cardiovascular diseases, however each of these factors put an impact on the individual and becomes a determining factor the occurrence of CVD. Cardiovascular diseases put a heavy toll on the health of all the people who are suffering from the disease as well as on the economic status as it is considered to be one of the most costly disease and it will cause the increase in the cost of healthcare services in the coming decades23. This can be said by looking at the statistical data as the Australian Government invests nearly about$8.8bn every year for the direct healthcare expenses. It is thus, the most costly disease to treat which 20Khan, Jahangir AM, Sayem Ahmed, and Timothy G. Evans. "Catastrophic healthcare expenditure and poverty related to out-of-pocket payments for healthcare in Bangladesh—an estimation of financial risk protection of universal health coverage."Health policy and planning32, no. 8 (2017): 1102-1110. 21Rasu, Rafia S., Walter Agbor Bawa, Richard Suminski, Kathleen Snella, and Bradley Warady. "Health literacy impact on national healthcare utilization and expenditure."International journal of health policy and management4, no. 11 (2015): 747. 22Callander, Emily J., Lisa Corscadden, and Jean-Frederic Levesque. "Out-of-pocket healthcare expenditure and chronic disease–do Australians forgo care because of the cost?."Australian Journal of Primary Health23, no. 1 (2017): 15-22. 23Bernard, Didem Minbay, Patrik Johansson, and Zhengyi Fang. "Out-of-pocket healthcare expenditure burdens among nonelderly adults with hypertension."The American journal of managed care20, no. 5 (2014): 406-413.
8HEALTHCARE SYSTEM EXPENDITURE accounts for nearly 11.1% of the total spending on the patients who are admitted to the hospital24. As the per capita income of the individual is increasing thus it allows for the overall increase in the healthcare expenditure. This causes a natural and income related gradual increase in the expansion of the healthcare expenditure. Fig-1: Out-of-pocket expenses (Source:Carter, Schofield & Shrestha, 2019) CVD is thus, one of the major driver for the healthcare expenditure growth as the Government has introduced a number of plans and policies that can help the people to reduce the risk of the heart diseases. These plans and polices are being implemented by the Government, however they are not cost-effective that can increase the overall cost of treatment leading to overall hike in the healthcare expenses25. These plans and policies generate revenue for the Government that could be nearly about$3.3bn a year that will in 24Geue, Claudia, Andrew Briggs, James Lewsey, and Paula Lorgelly. "Population ageing and healthcare expenditure projections: new evidence from a time to death approach."The European Journal of Health Economics15, no. 8 (2014): 885-896.
9HEALTHCARE SYSTEM EXPENDITURE turn help the Government to increase the investment in the healthcare services. So in turn of increasing the revenue the overall healthcare expenditure is increasing and that is having an impact on the people irrespective of their economic status26. Cardiovascular Diseases As cardiovascular diseases is the major contributor to the global mortality it can lead to loss in the amount of productivity that is often associated with the economic and policy implications.Thus, it one of the finest example to explain the fact that the countries are spending a lot of money on the overall development of the health care services but still people have to pay a lot of money from their own pockets. The rate of spending money on the health of the citizen’s account for 10% of the global gross domestic product or the GDP27. Report from the WHO has revealed that there is an increase in the global health expenditure which is noticeable in the middle and low income countries where the spending on the health expenses is about the 6% per year whereas in counties with high average income it is only 4%. As it is known that health spending is consisted of government expenditure and other sources such as voluntary health insurance, activities performed by the non-governmental organizations (NGO) and the employer-provided health programs28. 25Muka, Taulant, David Imo, Loes Jaspers, Veronica Colpani, Layal Chaker, Sven J. van der Lee, Shanthi Mendis et al. "The global impact of non-communicable diseases on healthcare spending and national income: a systematic review."European Journal of Epidemiology30, no. 4 (2015): 251-277. 26Muka, Taulant, David Imo, Loes Jaspers, Veronica Colpani, Layal Chaker, Sven J. van der Lee, Shanthi Mendis et al. "The global impact of non-communicable diseases on healthcare spending and national income: a systematic review."European Journal of Epidemiology30, no. 4 (2015): 251-277. 27Lippi, Giuseppe, and Mario Plebani. "Statins for primary prevention of cardiovascular disease."Trends in pharmacological sciences38, no. 2 (2017): 111-112. 28Waters, Anne‐Marie, Lany Trinh, Theresa Chau, Michael Bourchier, and Lynelle Moon. "Latest statistics on cardiovascular disease in A ustralia."Clinical and Experimental Pharmacology and Physiology40, no. 6 (2013): 347-356.
