The Internal Structure of U. S. Consumption Expenditures

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More generally, it is not clear to me why we should want to specifically and target healthcare for broad cost containment over other expenditures we collectively make. Posted in - Economics , Health policy. USA is taking care of their people while making huge spending on health sectors. It shows that the nation takes and concern more about the public health. An interesting article, consistent with my observation that much healthcare spending in the US is high-status, consumer non-durable spending.

However, given our high levels of health expenditures, there is relatively little cost-benefit analysis on effects of healthcare spending, e. There is an articulate advocate for every medical intervention, even for those with no demonstrable benefit. Even with substantial Federal subsidies, there is evidence that markets can restrain growth in spending if consumers have enough choice. Of course, there are a few that really hate this idea. They include doctors, hospitals and pharmaceutical companies.

Well done again! I think you have done more to advance understanding on this point than anyone else that I know of. Thanks for advancing the state of knowledge. Thanks for clarifying… I was going to ask inequality of what? In what way would you expect inequality to affect the numbers compared to other developed nations? I mean that compares starkly against the kind of care you can get in a relatively wealthy urban center. Related is the point about income inequality.

My point was that individual income inequality, which is the stat people are presumably talking about here when they make x-country comparisons, is not likely to matter much since the best available data suggests the poor spend at least as much as the rich in the US and virtually nothing suggests large differences. Quasi-experimental research studies also point in a very similar direction. Reblogged this on Davi Lyra-Leite and commented: This is an amazing analysis on healthcare costs versus consumption of goods in the US and Europe.

The study that tries to determines health price indexes is incredibly surprising to say least. The study which tackles specific hospital pricing costs is more in line with my expectations. That is, specific procedures are usually much cheaper to get in Canada, but not so much relatively cheaper when AIC is factored in. I am missing something with regards to the health price index study? How does the US do so favorably in this study when the high specific hospital pricing costs should suggest a more modest result?

Exchange rates are pretty volatile which can make point in time PLIs between country comparisons a little bit unreliable since exchange rates are part of the equation. Also, probably more importantly, the US is a bit unusual as a de facto reserve currency and the like. Thanks for the pointer. I think I could share down government f. These data along with government individual consumption and [also in Table ] in-kind transfers help unpack the net government impact on AIC.

Most of your discussion is in regard to the use of GDP as a valid figure for the ratio. I have some questions regarding the underlying data for the expenditures of the ratio. What is included in the figures for expenditures for health care and where does the data come from? Does it include insurance premiums, HSA and other health saving instruments, over the counter expenditures and so on? Would it be useful to review how these influence the analysis? We also contribute the maximum amount to an HSA and the out of pocket expenses come out of that account.

My actual household annual expense for healthcare items is substantially smaller than the outlay for premiums and HSA contributions. I cannot say if this is a common scenario for Americans.


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However, the reality is I am actually paying a substantial amount for healthcare due to premiums and HSA contributions. I am just not getting much healthcare in return, compared to the amounts being spent. Obviously, in any given year, this could change dramatically for my household. I have similar questions for those with company sponsored plans where the employee pays some percentage of the premium and the company pays the rest. Although, I think even that may be complicated in the cases where the sponsored plans are self-funded.

I do not think the company actually pays the entirety of the remaining premium. The premium shown the employee may only be an actuarial figure and, since the plan is self-funded, the company does not have to pay the entire amount. Another question, assuming premiums are included: how is profit to the health insurance company accommodated? Is this profit included in the health care expenditures?

Would it be significant enough to change the final numbers if it was excluded? If premiums are included, are payroll deductions for Medicare also included or should they be excluded.

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FICA deductions for Medicare are 2. For Medicare, the household incurs the cost during their working years but the actual provision of Medicare paid healthcare, if any, for that household would not occur until reaching Medicare status, typically aged If the numbers are only for expenditures for direct medical care, how is this figure arrived at.

