IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0061718.html

The Association between Health System Development and the Burden of Cardiovascular Disease: An Analysis of WHO Country Profiles

Author

Listed:
  • Yanmei Liu
  • Koustuv Dalal
  • Björn Stollenwerk

Abstract

Background: Several risk factors for cardiovascular disease (CVD) have been identified in recent decades. However, the association between the health system and the burden of CVD has not yet been sufficiently researched. The objective of this study was to analyse the association between health system development and the burden of CVD, in particular CVD-related disability-adjusted life–years (DALYs). Methods: Univariate and multivariate generalized linear mixed models were applied to country-level data collected by the World Bank and World Health Organization. Response variables were the age-standardized CVD mortality and age-standardized CVD DALY rates. Results: The amount of available health system resources, indicated by total health expenditures per capita, physician density, nurse density, dentistry density, pharmaceutical density and the density of hospital beds, was associated with reduced CVD DALY rates and CVD mortality. However, in the multivariate models, the density of nurses and midwives was positively associated with CVD. High out-of-pocket costs were associated with increased CVD mortality in both univariate and multivariate analyses. Conclusion: A highly developed health system with a low level of out-of-pocket costs seems to be the most appropriate to reduce the burden of CVD. Furthermore, an efficient balance between human health resources and health technologies is essential.