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10HEALTHCARE SYSTEM EXPENDITURE Cardiovascular diseases increase the rate of morbidity among the patients and that is accelerated by the age of patients as the older patients are also at higher risk for the disease. As there is improvement in the healthcare facilities thus, it can also lead to the higher demand among the people regarding the life expectancy and also for the increased demand for the better quality of life29.Along with this there is increased growth in the prices of the physician and the clinical services that can cause the rise in the wage of the services provided by the various healthcare personnel. Thus, the relation of the mortality rate with the CVD is also related to the economic productivity of the country as it demands a lot of potential investments that is required for the proper preventive step that can reduce the associated risk of CVD30. Government provides an average of about 51% of a country’s health spending while more than 35% of the health expenses are due to the out-of pocket expenditure. This creates an imbalance among the people who can afford the various healthcare facilities and those who cannot afford the facilities due to the difference in the economic status31. Thus, in order to provide affordable healthcare services to all the people there is continuous rise in the healthcare expenditure. The increase in the rate of chronic illness is definitely a driving factor thatcancausetheriseinhealthcareexpenditure.Theoutpatientcausesincludethe 29de Meijer, Claudine, Owen O’Donnell, Marc Koopmanschap, and Eddy Van Doorslaer. "Health expenditure growth: looking beyond the average through decomposition of the full distribution."Journal of Health Economics32, no. 1 (2013): 88-105. 30Schofield, Deborah, Rupendra Shrestha, Richard Percival, Megan Passey, Emily Callander, and Simon Kelly. "The personal and national costs of CVD: impacts on income, taxes, government support payments and GDP due to lost labour force participation."International journal of cardiology166, no. 1 (2013): 68-71. 31Prince, Martin J., Fan Wu, Yanfei Guo, Luis M. Gutierrez Robledo, Martin O'Donnell, Richard Sullivan, and Salim Yusuf. "The burden of disease in older people and implications for health policy and practice."The Lancet385, no. 9967 (2015): 549-562.
11HEALTHCARE SYSTEM EXPENDITURE ambulatory care that also drives the increase in the overall healthcare expenditure32. This is also related to the physician and clinical services that are used by the patients to improve the condition of the patient and also to increase the quality of services that is being provided by them. Thus, in order to improve the quality of services it is important to increase the amount of healthcare expenditure. Healthcare expenditure is also accelerated by the hike in the insurance premium that is related to the improved chances of getting better healthcare services33. Another driving factor for the overall increase of healthcare expenditure is the rising cost of premiums in the health insurance policies. There has been a number of government programs that have increased the overall demand for the medical services that results in the higher prices for the health care facilities34. Thus in the last 40 years there has been a rapid increase in the expenditure done by the Government specifically on the public welfare arrangements. The increase in the healthcare expenses is also due to the organization of the entire healthcare system. Now-a-days healthcare shows signs of productivity level that is very poor as compared to other services. This causes an overall inflation of the healthcare services as compared to other services and this has created high costs that push up the expenditure of the healthcare services35. 32Tapia Granados, José A., and Edward L. Ionides. "Population health and the economy: Mortality and the Great Recession in Europe."Health economics26, no. 12 (2017): e219-e235. 33Misra, Anoop, Nikhil Tandon, Shah Ebrahim, Naveed Sattar, Dewan Alam, Usha Shrivastava, KM Venkat Narayan, and Tazeen H. Jafar. "Diabetes, cardiovascular disease, and chronic kidney disease in South Asia: current status and future directions."bmj357 (2017): j1420. 34Bhatnagar, Prachi, Kremlin Wickramasinghe, Julianne Williams, Mike Rayner, and Nick Townsend. "The epidemiology of cardiovascular disease in the UK 2014."Heart101, no. 15 (2015): 1182-1189. 35Watkins, David A., Zachary D. Olson, Stéphane Verguet, Rachel A. Nugent, and Dean T. Jamison. "Cardiovascular disease and impoverishment averted due to a salt reduction policy in South Africa: an extended cost-effectiveness analysis."Health policy and planning31, no. 1 (2015): 75-82.
