Healthcare System Expenditure: Growth, Drivers, and Impact

This essay comprehensively examines the factors contributing to the rapid expansion of healthcare expenditure. It highlights the influence of an aging population, increased life expectancy, unhealthy lifestyles, and the epidemiology of diseases, particularly cardiovascular diseases. The discussion delves into the developmental goals of the new generation, emphasizing the need for increased healthcare expenditure to achieve overall progress. The essay analyzes the drivers of healthcare expenditure, including the rising prevalence of chronic diseases, the role of private health insurance, and the specific impact of cardiovascular diseases. It further explores the effects of decreased mortality rates, the costs associated with out-of-pocket expenses, and the relationship between healthcare service utilization and expenditure. The essay also touches upon the impact of age, sex, and ethnicity on cardiovascular disease prevalence and the financial implications of government policies. The analysis includes statistical data on healthcare spending, the impact of cardiovascular diseases on global mortality, and the relationship between healthcare expenditure and economic indicators. The essay concludes by highlighting the ongoing challenges and the importance of addressing the drivers of healthcare expenditure to ensure sustainable development.

Running Head: HEALTHCARE SYSTEM EXPENDITURE
HEALTHCARE SYSTEM EXPENDITURE
Name of the Student
Name of the University
Author Note

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 management 1, 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 Journal 103, 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 Economics 15, 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
There is increased prevalence of chronic diseases that includes cardiovascular
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 Health 23, 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
planning 32, 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 care 20, no. 5 (2014): 406-413.

3HEALTHCARE SYSTEM EXPENDITURE
socio-economic status of the individuals who were admitted for the treatment of 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 management 4, 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 management 1, 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 Economics 15, no. 8 (2014): 885-896.

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 Factorsa PTrendb
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." In Proceedings 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
planning 31, 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 economics 26, no. 12 (2017): e219-e235.

5HEALTHCARE SYSTEM EXPENDITURE
Characteristics of
Participants With Dietary
Data
Number of Ideal Life's Simple 7 Factorsa PTrendb
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%)
Women 64.2% 57.8% 52.3% 51.9% 47.7% <0.001
Black race 44.9% 36.2% 29.2% 20.9% 12.8% <0.001
Annual income <$20 000 31.7% 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
Unmarried 50.7% 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." Heart 101, 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
is specific to each individual16. The out-of hospital and prescription pharmaceutical
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 Economics 32, 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 Epidemiology 30,
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 Physiology 40, no. 6 (2013): 347-356.

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
the cost of the medicines and that has impacted the overall rise in the healthcare
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, sex and ethnicity should not have any impact on the prevalence of
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
planning 32, 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 management 4, 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 Health 23, 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 care 20, 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 Economics 15, 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 Epidemiology 30,
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 Epidemiology 30,
no. 4 (2015): 251-277.
27Lippi, Giuseppe, and Mario Plebani. "Statins for primary prevention of cardiovascular disease." Trends in pharmacological sciences 38,
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 Physiology 40, no. 6 (2013): 347-356.

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
that can cause the rise in healthcare expenditure. The outpatient causes include the
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 Economics 32, 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 Lancet 385, 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 economics 26, 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." bmj 357 (2017): j1420.
34Bhatnagar, Prachi, Kremlin Wickramasinghe, Julianne Williams, Mike Rayner, and Nick Townsend. "The epidemiology of cardiovascular
disease in the UK 2014." Heart 101, 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
planning 31, 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." In Proceedings of
the ACM SIGKDD Workshop on Health Informatics. 2014.
37Wendt, Claus. "Changing healthcare system types." Social policy & administration 48, 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 failure 18, no. 9 (2016): 1132-1140.

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 economics 14, 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 Modelling 32 (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. "Healthcare expenditure and economic growth in developing
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 care 20, 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." Heart 101, 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 Health 23, 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 Economics 32, 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‐

16HEALTHCARE SYSTEM EXPENDITURE
based analysis of 88 195 patients." European journal of heart failure 18, 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 Economics 15, 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 economics 14, 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
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