IDEAS home Printed from https://ideas.repec.org/p/pra/mprapa/16026.html
   My bibliography  Save this paper

The Sustainability of European Health Care Systems: Beyond Income and Ageing

Author

Listed:
  • Pammolli, Fabio
  • Riccaboni, Massimo
  • Magazzini, Laura

Abstract

During the last thirty years health care expenditure (HCE) has been growing much more rapidly than GDP in all OECD countries. Against this background, we look at the determinants of HCE growth in Europe, explicitly taking into account the role of income, ageing population, life habits, technological progress, as well as institutional and budgetary variables. Our results confirm that the current trend of increasing HCE is rooted in a set of differentiated factors. Income levels lead to higher HCE, and the magnitude of the estimated elasticity poses serious concerns about long-term sustainability of current trends. All in all, HCE growth appears to be driven by structural factors that cannot be easily compressed if not through rationing. The key challenge for many European Governments seems to be the design of pluralistic systems, where a well-balanced mix of public and private financing can realize a balance between sustainability and access.

Suggested Citation

  • Pammolli, Fabio & Riccaboni, Massimo & Magazzini, Laura, 2008. "The Sustainability of European Health Care Systems: Beyond Income and Ageing," MPRA Paper 16026, University Library of Munich, Germany.
  • Handle: RePEc:pra:mprapa:16026
    as