12HEALTHCARE SYSTEM EXPENDITURE All this reasons highlights the urgent need of various ways that can help in the use of various resources much more efficiently and also to introduce new sources that can finance the increasing demands of healthcare in order to accommodate healthcare demands. The rising healthcare expenditure is due to the increasing income and the upcoming changes in the choice of an individual36. The additional supply of the healthcare appliances or equipment also add new elements or additional technologies for the improvement of the healthcare services.Thus, the increased supply of the appliances and the decreased amount of the supply creates an imbalance in the trade market that can be one of the reasons for the increase in the cost of healthcare services. As healthcare services are non-tradable and thus, local costs and local cost development is not related to the market prices across the world37. Recommendations The ways in which the soaring cost of the healthcare services can be reduced by emphasizing on the potential ways in which the diseases can be prevented. Changes in the lifestyle or the diet could prevent the chronic diseases that will ultimately lower the healthcare costs, help in improving health and can also reduce the need for expensive treatments38.Hence, the fastest way to reduce the cost is to reduce the number of people who have excessive weight, drink or smoke too much. Epidemiologic research has shown that there is a strong link between obesity and the cardiovascular diseases. Until the people make 36Lahiri, Bibudh, and Nitin Agarwal. "Predicting healthcare expenditure increase for an individual from medicare data." InProceedings of the ACM SIGKDD Workshop on Health Informatics. 2014. 37Wendt, Claus. "Changing healthcare system types."Social policy & administration48, no. 7 (2014): 864-882 38Farré, Nuria, Emili Vela, Montse Clèries, Montse Bustins, Miguel Cainzos‐Achirica, Cristina Enjuanes, Pedro Moliner, Sonia Ruiz, Jose Maria Verdú‐Rotellar, and Josep Comín‐Colet. "Medical resource use and expenditure in patients with chronic heart failure: a population‐ based analysis of 88 195 patients."European journal of heart failure18, no. 9 (2016): 1132-1140.
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13HEALTHCARE SYSTEM EXPENDITURE changes in their lifestyle the number of people who are falling prey to cardiovascular diseases and also the cost of the treatment will continue to increase39. The Government should also introduce the chronic disease management that would enable the people to receive preventive services by allowing high-deductible insurance plans in order to cover the charges before the deductible is met. Other approaches will include public awareness and health education campaigns along with financial incentives for loss in weight, cessation of smoking and also for performing exercises40. In order to reduce the cost of the healthcare services Government should invest more in the infrastructure that will encourage the people to jog and walk. The Government should also use taxes and regulation on the food industry to limit the use of salt, sugar, fat and other unhealthy services. There should also be use of taxes in order to limit the unhealthy consumption of tobacco and alcohol41. Conclusion Thus, it can be concluded from the above essay that healthcare cost are rapidly increasing due to the hike in cost of the patient services, out-patient services and also due to the cost of the follow-up services that are required after the discharge of the patient. The cost of the medicines and the increase in the premium of the insurance schemes also creates a gap between the healthcare services and the people who can afford it. Thus, in order to reduce the 39Hadad, Sharon, Yossi Hadad, and Tzahit Simon-Tuval. "Determinants of healthcare system’s efficiency in OECD countries."The European journal of health economics14, no. 2 (2013): 253-265. 40Blanco-Moreno, Ángela, Rosa M. Urbanos-Garrido, and Israel John Thuissard-Vasallo. "Public healthcare expenditure in Spain: Measuring the impact of driving factors."Health policy111, no. 1 (2013): 34-42. 41Lago-Peñas, Santiago, David Cantarero-Prieto, and Carla Blázquez-Fernández. "On the relationship between GDP and health care expenditure: a new look."Economic Modelling32 (2013): 124-129.
