[go: up one dir, main page]
IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v137y2023ics0168851023001872.html
   My bibliography  Save this article

Under-spending, over-spending or substitution among services? Spatial patterns of unexplained shares of health care expenditures

Author

Listed:
  • Torrini, Irene
  • Grassetti, Luca
  • Rizzi, Laura
Abstract
Using individual-level administrative data, we investigate the spatial patterns of unexplained shares of health care expenditures (HCE) at the municipality level. The focus is on the elderly population in the Italian Region Friuli-Venezia Giulia observed over the period 2017-2019. The empirical analysis comprises two steps. First, random-effects two-part models are estimated to analyze the effect of age, morbidity, and death on the probability and amount of positive individual total HCE and its components. Second, the unexplained shares of HCE at the municipality level are examined to identify areas with under- or over-spending and substitution among services. Results confirm the existing findings on the determinants of HCE and reveal geographic patterns in the unexplained shares of expenditures. We identify clusters of municipalities with observed HCE higher than predicted for each type of service and clusters with substitution between home care and all other services. These findings are associated with the degree of urbanization of these areas and, consequently, with the ease of access to health care. This is crucial from a policy perspective, as it indicates specific policy targets for public health intervention.

Suggested Citation

  • Torrini, Irene & Grassetti, Luca & Rizzi, Laura, 2023. "Under-spending, over-spending or substitution among services? Spatial patterns of unexplained shares of health care expenditures," Health Policy, Elsevier, vol. 137(C).
    • Handle: RePEc:eee:hepoli:v:137:y:2023:i:c:s0168851023001872
    DOI: 10.1016/j.healthpol.2023.104902
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0168851023001872
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.healthpol.2023.104902?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
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Filippini, Massimo & Masiero, Giuliano & Moschetti, Karine, 2006. "Socioeconomic determinants of regional differences in outpatient antibiotic consumption: Evidence from Switzerland," Health Policy, Elsevier, vol. 78(1), pages 77-92, August.
    2. Howdon, Daniel & Rice, Nigel, 2018. "Health care expenditures, age, proximity to death and morbidity: Implications for an ageing population," Journal of Health Economics, Elsevier, vol. 57(C), pages 60-74.
    3. Nisha C. Hazra & Caroline Rudisill & Martin C. Gulliford, 2018. "Determinants of health care costs in the senior elderly: age, comorbidity, impairment, or proximity to death?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(6), pages 831-842, July.
    4. Albert Wong & Pieter H. M. van Baal & Hendriek C. Boshuizen & Johan J. Polder, 2011. "Exploring the influence of proximity to death on disease‐specific hospital expenditures: a carpaccio of red herrings," Health Economics, John Wiley & Sons, Ltd., vol. 20(4), pages 379-400, April.
    5. 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.
    6. Duan, Naihua, et al, 1984. "Choosing between the Sample-Selection Model and the Multi-part Model," Journal of Business & Economic Statistics, American Statistical Association, vol. 2(3), pages 283-289, July.
    7. Eibich, Peter & Ziebarth, Nicolas R., 2014. "Analyzing regional variation in health care utilization using (rich) household microdata," Health Policy, Elsevier, vol. 114(1), pages 41-53.
    8. Heidi H. Ewen & Tiffany R. Washington & Kerstin G. Emerson & Andrew T. Carswell & Matthew Lee Smith, 2017. "Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services," IJERPH, MDPI, vol. 14(3), pages 1-12, March.
    9. Amy Finkelstein & Matthew Gentzkow & Heidi Williams, 2016. "Sources of Geographic Variation in Health Care: Evidence From PatientMigration," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 131(4), pages 1681-1726.
