Who's Going Broke? Comparing Growth in Healthcare Costs in Ten OECD Countries
AbstractGovernment healthcare expenditures have been growing much more rapidly than GDP in OECD countries. For example, between 1970 and 2002 these expenditures grew 2.3 times faster than GDP in the U.S., 2.0 times faster than GDP in Germany, and 1.4 times faster than GDP in Japan. How much of government healthcare expenditure growth is due to demographic change and how much is due to increases in benefit levels; i.e., in healthcare expenditures per beneficiary at a given age? This paper answers this question for ten OECD countries -- Australia, Austria, Canada, Germany, Japan, Norway, Spain, Sweden, the UK, and the U.S. Specifically, the paper decomposes the 1970-2002 growth in each countrys healthcare expenditures into growth in benefit levels and changes in demographics. Growth in real benefit levels has been remarkably high and explains the lions share %uF818 89 percent %uF818 of overall healthcare spending growth in the ten countries. Norway, Spain, and the U.S. recorded the highest annual benefit growth rates. Norways rate averaged 5.04 percent per year. Spain and the U.S. were close behind with rates of 4.63 percent and 4.61 percent, respectively. Allowing benefit levels to continue to grow at historic rates is fraught with danger given the impending retirement of the baby boom generation. In Japan, for example, maintaining its 1970-2002 benefit growth rate of 3.57 percent for the next 40 years and letting benefits grow thereafter only with labor productivity entails present value healthcare expenditures close to 12 percent of the present value of GDP. By comparison, Japans government is now spending only 6.7 percent of Japans current output on healthcare. In the U.S., government healthcare spending now totals 6.6 percent of GDP. But if the U.S. lets benefits grow for the next four decades at past rates, it will end up spending almost 18 percent of its future GDP on healthcare. The difference between the Japanese 12 percent and U.S. 18 percent figures is remarkable given that Japan is already much older than the U.S. and will age more rapidly in the coming decades. Although healthcare spending is growing at unsustainable rates in most, if not all, OECD countries, the U.S. appears least able to control its benefit growth due to the nature of its fee-for-service healthcare payment system. Consequently, the U.S. may well be in the worst long-term fiscal shape of any OECD country even though it is now and will remain very young compared to the majority of its fellow OECD members.
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Bibliographic InfoPaper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 11833.
Date of creation: Dec 2005
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Publication status: published as Christian Hagist & Laurence J. Kotlikoff, 2009. "Whoâ€™s going broke? Comparing growth in Public healthcare expenditure in Ten OECD Countries," Hacienda PÃºblica EspaÃ±ola, IEF, vol. 188(1), pages 55-72, March.
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- Laurence J. Kotlikoff & Christian Hagist, 2005. "Who’s Going Broke? Comparing Growth in Healthcare Costs in Ten OECD Countries," Working Papers id:286, eSocialSciences.
- H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
- I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
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- Breyer, Friedrich & Felder, Stefan, 2006.
"Life expectancy and health care expenditures: A new calculation for Germany using the costs of dying,"
Elsevier, vol. 75(2), pages 178-186, January.
- Friedrich Breyer & Stefan Felder, 2004. "Life Expectancy and Health Care Expenditures: A New Calculation for Germany Using the Costs of Dying," Discussion Papers of DIW Berlin 452, DIW Berlin, German Institute for Economic Research.
- Benz, Ulrich & Fetzer, Stefan, 2004. "Indicators for Measuring Fiscal Sustainability: A Comparative Application of the OECD-Method and Generational Accounting," Discussion Papers 118, Institut für Finanzwissenschaft, Albert-Ludwigs-Universität Freiburg.
- Peter Zweifel, 2003. "Medical Innovation: A Challenge to Society and Insurance," The Geneva Papers on Risk and Insurance, The International Association for the Study of Insurance Economics, vol. 28, pages 194-202, 04.
- Peter Zweifel & Stefan Felder & Andreas Werblow, 2004.
"Population Ageing and Health Care Expenditure: New Evidence on the "Red Herring","
The Geneva Papers on Risk and Insurance,
The International Association for the Study of Insurance Economics, vol. 29(4), pages 652-666, October.
- Peter Zweifel & Stefan Felder & Andreas Werblow, 2004. "Population Ageing and Health Care Expenditure: New Evidence on the “Red Herring”," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan, vol. 29(4), pages 652-666, October.
- Friedrich Breyer & Volker Ulrich, 2000. "Gesundheitsausgaben, Alter und medizinischer Fortschritt: Eine Regressionsanalyse," Journal of Economics and Statistics (Jahrbuecher fuer Nationaloekonomie und Statistik), Justus-Liebig University Giessen, Department of Statistics and Economics, vol. 220(1), pages 1-17.
- Joseph P. Newhouse, 1992. "Medical Care Costs: How Much Welfare Loss?," Journal of Economic Perspectives, American Economic Association, vol. 6(3), pages 3-21, Summer.
- Phillips, P.C.B., 1986.
"Testing for a Unit Root in Time Series Regression,"
Cahiers de recherche
8633, Universite de Montreal, Departement de sciences economiques.
- Peter Zweifel, 2003. "Medical Innovation: A Challenge to Society and Insurance," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan, vol. 28(2), pages 194-202, April.
- Florian Buchner & J�rgen Wasem, 2006.