I do not think it could be gathered from census data or income tax data since too many, particularly those with Medicare, have no real idea of how much cost was incurred for medical treatment. If, for example, Medicare supplied data is included, those expenses are for households which are, generally, not really incurring much, if any, actual direct expenses. Perhaps there needs to be analysis of healthcare expenditures for healthcare which is never received?

For me, I am skeptical regarding figures for healthcare outlays in any given year since there are so many possible items which could skew the numbers, perhaps quite dramatically. And I have no idea how the figures gathered for the US would be able to compare meaningfully with expenditures for healthcare in countries with mostly, or entirely, government funded healthcare systems such at Canada, GB, France, etc.

Again, thanks for this analysis. It has certainly be thought provoking and now I will need to browse through your other entries. Amongst developed countries, like the US, the NHE estimates should be quite accurate and quite comparable as in, comparing like-with-like , especially in more recent years post as these countries further harmonized their internal national health accounts systems with SHA latest international system and report the data internationally according to those conventions. This is all based on expenditure accounting. Amongst other things, it lets them allocate these expenditures to different types of providers, functions, and financing sources.

I have spent some time with each of the links but I am not really convinced the data is reliable. Since the methodology takes over pages to discuss, it is a pretty complicated problem SHA is trying to address. This appears to be the first major revision to their methodology. With this much difficulty, I have to wonder what the main flaws are, what magnitude they are, and which direction the issues tend to skew the numbers.

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Depending on your view of how solid the expenditure data is, you can probably just skip the rest of this post! I mostly just skimmed through the rest. Health accounts should use the accrual method, in which expenditures are attributed to the time period during which the economic value was created, rather than the cash method, in which expenditures are registered when the actual cash disbursements took place. This could be a pretty big issue. If they do not, it would tend to over state healthcare expenditures in the US, possibly by a substantial amount.

The people doing this work are not idiots and surely thought about this but I do not find where or how they accommodated the issue. To me it is an important question since the ratio of collections to billings is an often discussed topic among private practice providers, although I find it mostly useless since a clinic can set the fee schedule very high knowing the amount is unlikely to ever be collected.

I have heard discussions from providers where they take the Medicare fee schedule and multiply it by as much as a factor of 7 to set their own fee schedule. When talking to these providers, the billed amount is often the figure used when discussing their actual performance. I would have to guess in countries with national health systems this would be a different issue since the providers may not be setting their own fee schedules. Regardless, it is not clear to me how it is being handled, much less how it should be handled.

My first thought is to take all the various expenditures made by the various forms of HF towards the specified allowable healthcare expenditures and then add in items such as out of pocket expenses. I see they do include some OTC expenditures as long as they meet specific criteria.

Why does the US spend so much and get so little for its spending? Are US doctors and hospitals less competent? This seems hard to believe. Does the US system provide expensive services of marginal utility to some people, while withholding essential services from others? This seems more likely. Outcomes-based analysis is tricky here. The trouble is that there are surely many other major factors impacting health outcomes between countries than the provision of health care alone.

The US fares very poorly in many of these other determinants of health outcomes.

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For example, the US has obesity and diabetes rates much higher than other countries — factors that predict much worse health outcomes other things equal. The US also had very high smoking rates in the past number one according to some credible estimates and the peak effects on mortality rates are thought to lag by decades. Unsurprisingly, if one looks at parts of the US that look and behave more like Europe, the health outcomes tend to be quite comparable despite still higher rates of obesity low-to-modest by US standards.

The poor health outcomes tend to be concentrated in communities counties, MSAs, etc troubled by precisely these sorts of factors; indeed they are highly correlated with these factors and appear to be uncorrelated with health spending and many other indicators of healthcare provision e.

We find consistent outcomes outside of the US. However, many other high-income countries have also long since crossed this inflection point and show no more sign of changing their aggregate health spending patterns with respect to income. Here are some that come to mind:. Namely government intervention. These tabs show where you are within the application and at what step can criteria be selected or changed.

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