    Download full text from publisher

    File URL: https://mpra.ub.uni-muenchen.de/16026/1/MPRA_paper_16026.pdf
    File Function: original version
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Richard Rogerson, 2006. "Understanding Differences in Hours Worked," Review of Economic Dynamics, Elsevier for the Society for Economic Dynamics, vol. 9(3), pages 365-409, July.
    2. John Nixon, "undated". "Convergence Analysis of Health Care Expenditure in the EU Countries Using Two Approaches," Discussion Papers 99/3, Department of Economics, University of York.
    3. Andrea Bassanini & Stefano Scarpetta, 2001. "Does Human Capital Matter for Growth in OECD Countries?: Evidence from Pooled Mean-Group Estimates," OECD Economics Department Working Papers 282, OECD Publishing.
    4. Hartwig, Jochen, 2008. "What drives health care expenditure?--Baumol's model of 'unbalanced growth' revisited," Journal of Health Economics, Elsevier, vol. 27(3), pages 603-623, May.
    5. Richard Rogerson, 2008. "Structural Transformation and the Deterioration of European Labor Market Outcomes," Journal of Political Economy, University of Chicago Press, vol. 116(2), pages 235-259, April.
    6. Hans‐Peter Kohler & Francesco C. Billari & José Antonio Ortega, 2002. "The Emergence of Lowest‐Low Fertility in Europe During the 1990s," Population and Development Review, The Population Council, Inc., vol. 28(4), pages 641-680, December.
    7. Blundell, Richard & Bond, Stephen, 1998. "Initial conditions and moment restrictions in dynamic panel data models," Journal of Econometrics, Elsevier, vol. 87(1), pages 115-143, August.
    8. Joseph P. Newhouse, 1977. "Medical-Care Expenditure: A Cross-National Survey," Journal of Human Resources, University of Wisconsin Press, vol. 12(1), pages 115-125.
    9. Okunade, Albert A. & Murthy, Vasudeva N. R., 2002. "Technology as a 'major driver' of health care costs: a cointegration analysis of the Newhouse conjecture," Journal of Health Economics, Elsevier, vol. 21(1), pages 147-159, January.
    10. Robert E. Hall & Charles I. Jones, 2007. "The Value of Life and the Rise in Health Spending," The Quarterly Journal of Economics, Oxford University Press, vol. 122(1), pages 39-72.
    11. Gianluca Baio & Laura Magazzini & Claudia Oglialoro & Fabio Pammolli & Massimo Riccaboni, 2005. "Medical Devices: Competitiveness and Impact on Public Health Expenditure," Working Papers CERM 05-2005, Competitività, Regole, Mercati (CERM).
    12. 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, September.
    13. Mary O'Mahony & Marcel P. Timmer, 2009. "Output, Input and Productivity Measures at the Industry Level: The EU KLEMS Database," Economic Journal, Royal Economic Society, vol. 119(538), pages 374-403, June.
    14. Getzen, Thomas E., 2000. "Health care is an individual necessity and a national luxury: applying multilevel decision models to the analysis of health care expenditures," Journal of Health Economics, Elsevier, vol. 19(2), pages 259-270, March.
    15. Jochen Hartwig, 2011. "Testing The Baumol–Nordhaus Model With Eu Klems Data," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 57(3), pages 471-489, September.
    16. Han, Yoo-Jin, 2007. "Measuring industrial knowledge stocks with patents and papers," Journal of Informetrics, Elsevier, vol. 1(4), pages 269-276.
    17. Gerdtham, Ulf-G. & Jonsson, Bengt, 2000. "International comparisons of health expenditure: Theory, data and econometric analysis," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 1, pages 11-53, Elsevier.
    18. Carrion-i-Silvestre, Josep Lluis, 2005. "Health care expenditure and GDP: Are they broken stationary?," Journal of Health Economics, Elsevier, vol. 24(5), pages 839-854, September.
    19. Daniela Del Boca & Daniela Vuri, 2007. "The mismatch between employment and child care in Italy: the impact of rationing," Journal of Population Economics, Springer;European Society for Population Economics, vol. 20(4), pages 805-832, October.
    20. Elizabeth Docteur & Howard Oxley, 2003. "Health-Care Systems: Lessons from the Reform Experience," OECD Health Working Papers 9, OECD Publishing.
    21. N.R. Murthy & Albert Okunade, 2000. "Managed care, deficit financing, and aggregate health care expenditure in the United States: A cointegration analysis," Health Care Management Science, Springer, vol. 3(4), pages 279-285, September.
    22. 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.
    23. Nickell, Stephen J, 1981. "Biases in Dynamic Models with Fixed Effects," Econometrica, Econometric Society, vol. 49(6), pages 1417-1426, November.
    24. Baumol, William J, 1993. "Health Care, Education and the Cost Disease: A Looming Crisis for Public Choice," Public Choice, Springer, vol. 77(1), pages 17-28, September.
    25. Jewell, Todd & Lee, Junsoo & Tieslau, Margie & Strazicich, Mark C., 2003. "Stationarity of health expenditures and GDP: evidence from panel unit root tests with heterogeneous structural breaks," Journal of Health Economics, Elsevier, vol. 22(2), pages 313-323, March.
