Analyzing the impact of fiscal conditions on private health expenditures in OECD countries: a quantile ARDL investigation.

Organization for Economic Co-operation and Development (OECD) countries have embraced the aim of universal health coverage, as established in Sustainable Development Goal (SDG) 3.8. This goal guarantees access to quality healthcare services without financial hardship or poverty. Additionally, it requires correct and adequate financing sources. A country with weak protection for its population tends to spend less on healthcare and experiences a high share of out-of-pocket payments (OOPs), increasing the likelihood of people falling into poverty. This study aims to understand the relationship and causal effects between macroeconomic and public fiscal conditions and private health expenditure in OECD countries between 1995 and 2019. We retrieved OECD data for 26 OECD countries for the period 1995-2019. Panel AutoRegressive Distributed Lag (PARDL) and panel quantile AutoRegressive Distributed Lag (PQARDL) models were estimated to examine the relationship between private health expenditures and macroeconomic and public fiscal variables. Our results reveal a positive influence of government debt and economic freedom on private health expenditures. They also show a negative influence of the government budget balance, government health expenditures, and economic growth on private health expenditures. These results collectively suggest that public fiscal conditions will likely impact private health expenditures. The findings of this study raise concerns about the equity and financial protection objectives of universal health coverage in OECD countries.

Treatable mortality and health care related factors across European countries.

Introduction: Despite the improvements in European health systems, a large number of premature deaths are attributable to treatable mortality. Men make up the majority of these deaths, with a significant gap existing between women and men's treatable mortality rate in the EU. Aim: This study aims to identify the healthcare-related factors, including health expenditures, human and physical resources, and hospital services use associated with treatable mortality in women and men across European countries during the period 2011-2019. Methods: We use Eurostat data for 28 EU countries in the period 2011-2019. We estimate a panel data linear regression with country fixed effects and quantile linear regression for men and women. Results: The results found (i) differences in drivers for male and female treatable mortality, but common drivers hold the same direction for both sexes; (ii) favorable drivers are GDP per capita, health expenditures, number of physicians per capita, and (only for men) the average length of a hospital stay, (iii) unfavorable drivers are nurses and beds per capita, although nurses are not significant for explaining female mortality. Conclusion: Policy recommendations may arise that involve an improvement in hospital bed management and the design of more specific policies aimed at healthcare professionals.

Voluntary private health insurance demand by Portuguese seniors before the COVID-19 pandemic.

AIMS: The Portuguese health system is mainly described as a National Health Service (NHS), but it also has some Bismarckian features. On top of these two layers of health insurance coverage, there is a market for voluntary private health insurance (VPHI). Usually, seniors are not eligible for this type of health insurance and this may serve as a complement or supplement to the NHS. The purpose of this work is to identify the main factors associated with holding a VPHI policy among seniors before the COVID-19 pandemic. MATERIAL AND METHODS: We use data collected by the National Health Survey of 2019/20 and estimate a multivariate logistic regression. RESULTS: The main findings show that VPHI may be bought by seniors as a facilitator to access health care, either specialised or dental care. While oral health is not covered by the NHS, specialist care is only available after referral by a gatekeeper and requires a long waiting time to be scheduled. Results show that people who had an appointment with a dentist or a specialist in the last 12 months are more likely to have a VPHI policy. Additionally, it was found that people benefiting from occupation-based insurance schemes are less likely to buy private health insurance. CONCLUSION: The current Portuguese health system organization based on different layers of health protection raises some issues concerning equity to health care access by seniors.

Factors Contributing to Self-Medication and Consumption of Non-Prescribed Drugs in Portugal.

Objectives: This work sets out to find the relationship between taking non-prescribed drugs and predisposing, enabling and need factors. Specifically, our main aim is to find the relationship between taking non-prescribed drugs and the lack of health care. Methods: We used data from the last 2019 National Health Survey and estimate logistic regressions for the whole sample and stratified by sex. Results: The most striking finding is that people self-medicating with non-prescribed drugs seem to be replacing health care when this is not used because of financial constraints or distance from provider. This suggests that non-prescribed drugs are a fast, affordable, alternative to health care. Other findings show that income and the financial resources to cope with unexpected expenditure are considerations in taking these drugs. Health and needs are other factors triggering their consumption. Conclusion: Policy measures need to be aimed at improving access to medical care, providing responses to health needs such as those arising from chronic pain, and improving health literacy.

Older Europeans' experience of unmet health care during the COVID-19 pandemic (first wave).

BACKGROUND: During the COVID-19 pandemic the utilization of health services has changed. People were living in a very different social, economic and epidemiological context. Unmet health care is expected to happen. The purposes of this work are i) to compare the differences between unmet care across countries, ii) to find the main factors which are associated with unmet health care, which includes giving up and postponing medical care, as well as denial of medical care provision by the health services, and iii) to determine if health systems' characteristics and government decisions on lockdown were related to unmet care. METHODS: We have used the most recent dataset collected by the SHARE-COVID Survey during the summer of 2020. These data cover all EU countries and are applied to people over 50. We have estimated a set of logistic regressions to explain unmet health care. RESULTS: The results indicate that women, people who are slightly younger, with higher education and income, who find it hard to make ends meet each month, and people with poorer health were more likely to experience unmet health care. We also found that in health systems with high out-of-pocket payments people are more likely to give up health care while in countries with previous high levels of unmet health needs this likelihood was the opposite; people in countries with a high number of beds per capita and with a Beveridge-type health system were reporting less postponement of health care. CONCLUSION: Some policy measures may be suggested such as social and economic measures to mitigate loss of income, expansion of the points and forms of access to health care to improve utilisation.

