Browsing by Author "Ferreira, Ernesto Raúl"
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- Social spending and health care outcomesPublication . Ferreira, Ernesto Raúl; Manso, José Ramos PiresFrom the very young to the very old, disease defines our roles in society and affects everyone. But medical care saves or extends lives. Because it (seems) to have some power over disease and retards or slows the rate of depreciation of an individual´s initial endowment of health, it is perceived very positively. Thus, as of 2015, individuals and populations in the Organization for Economic Cooperation and Development (OECD) area-countries spent approximately 9.0 percent of their incomes (as measured by GDP per capita) on health care—up from 8.3 percent in 2008. With national governments assuming an increasing share of these costs and pressures to spend more likely to continue, controlling this type of spending is a problem that all modern societies face and one which every country must grapple with. Therefore, this thesis begins with the questions: what factors are behind this push for more spending? And does government involvement in health care affect health care costs and spending? If so, how? Thus, to inform on what is ultimately a political decision, we looked at the determinants of health care expenditure growth in Portugal and a set of countries in the OECD area, taking into account the role of income, the share of publicly funded health care, ageing population, as well as technological progress. Although governments seem unable to control health care costs and spending, the results from Part One of our research (Chapters 2 and 3) suggest that the current trend of increasing health care expenditure is rooted in a set of differentiated factors. In Chapter 2, higher Portuguese income levels lead to higher health care expenditure, and the magnitude of the estimated elasticity poses some concern about long-term sustainability of current trends of spending. However, the income elasticity of health care expenditure not only depends on the level of analysis but also the range of income and economic development. For example, characteristics of a non-luxury good for health care have been found in Chapter 3, in the study examining the determinants of expenditure growth in a sample of OECD countries. This indicates that the delivery of health is determined according to needs, rather than responsiveness to income changes, and thus warrants greater public involvement in the provision and financing of health care. In addition, our main results confirm that the growth in numbers of the elderly and the development of new medical technologies are determining factors of current health expenditure growth, and these may not be easily compressed if not through rationing. Besides informing on the factors that are behind the push for health care expenditure growth, this thesis also looks at the socio-economic determinants of health, particularly how government involvement in health care and social protection programs may lead to better health care outcomes. Although publicly funded health care spending seems to have very little impact on all-cause and cause-specific mortality rates, the results of our investigation indicate that other factors (such as, for example, higher levels of income and publicly funded welfare spending, as well as advances in new medical technologies, do significantly influence the overall health status and well-being of a country´s population. Thus, while using data from the European Union for a period that leads up to, and coincided with the ongoing recession (2008-2013), the evidence emerging from Part Two (Chapters 4, 5 and 6) of our research suggests that when it comes to protecting population health, the results are that social welfare spending is as relevant, if not more so, than public health spending in moderating increased vulnerabilities to adverse economic shocks, especially among younger males and females, the poor and their children, and should be accounted for in future inquiry into the determinants of aggregate population health.