    26. Blomqvist, A. G. & Carter, R. A. L., 1997. "Is health care really a luxury?," Journal of Health Economics, Elsevier, vol. 16(2), pages 207-229, April.
    27. Manuel Arellano & Stephen Bond, 1991. "Some Tests of Specification for Panel Data: Monte Carlo Evidence and an Application to Employment Equations," Review of Economic Studies, Oxford University Press, vol. 58(2), pages 277-297.
    28. Anderson, T. W. & Hsiao, Cheng, 1982. "Formulation and estimation of dynamic models using panel data," Journal of Econometrics, Elsevier, vol. 18(1), pages 47-82, January.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Mihaela Tofan & Mihaela Onofrei & Anca-Florentina Vatamanu, 2020. "Fiscal Responsibility Legal Framework—New Paradigm for Fiscal Discipline in the EU," Risks, MDPI, vol. 8(3), pages 1-18, July.
    2. Lakomaa, Erik & Sanandaji, Tino, 2017. "Integrating community driven care service in European welfare states – nonprofit institutional entrepreneurship as driver for expanding access," SSE Working Paper Series in Economic History 2017:5, Stockholm School of Economics.
    3. Rocco Palumbo, 2020. "Improving Health Professionals’ Involvement Whilst Sustaining Work–Life Balance: Evidence from an Empirical Analysis," Sustainability, MDPI, vol. 12(21), pages 1-21, November.
    4. Michael Osti & Johannes Steyrer, 2017. "A perspective on the health care expenditures for defensive medicine," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(4), pages 399-404, May.
    5. Pammolli, Fabio & Salerno, Nicola, 2011. "Le differenze regionali nella governance della spesa sanitaria. La sanità alla sfide del federalismo: il modello SaniRegio di CeRM [Regional differences in the governance of health care expenditure," MPRA Paper 36934, University Library of Munich, Germany.
    6. Renuga Nagarajan & Aurora A.C. Teixeira & Sandra T. Silva, 2013. "The impact of population ageing on economic growth: an in-depth bibliometric analysis," FEP Working Papers 505, Universidade do Porto, Faculdade de Economia do Porto.
    7. Sónia Morgado, 2014. "Does health promote economic growth? Portuguese case study: from dictatorship to full democracy," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(6), pages 591-598, July.
    8. Allen, Nicola & Pichler, Franz & Wang, Tina & Patel, Sundip & Salek, Sam, 2013. "Development of archetypes for non-ranking classification and comparison of European National Health Technology Assessment systems," Health Policy, Elsevier, vol. 113(3), pages 305-312.
    9. Héctor Bellido & Lorena Olmos & Juan Antonio Román-Aso, 2019. "Do political factors influence public health expenditures? Evidence pre- and post-great recession," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(3), pages 455-474, April.
    10. Carla Blazquez-Fernandez & David Cantarero & Patricio Perez, 2014. "Disentangling the heterogeneous income elasticity and dynamics of health expenditure," Applied Economics, Taylor & Francis Journals, vol. 46(16), pages 1839-1854, June.
    11. Sanandaji, Tino & Lakomaa, Erik, 2016. "Care, Commons and Entrepreneurship," SSE Working Paper Series in Economic History 2016:2, Stockholm School of Economics.
    12. Di Matteo, Livio & Cantarero-Prieto, David, 2018. "The Determinants of Public Health Expenditures: Comparing Canada and Spain," MPRA Paper 87800, University Library of Munich, Germany.
    13. 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.
    14. José Castillo-Manzano & Mercedes Castro-Nuño & Xavier Fageda, 2014. "Can health public expenditure reduce the tragic consequences of road traffic accidents? The EU-27 experience," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(6), pages 645-652, July.
    15. Renuga Nagarajan & Aurora A. C. Teixeira & Sandra Silva, 2017. "The Impact Of Population Ageing On Economic Growth: A Bibliometric Survey," The Singapore Economic Review (SER), World Scientific Publishing Co. Pte. Ltd., vol. 62(02), pages 275-296, June.
    16. Lakomaa, Erik & Sanandaji, Tino, 2017. "Can Community Driven Care be integrated in the European Welfare System? Institutional Challenges and Historical Lessons," SSE Working Paper Series in Economic History 2017:3, Stockholm School of Economics.
    17. Fabio Pammolli & Nicola Carmine Salerno, 2011. "Le differenze regionali nella governance della spesa sanitaria - SaniRegio-2011," Working Papers CERM 02-2011, Competitività, Regole, Mercati (CERM).
    18. Munjae Lee & Sewon Park & Kyu-Sung Lee, 2019. "What Are the Features of Successful Medical Device Start-Ups? Evidence from KOREA," Sustainability, MDPI, vol. 11(7), pages 1-17, April.
    19. Kirsten Beedholm & Kirsten Frederiksen & Anne‐Marie Skovsgaard Frederiksen & Kirsten Lomborg, 2015. "Attitudes to a robot bathtub in Danish elder care: A hermeneutic interview study," Nursing & Health Sciences, John Wiley & Sons, vol. 17(3), pages 280-286, September.
    20. Joohun Han & Chanjin Chung, 2021. "Impact of Aging and Underemployment on Income Disparity between Agricultural and Non-Agricultural Households," Sustainability, MDPI, vol. 13(21), pages 1-15, October.