Suggested Citation

  • Yanmei Liu & Koustuv Dalal & Björn Stollenwerk, 2013. "The Association between Health System Development and the Burden of Cardiovascular Disease: An Analysis of WHO Country Profiles," PLOS ONE, Public Library of Science, vol. 8(4), pages 1-7, April.
    • Handle: RePEc:plo:pone00:0061718
    DOI: 10.1371/journal.pone.0061718
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0061718
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0061718&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0061718?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Björn Stollenwerk & Afschin Gandjour & Markus Lüngen & Uwe Siebert, 2013. "Accounting for increased non-target-disease-specific mortality in decision-analytic screening models for economic evaluation," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(6), pages 1035-1048, December.
    2. Stock, Stephanie & Schmidt, Harald & Büscher, Guido & Gerber, Andreas & Drabik, Anna & Graf, Christian & Lüngen, Markus & Stollenwerk, Björn, 2010. "Financial incentives in the German Statutory Health Insurance: New findings, new questions," Health Policy, Elsevier, vol. 96(1), pages 51-56, June.
    3. Falkingham, Jane, 2004. "Poverty, out-of-pocket payments and access to health care: evidence from Tajikistan," Social Science & Medicine, Elsevier, vol. 58(2), pages 247-258, January.
    4. Elola, J. & Daponte, A. & Navarro, V., 1995. "Health indicators and the organization of health care systems in Western Europe," American Journal of Public Health, American Public Health Association, vol. 85(10), pages 1397-1401.
    5. Björn Stollenwerk & Andreas Gerber & Karl W. Lauterbach & Uwe Siebert, 2009. "The German Coronary Artery Disease Risk Screening Model: Development, Validation, and Application of a Decision-Analytic Model for Coronary Artery Disease Prevention with Statins," Medical Decision Making, , vol. 29(5), pages 619-633, September.
    6. Emil Victor Gruber & Stephanie Stock & Björn Stollenwerk, 2012. "Breast Cancer Attributable Costs in Germany: A Top-Down Approach Based on Sickness Funds Data," PLOS ONE, Public Library of Science, vol. 7(12), pages 1-6, December.
    7. repec:wbk:wbpubs:7039 is not listed on IDEAS
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Sabine Witt & Reiner Leidl & Christian Becker & Rolf Holle & Michael Block & Johannes Brachmann & Sigmund Silber & Björn Stollenwerk, 2014. "The Effectiveness of the Cardiovascular Disease Prevention Programme ‘KardioPro’ Initiated by a German Sickness Fund: A Time-to-Event Analysis of Routine Data," PLOS ONE, Public Library of Science, vol. 9(12), pages 1-17, December.
    2. Guglielmo Maria Caporale & Luis A. Gil-Alana, 2015. "Infant mortality rates: time trends and fractional integration," Journal of Applied Statistics, Taylor & Francis Journals, vol. 42(3), pages 589-602, March.
    3. Singh, Dharmendra P. & Biradar, Rajeshwari A. & Halli, Shiva S. & Dwivedi, Laxmi Kant, 2021. "Effect of maternal nutritional status on children nutritional status in India," Children and Youth Services Review, Elsevier, vol. 120(C).
    4. Becchetti, Leonardo & Conzo, Pierluigi & Salustri, Francesco, 2017. "The impact of health expenditure on the number of chronic diseases," Health Policy, Elsevier, vol. 121(9), pages 955-962.
    5. Ilhom Abdulloev & Ira N. Gang & John Landon-Lane, 2011. "Migration as a Substitute for Informal Activities: Evidence from Tajikistan," Working Papers 311, Leibniz Institut für Ost- und Südosteuropaforschung (Leibniz Institute for East and Southeast European Studies).
    6. Lewis, Maureen & Pettersson, Gunilla, 2009. "Governance in health care delivery : raising performance," Policy Research Working Paper Series 5074, The World Bank.
    7. Parida Wubulihasimu & Werner Brouwer & Pieter van Baal, 2016. "The Impact of Hospital Payment Schemes on Healthcare and Mortality: Evidence from Hospital Payment Reforms in OECD Countries," Health Economics, John Wiley & Sons, Ltd., vol. 25(8), pages 1005-1019, August.
    8. Alassane DRABO & Christian EBEKE, 2010. "Remittances, Public Health Spending and Foreign Aid in the Access to Health Care Services in Developing Countries," Working Papers 201004, CERDI.
    9. Qili Wang & Liangfei Qiu & Wei Xu, 2024. "Informal Payments and Doctor Engagement in an Online Health Community: An Empirical Investigation Using Generalized Synthetic Control," Information Systems Research, INFORMS, vol. 35(2), pages 706-726, June.
    10. Williams, Colin C. & Horodnic, Adrian V., 2017. "Rethinking informal payments by patients in Europe: An institutional approach," Health Policy, Elsevier, vol. 121(10), pages 1053-1062.
    11. Gaal, Peter & McKee, Martin, 2005. "Fee-for-service or donation? Hungarian perspectives on informal payment for health care," Social Science & Medicine, Elsevier, vol. 60(7), pages 1445-1457, April.
    12. Cacace, Mirella & Ettelt, Stefanie & Mays, Nicholas & Nolte, Ellen, 2013. "Assessing quality in cross-country comparisons of health systems and policies: Towards a set of generic quality criteria," Health Policy, Elsevier, vol. 112(1), pages 156-162.
    13. Arsenijevic, Jelena & Pavlova, Milena & Groot, Wim, 2015. "Out-of-pocket payments for health care in Serbia," Health Policy, Elsevier, vol. 119(10), pages 1366-1374.
    14. Jeroen Klomp & Jakob De Haan, 2008. "Effects of Governance on Health: a Cross‐National Analysis of 101 Countries," Kyklos, Wiley Blackwell, vol. 61(4), pages 599-614, November.
    15. Petracca, Francesco & Ardito, Vittoria & Sala, Francesca & Bertolaso, Guido & Menichelli, Lorenzo & Vecchio, Riccardo & Tarricone, Rosanna, 2025. "Harnessing financial incentives for health promotion: A scoping review of prevention programs implemented in upper-middle and high-income countries," Social Science & Medicine, Elsevier, vol. 383(C).
    16. John Nixon & Philippe Ulmann, 2006. "The relationship between health care expenditure and health outcomes," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 7(1), pages 7-18, March.
    17. World Bank, 2008. "Tajikistan - Second Programmatic Public Expenditure Review : Volume 4. Public Expenditure Ttracking Survey (PETS), Health Sector," World Bank Publications - Reports 6135, The World Bank Group.
    18. Niccol? Persiani & Alberto Romolini & Claudia Galanti & Maria Jos? Cald?s Pinilla & Michele De Luca, 2014. "La riforma del sistema di finanziamento del Servizio Sanitario nazionale albanese," MECOSAN, FrancoAngeli Editore, vol. 2014(89), pages 7-30.
    19. Zechariah Langnel & Ponlapat Buracom, 2020. "Governance, health expenditure and infant mortality in sub‐Saharan Africa," African Development Review, African Development Bank, vol. 32(4), pages 673-685, December.
    20. Boris Augurzky & Arndt R. Reichert & Christoph M. Schmidt & Ansgar Wübker, 2026. "Participation in a bonus program for preventive behavior and its association with health care expenditures," Empirica, Springer;Austrian Institute for Economic Research;Austrian Economic Association, vol. 53(1), pages 231-252, February.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0061718. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.