Multi-layer health insurance coverage, medical services use and health in a Universal National Health System, the case of Portugal.

The Portuguese health system has the peculiar characteristic of being a Beveridge-Bismarck type aiming at universal coverage. On top of the national health system coverage, there is a second coverage provided to some professionals, plus a third layer of coverage that can be acquired by taking out voluntary private health insurance. The aim of this work is to ascertain whether people benefiting from supplemental multi-layer health coverage (on top of the existing National Health System) have more consultations, either with general practitioners or with specialists, and enjoy better health status. We used data from the National Health Survey from 2014 to estimate a recursive system of ordered probits. The main results confirm that multi-layer health coverage is correlated with the use of more specialist consultations, but not with more GP consultations. It is also correlated with better health status. These results may indicate the existence of moral hazard, induced demand and/or 'access effect'. Regarding policy matters, the measures aimed to reduce waiting times, improve patient choice, and increase access could counteract such results and mitigate the potential inequity of access and health status, and also excessive use of medical services that can happen under double health coverage.

Public satisfaction with health system coverage, empirical evidence from SHARE data.

People's satisfaction with the health system, including the coverage provided, has been a concern for some years now but research into the main explanatory factors is in progress. This work focuses on European countries plus Israel, using the SHARE database to find what determines people's satisfaction with the basic coverage provided by the health system of each country. On top of the usual individual socioeconomic characteristics, other explanatory factors were also considered. These include, at individual level, trust in others, political positioning, and risk aversion; at country level, they include access to specialist care and the type of health system financing. Estimation of an ordered logistic model found that the main predictors for satisfaction with a health system's basic coverage include trust in others, unmet health needs, self-assessed health, free access to specialists, health system financed through social insurance, and out-of-pocket payments. These results provide the basis for possible policies designed to improve people's satisfaction.

Voluntary private health insurance demand determinants and risk preferences: Evidence from SHARE.

The demand for voluntary private health insurance (VPHI) in universal coverage health systems in Europe raises some questions. The aim of this paper is to determine the factors that explain the decision to purchase VPHI, to analyse the role of individual risk attitudes and self-assessed health (SAH) in purchasing VPHI, to explore the factors that explain individual risk preferences, and to test how SAH relates to those preferences. To achieve this aim, two recursive simultaneous probits are estimated using data collected by SHARE, wave 6. The main results indicate that people who are more satisfied with the health system coverage are more likely to buy VPHI; SAH is negative correlated with VPHI, but being a risk taker contributes to that decision; however, being a risk taker is positively influenced by good health status. This paper contributes to the discussion on the role of SAH and risk preferences in the decision to buy VPHI. It brings new insights for the health insurance companies and for health policy makers. HIGHLIGHTS: People who are more satisfied with the health system coverage are more likely to buy voluntary private health insurance. The longer the planning horizon assumed by individuals, the greater the likelihood they are risk takers. People reporting being risk takers are more likely to have taken out voluntary private health insurance. Self-assessed health influences the decision to buy voluntary private health insurance in two ways: a direct one, where better health lowers the odds of having insurance, and an indirect one through risk taking, which increases the odds of having insurance. Contributions of this work are mainly for health policy makers and insurance companies.

EU health systems classification: a new proposal from EURO-HEALTHY.

BACKGROUND: In accordance the WHO framework of health system functions and by using the indicators collected within the EURO-HEALTHY project, this work aims to contribute to the discussion on the classification of EU health systems. METHODS: Three methods were used in this article: factor analysis, cluster analysis and descriptive analysis; data were mainly collected from the WHO and Eurostat databases. RESULTS: The most relevant result is the proposed classification of health systems into the following clusters: Austria-Germany, Central and Northern Countries, Southern Countries, Eastern Countries 'A' and Eastern Countries 'B'. CONCLUSIONS: The proposed typology contributes to the discussion about how to classify health systems; the typology of EU health systems allows comparisons of characteristics and health system performance across clusters and policy assessment and policy recommendation within each cluster.

Physical activity and healthy diet: determinants and implicit relationship.

OBJECTIVE: People who decide to lose weight by dieting often do so without participating in any associated physical activity. Although some people who participate in sports are unconcerned about their diet, it is generally believed that people who exercise tend to eat a healthy diet and those who do not exercise eat a less healthy diet. There is no clear relationship between the decisions regarding participation in physical activity and eating a healthy diet when choices are taken freely and not influenced by policy factors promoting healthy behaviour. However, these decisions may reveal some common explanatory factors and an implicit link. As such the aim of this study was to identify the common explanatory factors and investigate the existence of an implicit relationship. STUDY DESIGN: Econometric estimate - bivariate probit estimation. METHOD: Using data from the Portuguese National Health Survey, a bivariate probit was undertaken for decisions regarding participation in physical activity and eating a healthy diet. The correlation between the residuals gives information on the implicit relationship between the healthy choices. RESULTS: Common explanatory factors were found between the decisions to eat healthy snacks and participate in physical activity, such as being married. However, holding voluntary private health insurance, smoking, getting older, living alone and unemployment were found to dissuade people from making healthy choices. Positive correlation was found between the residuals of the probit estimations, indicating that other unmeasurable variables have a similar influence on both decisions, such as peer pressure, cultural values, fashion, advertising and risk aversion. CONCLUSIONS: Further research is needed to improve understanding of decision making related to participation in physical activity and eating a healthy diet. This will facilitate the design of policies that will make a greater contribution to healthy lifestyles.