    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. Felipa de Mello-Sampayo & Sofia de Sousa-Vale, 2014. "Financing Health Care Expenditure in the OECD Countries: Evidence from a Heterogeneous, Cross-Sectional Dependent Panel," Panoeconomicus, Savez ekonomista Vojvodine, Novi Sad, Serbia, vol. 61(2), pages 207-225.
    2. Felipa de Mello-Sampayo & Sofia de Sousa-Vale, 2014. "Financing Health Care Expenditure in the OECD Countries: Evidence from a Heterogeneous, Cross-Sectional Dependent Panel," Panoeconomicus, Savez ekonomista Vojvodine, Novi Sad, Serbia, vol. 61(2), pages 207-225, March.
    3. Joan Costa-Font & Marin Gemmill & Gloria Rubert, 2008. "Re-visiting the Health Care Luxury Good Hypothesis: Aggregation, Precision, and Publication Biases?," Working Papers in Economics 197, Universitat de Barcelona. Espai de Recerca en Economia.
    4. Hartwig, Jochen, 2008. "What drives health care expenditure?--Baumol's model of 'unbalanced growth' revisited," Journal of Health Economics, Elsevier, vol. 27(3), pages 603-623, May.
    5. Chakroun, Mohamed, 2009. "Health care expenditure and GDP: An international panel smooth transition approach," MPRA Paper 14322, University Library of Munich, Germany.
    6. Muhammad Arshad Khan & Muhammad Iftikhar Ul Husnain, 2019. "Is health care a luxury or necessity good? Evidence from Asian countries," International Journal of Health Economics and Management, Springer, vol. 19(2), pages 213-233, June.
    7. repec:dau:papers:123456789/7972 is not listed on IDEAS
    8. Vasudeva N. R. Murthy & Natalya Ketenci, 2017. "Is technology still a major driver of health expenditure in the United States? Evidence from cointegration analysis with multiple structural breaks," International Journal of Health Economics and Management, Springer, vol. 17(1), pages 29-50, March.
    9. Di Matteo, Livio, 2005. "The macro determinants of health expenditure in the United States and Canada: assessing the impact of income, age distribution and time," Health Policy, Elsevier, vol. 71(1), pages 23-42, January.
    10. Baltagi, Badi H. & Moscone, Francesco, 2010. "Health care expenditure and income in the OECD reconsidered: Evidence from panel data," Economic Modelling, Elsevier, vol. 27(4), pages 804-811, July.
    11. Badi H. Baltagi & Raffaele Lagravinese & Francesco Moscone & Elisa Tosetti, 2017. "Health Care Expenditure and Income: A Global Perspective," Health Economics, John Wiley & Sons, Ltd., vol. 26(7), pages 863-874, July.
    12. Potrafke, Niklas, 2010. "The growth of public health expenditures in OECD countries: Do government ideology and electoral motives matter?," Journal of Health Economics, Elsevier, vol. 29(6), pages 797-810, December.
    13. Fan, Victoria Y. & Savedoff, William D., 2014. "The health financing transition: A conceptual framework and empirical evidence," Social Science & Medicine, Elsevier, vol. 105(C), pages 112-121.
    14. Mehdi Barati & Hadiseh Fariditavana, 2020. "Asymmetric effect of income on the US healthcare expenditure: evidence from the nonlinear autoregressive distributed lag (ARDL) approach," Empirical Economics, Springer, vol. 58(4), pages 1979-2008, April.
    15. Kamil Dybczak & Bartosz Przywara, 2010. "The role of technology in health care expenditure in the EU," European Economy - Economic Papers 2008 - 2015 400, Directorate General Economic and Financial Affairs (DG ECFIN), European Commission.
    16. Joan Costa‐Font & Jordi Pons‐Novell, 2007. "Public health expenditure and spatial interactions in a decentralized national health system," Health Economics, John Wiley & Sons, Ltd., vol. 16(3), pages 291-306, March.
    17. Peter Willemé & Michel Dumont, 2016. "Machines that go ‘ping’: Medical Technology and Health Expenditures in OECD Countries," Health Economics, John Wiley & Sons, Ltd., vol. 25(3), pages 387-388, March.
    18. Yonghong An & Kai Zhao & Rong Zhou, 2016. "Health spending and public pension: evidence from panel data," Applied Economics, Taylor & Francis Journals, vol. 48(11), pages 987-1004, March.
    19. Victoria Fan and William Savedoff, 2014. "The Health Financing Transition: A Conceptual Framework and Empirical Evidence - Working Paper 358," Working Papers 358, Center for Global Development.
    20. Michel Dumont & Peter Willemé, 2013. "Working Paper 02-13 - Machines that go ‘ping’: medical technology and health expenditures in OECD countries," Working Papers 1302, Federal Planning Bureau, Belgium.
    21. Hyejin Lee & Dong-Yop Oh & Ming Meng, 2019. "Stationarity and cointegration of health care expenditure and GDP: evidence from tests with smooth structural shifts," Empirical Economics, Springer, vol. 57(2), pages 631-652, August.

    More about this item

    Keywords

    health care expenditure; sustainability; ageing population; income elasticity; welfare;
    All these keywords.

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health

    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:pra:mprapa:16026. 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: Joachim Winter (email available below). General contact details of provider: https://edirc.repec.org/data/vfmunde.html .

    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.