14HEALTHCARE SYSTEM EXPENDITURE cost of the healthcare services the Government should increase the investment in the infrastructure so that people will be encouraged to live healthy lifestyle. The increase in the prevalence of the unhealthy lifestyle choice can also lead to the increased cardiovascular diseases. In order to reduce the risk of cardiovascular diseases and also to keep the citizen healthy the Government will invest much more on the healthcare services that will ultimately impact on the healthcare services. References Aaron, K. J., Colantonio, L. D., Deng, L., Judd, S. E., Locher, J. L., Safford, M. M., … Muntner, P. (2017). Cardiovascular Health and Healthcare Utilization and Expenditures Among Medicare Beneficiaries: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study.Journal of the American Heart Association,6(2), e005106. doi:10.1161/JAHA.116.005106
15HEALTHCARE SYSTEM EXPENDITURE Bedir,Serap."Healthcareexpenditureandeconomicgrowthindeveloping countries."Advances in Economics and Business4, no. 2 (2016): 76-86. Bernard, Didem Minbay, Patrik Johansson, and Zhengyi Fang. "Out-of-pocket healthcare expenditure burdens among nonelderly adults with hypertension."The American journal of managed care20, no. 5 (2014): 406-413. Bhatnagar, Prachi, Kremlin Wickramasinghe, Julianne Williams, Mike Rayner, and Nick Townsend. "The epidemiology of cardiovascular disease in the UK 2014."Heart101, no. 15 (2015): 1182-1189. Blanco-Moreno, Ángela, Rosa M. Urbanos-Garrido, and Israel John Thuissard-Vasallo. "Public healthcare expenditure in Spain: Measuring the impact of driving factors."Health policy111, no. 1 (2013): 34-42. Callander, Emily J., Lisa Corscadden, and Jean-Frederic Levesque. "Out-of-pocket healthcare expenditure and chronic disease–do Australians forgo care because of the cost?."Australian Journal of Primary Health23, no. 1 (2017): 15-22. Carter, H. E., Schofield, D., & Shrestha, R. (2019). Productivity costs of cardiovascular disease mortality across disease types and socioeconomic groups.Open heart,6(1), e000939. de Meijer, Claudine, Owen O’Donnell, Marc Koopmanschap, and Eddy Van Doorslaer. "Health expenditure growth: looking beyond the average through decomposition of the full distribution."Journal of Health Economics32, no. 1 (2013): 88-105. Farré, Nuria, Emili Vela, Montse Clèries, Montse Bustins, Miguel Cainzos‐Achirica, Cristina Enjuanes, Pedro Moliner, Sonia Ruiz, Jose Maria Verdú‐Rotellar, and Josep Comín‐Colet. "Medical resource use and expenditure in patients with chronic heart failure: a population‐
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16HEALTHCARE SYSTEM EXPENDITURE based analysis of 88 195 patients."European journal of heart failure18, no. 9 (2016): 1132- 1140. Geue, Claudia, Andrew Briggs, James Lewsey, and Paula Lorgelly. "Population ageing and healthcare expenditure projections: new evidence from a time to death approach."The European Journal of Health Economics15, no. 8 (2014): 885-896. Hadad, Sharon, Yossi Hadad, and Tzahit Simon-Tuval. "Determinants of healthcare system’s efficiency in OECD countries."The European journal of health economics14, no. 2 (2013): 253-265. Khan, Jahangir AM, Sayem Ahmed, and Timothy G. Evans. "Catastrophic healthcare expenditure and poverty related to out-of-pocket payments for healthcare in Bangladesh—an