    10. Felder, Stefan & Werblow, Andreas & Zweifel, Peter, 2010. "Do red herrings swim in circles? Controlling for the endogeneity of time to death," Journal of Health Economics, Elsevier, vol. 29(2), pages 205-212, March.
    11. Dirk Göpffarth & Thomas Kopetsch & Hendrik Schmitz, 2016. "Determinants of Regional Variation in Health Expenditures in Germany," Health Economics, John Wiley & Sons, Ltd., vol. 25(7), pages 801-815, July.
    12. Miranda, Rafael & Oliveira, Mónica Duarte & Baptista, Filipa Matos & Albuquerque, Isabel, 2023. "Telemonitoring in Portugal: where do we stand and which way forward?," Health Policy, Elsevier, vol. 131(C).
    13. Seshamani, Meena & Gray, Alastair M., 2004. "A longitudinal study of the effects of age and time to death on hospital costs," Journal of Health Economics, Elsevier, vol. 23(2), pages 217-235, March.
    14. Louise Sheiner & David M. Cutler, 1999. "The Geography of Medicare," American Economic Review, American Economic Association, vol. 89(2), pages 228-233, May.
    15. de Meijer, Claudine & Koopmanschap, Marc & d' Uva, Teresa Bago & van Doorslaer, Eddy, 2011. "Determinants of long-term care spending: Age, time to death or disability?," Journal of Health Economics, Elsevier, vol. 30(2), pages 425-438, March.
    16. Duan, Naihua, et al, 1983. "A Comparison of Alternative Models for the Demand for Medical Care," Journal of Business & Economic Statistics, American Statistical Association, vol. 1(2), pages 115-126, April.
    17. Joan Costa-Font & Ana Rico, 2006. "Devolution and the Interregional Inequalities in Health and Healthcare in Spain," Regional Studies, Taylor & Francis Journals, vol. 40(8), pages 875-887.
    18. Marc Carreras & Pere Ibern & José María Inoriza, 2018. "Ageing and healthcare expenditures: Exploring the role of individual health status," Health Economics, John Wiley & Sons, Ltd., vol. 27(5), pages 865-876, May.
    19. Moscone, Francesco & Knapp, Martin & Tosetti, Elisa, 2007. "Mental health expenditure in England: A spatial panel approach," Journal of Health Economics, Elsevier, vol. 26(4), pages 842-864, July.
    20. Moscone, Francesco & Skinner, Jonathan & Tosetti, Elisa & Yasaitis, Laura, 2019. "The association between medical care utilization and health outcomes: A spatial analysis," Regional Science and Urban Economics, Elsevier, vol. 77(C), pages 306-314.
    21. 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.
    22. Friedrich Breyer & Joan Costa-Font & Stefan Felder, 2010. "Ageing, health, and health care," Oxford Review of Economic Policy, Oxford University Press and Oxford Review of Economic Policy Limited, vol. 26(4), pages 674-690, Winter.
    23. Skinner, Jonathan, 2011. "Causes and Consequences of Regional Variations in Health Care," Handbook of Health Economics, in: Mark V. Pauly & Thomas G. Mcguire & Pedro P. Barros (ed.), Handbook of Health Economics, volume 2, chapter 0, pages 45-93, Elsevier.
    24. Liu, Lei & Strawderman, Robert L. & Cowen, Mark E. & Shih, Ya-Chen T., 2010. "A flexible two-part random effects model for correlated medical costs," Journal of Health Economics, Elsevier, vol. 29(1), pages 110-123, January.
    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. Jonas Krämer & Jonas Schreyögg, 2019. "Demand-side determinants of rising hospital admissions in Germany: the role of ageing," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(5), pages 715-728, July.
    2. Joan Costa‐Font & Cristina Vilaplana‐Prieto, 2020. "‘More than one red herring'? Heterogeneous effects of ageing on health care utilisation," Health Economics, John Wiley & Sons, Ltd., vol. 29(S1), pages 8-29, October.
    3. Maynou, Laia & Street, Andrew & García−Altés, Anna, 2023. "Living longer in declining health: Factors driving healthcare costs among older people," Social Science & Medicine, Elsevier, vol. 327(C).
    4. Kasteridis, Panagiotis & Rice, Nigel & Santos, Rita, 2022. "Heterogeneity in end of life health care expenditure trajectory profiles," Journal of Economic Behavior & Organization, Elsevier, vol. 204(C), pages 221-251.
    5. Maciej Lis, 2015. "Red Herring in the Vistula River: Time-to-Death and Health Care Expenditure," IBS Working Papers 13/2015, Instytut Badan Strukturalnych.
