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Returns to Local-Area Healthcare Spending: Evidence from Health Shocks to Patients Far From Home.

ABSTRACT: Healthcare spending varies widely across markets, and previous empirical studies find little evidence that higher spending translates into better health outcomes. The main innovation in this paper exploits this cross-sectional variation in hospital spending in a new way by considering patients who are exposed to healthcare systems not designed for them: patients far from home when a health emergency strikes. Visitors to Florida who become ill in high-spending areas have significantly lower mortality rates compared to visitors in lower-spending areas. The results are robust within groups of similar visitors and within groups of destinations that appear to be close demand substitutes-areas that likely attract similar visitors.

SUBMITTER: Doyle JJ

PROVIDER: S-EPMC3707795 | biostudies-literature | 2011 Jul

REPOSITORIES: biostudies-literature

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Returns to Local-Area Healthcare Spending: Evidence from Health Shocks to Patients Far From Home.

Doyle Joseph J JJ

American economic journal. Applied economics 20110701 3

Healthcare spending varies widely across markets, and previous empirical studies find little evidence that higher spending translates into better health outcomes. The main innovation in this paper exploits this cross-sectional variation in hospital spending in a new way by considering patients who are exposed to healthcare systems not designed for them: patients far from home when a health emergency strikes. Visitors to Florida who become ill in high-spending areas have significantly lower morta ...[more]

PMID: 23853699

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Project description:BackgroundSouth Africa has a dual system of healthcare model differentiated across socio-economic lines. While on the one hand there exists high quality private facilities that is expensive and accessible to the minority, on the other is the free but stretched and over-crowded public healthcare that the rest of the population relies on. Accessing private facilities requires private medical insurance or requires coping strategies that can lead to household vulnerability.ObjectiveThe objective of this study is to analyse the relationship between health shocks and household vulnerability in the South African context of high poverty and low medical insurance penetration rate.DataThe study employs data from waves three to five of South Africa's nationally representative National Income Dynamics Study (NIDS) conducted between the period 2012-2017 in approximately two-year intervals.MethodsUsing food expenditure shock as an indicator for vulnerability, the study utilises a range of econometric techniques from panel logit regression to quasi-experimental design based difference in difference regressions to assess the association between health shocks, medical insurance and household vulnerability.FindingsThe main finding of the study is that a significant proportion of households in the upper income quintile utilise private healthcare even when not covered by private medical insurance. This preference for private over public health facilities make them vulnerable to health shocks as they cope by sacrificing food consumption to incur additional health expenditure. In contrast, lower income households that are unable to access the high-cost private healthcare tend to rely on the strained public healthcare system. They are not able to use their constrained food expenditure as a coping strategy for private or out-of-pocket medical expenses because their food consumption is already at a bare minimum.ConclusionThe results confirm that access to quality healthcare is a privilege in South Africa, available only to the minority of the population. The study paints a grim picture of household vulnerability in South Africa and underlines the need for a National Health Insurance that would enable universal access to quality healthcare in the country.

Project description:ObjectivesChanges in public sector service spending may influence food consumption. We make use of changing local authority (LA) expenditure in England to assess impacts on food purchasing. We examine total LA service spending and explore two potential pathways: highways and transport spending which may affect access to food; and housing service expenditure which may affect household resources available to purchase foods.DesignLongitudinal panel survey at the LA level (2008-2015) using fixed effects linear regression.Setting324 LAs in England.Main exposureExpenditure per capita on total LA services, highways and transport services, and housing services.Main outcome measuresLA area estimates of purchasing of fresh fruits and vegetables, high in fat, sugar and salt (HFSS) foods, and takeaways at home, expressed as a percentage of total food and drink expenditure.ResultsTotal LA service spending decreased by 17% on average between 2008 and 2015. A 10% decrease in total LA spending was associated with a 0.071 percentage point decrease in HFSS (95% CI -0.093 to -0.050) and a 0.015 percentage point increase in takeaways (95% CI 0.006 to 0.024). A 10% decrease in highways and transport expenditure was associated with a 0.006 percentage point decrease in fruit and vegetable purchasing (95% CI -0.009 to -0.002) and a 0.006 percentage point increase in takeaway purchasing (95% CI 0.001 to 0.010). These associations were seen in urban areas only when analyses were stratified by rural/urban area status. A 0.006 percentage point decrease in HFSS purchasing was also seen with a 10% decrease in housing expenditure (95% CI -0.010 to -0.002).ConclusionChanges in LA spending may have impacts on food purchasing which are evident at the area level. This suggests that in addition to more prominent impacts such as foodbank use, austerity measures may have mixed impacts on food purchasing behaviours among the wider population. Individual-level research is needed to further elucidate these relationships.

Project description:IntroductionReductions in local government spending may have impacts on diets and health which increase the risk of hospital admissions for nutritional anaemias. Mechanisms include potential impacts of changes to local authority (LA) services (eg, housing services) on personal resources and food access, availability and provision. We therefore investigated the association between changes in LA spending and nutritional anaemia-related hospital admissions. Specifically, we address whether greater cuts to LA spending were linked to increased hospital admissions for nutritional anaemias.DesignLongitudinal analysis of LA panel data using Poisson fixed effects regression models.Setting312 LAs in England (2005-2018).Main exposureTotal LA service expenditure per capita per year.Main outcomePrincipal and total nutritional anaemia hospital admissions, for all ages and stratified by age (0-14, 15-64, 65+ years).ResultsLA service expenditure increased by 9% between 2005 and 2009 then decreased by 20% between 2010 and 2018. Total nutritional anaemia hospital admissions increased between 2005 and 2018 from 173 to 633 admissions per 100 000 population. A £100 higher LA service spending was associated with a 1.9% decrease in total nutritional anaemia hospital admissions (adjusted incidence rate ratio (aIRR): 0.98, 95% CI: 0.96 to 0.99). When stratified by age, this was seen only in adults. A £100 higher LA service spending was associated with a 2.6% decrease in total nutritional anaemia hospital admissions in the most deprived LAs (aIRR: 0.97, 95% CI: 0.95 to 1.0).ConclusionIncreased LA spending was associated with reduced hospital admissions for nutritional anaemia. Austerity-related reductions had the opposite effect, increasing admissions, with greater impacts in more deprived areas. This adds further evidence to the potential negative impacts of austerity policies on health and health inequalities. Among other impacts, re-investing in LA services may prevent hospital admissions associated with nutritional anaemias.

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Returns to Local-Area Healthcare Spending: Evidence from Health Shocks to Patients Far From Home.

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Returns to Local-Area Healthcare Spending: Evidence from Health Shocks to Patients Far From Home.

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