estimation of financial risk protection of universal health coverage."Health policy and planning32, no. 8 (2017): 1102-1110. Lago-Peñas, Santiago, David Cantarero-Prieto, and Carla Blázquez-Fernández. "On the relationship between GDP and health care expenditure: a new look."Economic Modelling32 (2013): 124-129. Lahiri, Bibudh, and Nitin Agarwal. "Predicting healthcare expenditure increase for an individual from medicare data." InProceedings of the ACM SIGKDD Workshop on Health Informatics. 2014. Lippi, Giuseppe, and Mario Plebani. "Statins for primary prevention of cardiovascular disease."Trends in pharmacological sciences38, no. 2 (2017): 111-112. Misra,Anoop,NikhilTandon,ShahEbrahim,NaveedSattar,DewanAlam,Usha Shrivastava, KM Venkat Narayan, and Tazeen H. Jafar. "Diabetes, cardiovascular disease,
17HEALTHCARE SYSTEM EXPENDITURE and chronic kidney disease in South Asia: current status and future directions."bmj357 (2017): j1420. Muka, Taulant, David Imo, Loes Jaspers, Veronica Colpani, Layal Chaker, Sven J. van der Lee, Shanthi Mendis et al. "The global impact of non-communicable diseases on healthcare spending and national income: a systematic review."European Journal of Epidemiology30, no. 4 (2015): 251-277. Prince, Martin J., Fan Wu, Yanfei Guo, Luis M. Gutierrez Robledo, Martin O'Donnell, Richard Sullivan, and Salim Yusuf. "The burden of disease in older people and implications for health policy and practice."The Lancet385, no. 9967 (2015): 549-562. Rasu, Rafia S., Walter Agbor Bawa, Richard Suminski, Kathleen Snella, and Bradley Warady."Healthliteracyimpactonnationalhealthcareutilizationand expenditure."International journal of health policy and management4, no. 11 (2015): 747. Samadi, Alihussein, and Enayatollah Homaie Rad. "Determinants of Healthcare Expenditure in Economic Cooperation Organization (ECO) Countries: Evidence from Panel Cointegration Tests."International journal of health policy and management1, no. 1 (2013): 63. Schofield, Deborah, Rupendra Shrestha, Richard Percival, Megan Passey, Emily Callander, and Simon Kelly. "The personal and national costs of CVD: impacts on income, taxes, government support payments and GDP due to lost labour force participation."International journal of cardiology166, no. 1 (2013): 68-71. Sturm, Roland, Ruopeng An, Josiase Maroba, and Deepak Patel. "The effects of obesity, smoking, and excessive alcohol intake on healthcare expenditure in a comprehensive medical scheme."South African Medical Journal103, no. 11 (2013): 840-844.
18HEALTHCARE SYSTEM EXPENDITURE Tapia Granados, José A., and Edward L. Ionides. "Population health and the economy: Mortality and the Great Recession in Europe."Health economics26, no. 12 (2017): e219- e235. Waters, Anne‐Marie, Lany Trinh, Theresa Chau, Michael Bourchier, and Lynelle Moon. "LateststatisticsoncardiovasculardiseaseinAustralia."ClinicalandExperimental Pharmacology and Physiology40, no. 6 (2013): 347-356. Watkins, David A., Zachary D. Olson, Stéphane Verguet, Rachel A. Nugent, and Dean T. Jamison. "Cardiovascular disease and impoverishment averted due to a salt reduction policy in South Africa: an extended cost-effectiveness analysis."Health policy and planning31, no. 1 (2015): 75-82. Wendt, Claus. "Changing healthcare system types."Social policy & administration48, no. 7 (2014): 864-882.