Health spending

S Smith, M Freeland, S Heffler, D McKusick. The next ten years of health spending what does the future hold . Health Affairs 17(5) 128-140, 1998. 

Year Public pharmaceutical spending/GDP Public health spending (excluding pharmaceuticals)/GDP Public pharmaceutical spending/total public health spending... 

Countries Health expenditure (% GDP) Pharmaceutical expenditure (% GDP) Pharmaceutical expenditure (% health spending) Pharmaceutical expenditure (S per capita)... 

Do the above comments disqualify the government s efforts to redress the growth of health spending We think not, although to our mind it would be... 

To sum up, the question that should concern decision-makers now is not so much whether Spain s current level of expenditure can be put on a par with that attained by its neighbouring countries, but rather to what extent current growth rates of public health spending are compatible with the income scenarios fixed by the Spanish public sector in the process of European convergence and its frameworks of stability. 

As we have stated elsewhere (Lopez-Casasnovas1), there is ample reason to believe that the rise in health spending in Spain can be traced to the diagnostic and therapeutic content of average health provision, for which the forecasts to date predict an increase in use as a consequence of the ageing of the population. 

An initial reading of the evolution of pharmaceutical consumption within the Spanish Social Security system enables us to conclude, albeit in isolation and tentatively, that in per capita terms drug consumption has grown more than the nominal GDP, but that it has maintained its position within public health expenditure as a whole. Therefore, in terms of evolution, rising consumption does not represent a differential feature within the general growth in health spending. 

Fig. 25.1 Relationship between total health spending per capita and GDP per capita, 1998. Source OECD Health Data 2001.

Sales reported for 2004 in the United States, which spends more per capita and absolutely on pharmaceuticals than does any other country, amounted to only 200 billion, which is about 1.7% of U.S. gross domestic product (GDP in that year, or 11.1% of total U.S. health spending Heffler et al. 2005). Assuming that drug manufacturers received about 75% of total retail sales and that their net after-tax proht margin was 16% on sales Fortune 2005), their after-tax profits of about 24 billion in 2004 amounted to only 0.20% of U.S. GDP in that year, and about 1.3% of total U.S. national health spending. 

HefUer, Stephen, SheUa Smith, Sean Keehan, Christine Borger, M. Kent Clemens, and Christopher Truffer. 2005. U.S. Health Spending for 2004-2014. Health Affairs -Web ExclusiveWS-JAr-SS. 

Table 23.2 Provincial health spending trends by economic classification ...

In addition, provincial hospitals have taken the lion s share of funding from the national health budget and it is projected to decline from 68 per cent to 61 per cent between 1999/2000 and 2005/6 (Blecher and Thomas 2003). But, provincial health spending on medicines (other current expenses) is expected to grow above personnel expenditure (see Table 23.2). 

Suncor offers its employees health spending accounts, education assistance, scholarships for dependents and health, prescription and dental plan options. 

Poisal JA, Truffer C, Smith S, et al. 2007. Health spending projections through 2016 Modest changes obscure Part D s impact. Health Affairs 26 w242 (published online February 21, 2007 10.1377/ hlthaff.26.2.w242). 

Heffler S, Smith S, et al. 2003. Health spending projections for 2002-2012. Health Affairs 22 W54. 

Heftier S, Smith S, Won G, Clemens MK, Keehan S, Zezza M. Health spending projections for 2001-2011 the latest outlook. Faster health spending growth and a slowing economy drive the health spending projection for 2001 up sharply. Hlth. Aff. (Millwood) 2002 21 207-218. 

Levit K, Smith C, Cowan C, Lazenby H, Martin A. Inflation spurs health spending in 2000. Hlth. Aff. 2002 21(1) 172-181. 

The present situation is that industry spends an enormous amount of money promoting its many names for the same article, and the community, as represented in the UK by the Department of Health, spends a small sum trying to persuade doctors to use nonproprietary names. Ordinary doctors who prescribe for their ordinary patients are the targets of both sides. 

In 1960,49% of health care revenues came from out-of-pocket payments from individuals. Out-of-pocket spending is defined as expenditures for coinsurance and deductibles required by insurers, as well as direct payments for services, which are covered by a third party. In 1990, individual consumers spent 144.4 billion ectly for out-of-pocket payments for personal health ser-vices.f This accounted for 38% of all personal health spending. In 1998, consumers spent 183.7billion in out-of-pocket payments, which accounts for 33% of the 558.7 billion in personal health spending. ... 

Despite this, the market is growing rapidly. Overall, in EU states, the proportion of total healthcare costs accounted for by outpatient drug costs rose from 13.3% in 1980 to 15.3% in 1999 (Martikainen, 2002), a faster increase than overall health spending. 

Smith, S., et al. The next decade of health spending A new outlook. Health Aff. 1999, 94, July/August. 

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