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Health expenditure growth: Looking beyond the average through decomposition of the full distribution

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  • de Meijer, Claudine
  • O’Donnell, Owen
  • Koopmanschap, Marc
  • van Doorslaer, Eddy

Abstract

Explanations of growth in health expenditures have restricted attention to the mean. We explain change throughout the distribution of expenditures, providing insight into how expenditure growth and its explanation differ along the distribution. We analyse Dutch data on actual health expenditures linked to hospital discharge and mortality registers. Full distribution decomposition delivers findings that would be overlooked by examination of changes in the mean alone. The growth rate of hospital expenditures is greatest at the middle of the distribution and is driven mainly by changes in the distributions of determinants. Pharmaceutical expenditures increase most rapidly at the top of the distribution and are mainly attributable to structural changes, including technological progress, making treatment of the highest cost cases even more expensive. Changes in hospital practice styles make the largest contribution of all determinants to increased spending not only on hospital care but also on pharmaceuticals, suggesting important spill over effects.

Suggested Citation

  • de Meijer, Claudine & O’Donnell, Owen & Koopmanschap, Marc & van Doorslaer, Eddy, 2013. "Health expenditure growth: Looking beyond the average through decomposition of the full distribution," Journal of Health Economics, Elsevier, vol. 32(1), pages 88-105.
  • Handle: RePEc:eee:jhecon:v:32:y:2013:i:1:p:88-105 DOI: 10.1016/j.jhealeco.2012.10.009
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    Cited by:

    1. Jones, A. & Lomas, J. & Rice, N., 2014. "Going Beyond the Mean in Healthcare Cost Regressions: a Comparison of Methods for Estimating the Full Conditional Distribution," Health, Econometrics and Data Group (HEDG) Working Papers 14/26, HEDG, c/o Department of Economics, University of York.
    2. José Villaverde & Adolfo Maza & María Hierro, 2014. "Health care expenditure disparities in the European Union and underlying factors: a distribution dynamics approach," International Journal of Health Economics and Management, Springer, vol. 14(3), pages 251-268, September.
    3. Decker, Simon & Schmitz, Hendrik, 2016. "Health shocks and risk aversion," Journal of Health Economics, Elsevier, vol. 50(C), pages 156-170.
    4. repec:eee:hapoch:v1_951 is not listed on IDEAS
    5. Pieter Bakx & Owen O’Donnell & Eddy van Doorslaer, 2016. "Spending on Health Care in the Netherlands: Not going so Dutch," Tinbergen Institute Discussion Papers 16-024/V, Tinbergen Institute.
    6. Kolodziej, Ingo W.K. & García-Gómez, Pilar, 2017. "The causal effects of retirement on mental health: Looking beyond the mean effects," Ruhr Economic Papers 668, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    7. Kokot, Johanna, 2017. "Does a spouse's health shock influence the partner's risk attitudes?," Ruhr Economic Papers 707, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.

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    Keywords

    Health care expenditure; Decomposition; Ageing; Pharmaceuticals; The Netherlands;

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health

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