"“Steeping” of Health Expenditure Profiles,"
The Geneva Papers on Risk and Insurance - Issues and Practice,
Palgrave Macmillan, vol. 31(4), pages 581-599, October.
- Peter Zweifel & Stefan Felder & Markus Meiers, 1999. "Ageing of population and health care expenditure: a red herring?," Health Economics, John Wiley & Sons, Ltd., vol. 8(6), pages 485-496.
- Sally C. Stearns & Edward C. Norton, 2004. "Time to include time to death? The future of health care expenditure predictions," Health Economics, John Wiley & Sons, Ltd., vol. 13(4), pages 315-327.
- Jennifer Roberts, 1999. "Sensitivity of elasticity estimates for OECD health care spending: analysis of a dynamic heterogeneous data field," Health Economics, John Wiley & Sons, Ltd., vol. 8(5), pages 459-472.
- Hansen, Paul & King, Alan, 1996. "The determinants of health care expenditure: A cointegration approach," Journal of Health Economics, Elsevier, vol. 15(1), pages 127-137, February.
- Hendrik Jürges & Vincent Pohl, 2012. "Medical guidelines, physician density, and quality of care: evidence from German SHARE data," The European Journal of Health Economics, Springer, vol. 13(5), pages 635-649, October.
- Kuhn, Andreas & Lalive, Rafael & Zweimüller, Josef, 2009.
"The public health costs of job loss,"
Journal of Health Economics,
Elsevier, vol. 28(6), pages 1099-1115, December.
- Kuhn, Andreas & Lalive, Rafael & Zweimüller, Josef, 2009. "The Public Health Costs of Job Loss," CEPR Discussion Papers 7420, C.E.P.R. Discussion Papers.
- Andreas Kuhn & Rafael Lalive & Josef Zweimüller, 2009. "The public health costs of job loss," IEW - Working Papers 424, Institute for Empirical Research in Economics - University of Zurich.
- Kuhn, Andreas & Lalive, Rafael & Zweimüller, Josef, 2009. "The Public Health Costs of Job Loss," IZA Discussion Papers 4355, Institute for the Study of Labor (IZA).
- Andreas Kuhn & Rafael Lalive & Josef Zweimüller, 2009. "The Public Health Costs of Job Loss," NRN working papers 2009-13, The Austrian Center for Labor Economics and the Analysis of the Welfare State, Johannes Kepler University Linz, Austria.
- Sørensen, Rune J., 2013. "Does aging affect preferences for welfare spending? A study of peoples' spending preferences in 22 countries, 1985–2006," European Journal of Political Economy, Elsevier, vol. 29(C), pages 259-271.
- Mukesh Chawla & Gordon Betcherman & Arup Banerji, 2007. "From Red to Gray : The "Third Transition" of Aging Populations in Eastern Europe and the Former Soviet Union," World Bank Publications, The World Bank, number 6741, October.
- Hanming Fang & Alessandro Gavazza, 2007. "Dynamic Inefficiencies in Employment-Based Health Insurance System Theory and Evidence," NBER Working Papers 13371, National Bureau of Economic Research, Inc.
- Friedrich Breyer & Normann Lorenz & Thomas Niebel, 2012.
"Health Care Expenditures and Longevity: Is There a Eubie Blake Effect?,"
Discussion Papers of DIW Berlin
1226, DIW Berlin, German Institute for Economic Research.
- Friedrich Breyer & Normann Lorenz & Thomas Niebel, 2012. "Health Care Expenditures and Longevity: Is there a Eubie Blake Effect?," Research Papers in Economics 2012-01, University of Trier, Department of Economics.
- Glorie, K.M. & van Oostrum, J.M. & Dur, A.J. & Kazemier, G. & Wagelmans, A.P.M., 2010. "Physician Incentive Management in University Hospitals: Including Efficient Behavior Through the Allocation of Research Facilities," Econometric Institute Research Papers EI 2010-58, Erasmus University Rotterdam, Erasmus School of Economics (ESE), Econometric Institute.
- Andreas KUHN & Rafael LALIVE & Josef ZWEIMÜLLER, 2007. "The Public Health Costs of Unemployment," Cahiers de Recherches Economiques du DÃ©partement d'EconomÃ©trie et d'Economie politique (DEEP) 07.08, Université de Lausanne, Faculté des HEC, DEEP.
- Max Groneck & Christoph Kaufmann, 2014. "Relative Sectoral Prices and Population Ageing: A Common Trend," Working Paper Series in Economics 69, University of Cologne, Department of Economics.
- W Todd Groome & Nicolas Blancher & Parmeshwar Ramlogan & Oksana Khadarina, 2006. "Population Ageing, the Structure of Financial Markets and Policy Implications," RBA Annual Conference Volume, in: Christopher Kent & Anna Park & Daniel Rees (ed.), Demography and Financial Markets Reserve Bank of Australia.
- Seher Nur Sulku & Asena Caner, 2009.
"Health Care Expenditures and Gross Domestic Product: The Turkish Case,"
0903, TOBB University of Economics and Technology, Department of Economics.
- Seher Sülkü & Asena Caner, 2011. "Health care expenditures and gross domestic product: the Turkish case," The European Journal of Health Economics, Springer, vol. 12(1), pages 29-38, February.
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