    6. Friedrich Breyer & Normann Lorenz, 2021. "The “red herring” after 20 years: ageing and health care expenditures," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(5), pages 661-667, July.
    7. Vincenzo Atella & Valentina Conti, 2013. "The effect of age and time to death on health care expenditures: the Italian experience," CEIS Research Paper 267, Tor Vergata University, CEIS, revised 12 Nov 2013.
    8. Mauro Laudicella & Paolo Li Donni & Kim Rose Olsen & Dorte Gyrd‐Hansen, 2022. "Age, morbidity, or something else? A residual approach using microdata to measure the impact of technological progress on health care expenditure," Health Economics, John Wiley & Sons, Ltd., vol. 31(6), pages 1184-1201, June.
    9. Moore, Patrick V. & Bennett, Kathleen & Normand, Charles, 2017. "Counting the time lived, the time left or illness? Age, proximity to death, morbidity and prescribing expenditures," Social Science & Medicine, Elsevier, vol. 184(C), pages 1-14.
    10. Audrey Tanguy-Melac & Dorian Verboux & Laurence Pestel & Anne Fagot-Campagna & Philippe Tuppin & Christelle Gastaldi-Ménager, 2021. "Evolution of health care utilization and expenditure during the year before death in 2015 among people with cancer: French snds-based cohort study," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(7), pages 1039-1052, September.
    11. Anne Mason & Idaira Rodriguez Santana & María José Aragón & Nigel Rice & Martin Chalkley & Raphael Wittenberg & Jose-Luis Fernandez, 2019. "Drivers of health care expenditure: Final report," Working Papers 169cherp, Centre for Health Economics, University of York.
    12. Atella, Vincenzo & Conti, Valentina, 2014. "The effect of age and time to death on primary care costs: The Italian experience," Social Science & Medicine, Elsevier, vol. 114(C), pages 10-17.
    13. Viktor von Wyl & Konstantin Beck, 2014. "Risk adjustment in aging societies," Health Economics Review, Springer, vol. 4(1), pages 1-14, December.
    14. Davillas, Apostolos & Pudney, Stephen, 2020. "Using biomarkers to predict healthcare costs: Evidence from a UK household panel," Journal of Health Economics, Elsevier, vol. 73(C).
    15. Howdon, Daniel & Rice, Nigel, 2018. "Health care expenditures, age, proximity to death and morbidity: Implications for an ageing population," Journal of Health Economics, Elsevier, vol. 57(C), pages 60-74.
    16. Nisha C. Hazra & Caroline Rudisill & Martin C. Gulliford, 2018. "Determinants of health care costs in the senior elderly: age, comorbidity, impairment, or proximity to death?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(6), pages 831-842, July.
    17. Eric French & John Bailey Jones & Elaine Kelly & Jeremy McCauley, 2018. "End-of-Life Medical Expenses," Working Paper 18-18, Federal Reserve Bank of Richmond.
    18. Calciolari, Stefano & Luini, Cecilia, 2023. "Effects of the bio-psycho-social frailty dimensions on healthcare utilisation among elderly in Europe: A cross-country longitudinal analysis," Social Science & Medicine, Elsevier, vol. 339(C).
    19. Caravaggio, Nicola & Resce, Giuliano, 2023. "Enhancing Healthcare Cost Forecasting: A Machine Learning Model for Resource Allocation in Heterogeneous Regions," Economics & Statistics Discussion Papers esdp23090, University of Molise, Department of Economics.
    20. Viktor von Wyl, 2019. "Proximity to death and health care expenditure increase revisited: A 15-year panel analysis of elderly persons," Health Economics Review, Springer, vol. 9(1), pages 1-16, December.

    More about this item

    Keywords

    Administrative population data; Elderly health care expenditures; Health econometrics; Spatial analysis;
    All these keywords.

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I10 - Health, Education, and Welfare - - Health - - - General
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public 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:eee:hepoli:v:137:y:2023:i:c:s0168851023001872. 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: Catherine Liu or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    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.