Determinanty wydatków na zdrowie w gospodarstwach domowych w Polsce

• Autorzy: Błażej Łyszczarz

Warianty tytułu

Determinants of household health expenditure in Poland

• Języki publikacji: PL

Abstrakty

Celem artykułu jest identyfikacja oraz kwantyfikacja społecznych i ekonomicznych determinant prywatnych wydatków na zdrowie ponoszonych przez gospodarstwa domowe w Polsce. Głównym przedmiotem zainteresowania jest przy tym wpływ wysokości dochodów na wydatki na zdrowie. W celu oszacowania tych zależności posłużono się analizą regresji dla danych panelowych, stosując przy tym modele z efektami ustalonymi, metodę zmiennych instrumentalnych oraz panel dynamiczny. Dane wykorzystane przy szacowaniu modeli pochodzą z Banku Danych Lokalnych GUS i dotyczą lat 1999-2015. Zmienną zależną w szacowanych równaniach są realne wydatki na zdrowie, wśród zmiennych objaśniających znalazły się zmienne ilustrujące realny dochód rozporządzalny; stan zdrowia; dostępność opieki zdrowotnej; cenę opieki zdrowotnej, zanieczyszczenie środowiska i strukturę wiekową populacji. W zależności od specyfikacji modelu elastyczność dochodowa wydatków na zdrowie waha się między 0,45 a 0,87. Elastyczność dochodowa popytu na poziomie mniejszym od 1 oznacza, że opieka zdrowotna finansowana bezpośrednio przez gospodarstwa domowe z funduszy własnych ma w Polsce cechy dobra podstawowego. Innymi czynnikami wpływającymi na wydatkami na zdrowie okazały się odsetek osób powyżej 70. roku życia i stan zdrowia mierzony trwaniem życia. Czynnikiem nieistotnym dla kształtowania wydatków na zdrowie gospodarstw domowych okazała się podaż opieki zdrowotnej. Niejednoznaczne wnioski w tym zakresie dotyczą natomiast cen opieki zdrowotnej i zanieczyszczenia środowiska. (abstrakt oryginalny)

EN

The aim of the paper is to identify and quantify the social and economic determinants of private health expenditures by Polish households with a primary interest in the role of income. Panel data regression analysis is used to estimate relationships between socioeconomic factors and households' health expenditures. Fixed-effects, instrumental variables and dynamic panel approaches are used in the estimation. The data is taken from the Local Data Bank of Poland's Central Statistical Office (GUS) and covers the period 1999-2015. Real per capita health expenditures are used as a dependent variable and the covariates are real disposable income, health status, healthcare availability, healthcare prices, pollution, and population age structure. Depending on model specification, the income elasticity of household health expenditure ranges from 0.45 to 0.87. Income elasticity lower than one means that healthcare financed directly from household budgets has the characteristics of a necessity good in Poland. Other factors that correlate with health spending are the proportion of the population over 70 years old and health status measured by life expectancy. Meanwhile, healthcare supply was a factor that proved to be unrelated to households' health expenditure. On the other hand, the impact of healthcare prices and pollution is unclear.(original abstract)

Słowa kluczowe

PL

Wydatki na ochronę zdrowia; Region; Modele panelowe; Elastyczność dochodowa

EN

Expenditures on health care; Region; Panel model; Income elasticity

• Czasopismo: Gospodarka Narodowa
• Rocznik: 2018
• Numer: nr 1
• Strony: 137--157

Twórcy

autor

Błażej Łyszczarz

• Uniwersytet Mikołaja Kopernika w Toruniu

Bibliografia

• Ang J. B. [2010], The determinants of health care expenditure in Australia, "Applied Economics Letters", vol. 17, no. 7: 639-644.
• Auteri M., Costantini M. [2004], Is social protection a necessity or a luxury good? New multivariate cointegration panel data results, "Applied Economics", vol. 36, no. 17: 1887-1898.
• Baltagi B. H. [2008], Econometric analysis of panel data, Wiley, Chichester.
• Baltagi B. H., Wu P. X. [1999], Unequally spaced panel data regression with AR (1) disturbances, "Econometric Theory", vol. 15, no. 6: 814-823.
• Barros P. P. [1998], The black box of health care expenditure growth determinants, "Health Economics", vol. 7, no. 6: 533-544.
• Bhalotra S. [2007], Spending to save? State health expenditure and infant mortality in India, "Health Economics", vol. 16, no. 9: 911-928.
• Blomqvist A. [2011], Public-sector health care financing, w: Glied S., Smith P. C. (red.), The Oxford handbook of health economics, Oxford University Press, Oxford.
• Blundell R., Bond S. [1998], Initial conditions and moment restrictions in dynamic panel data models, "Journal of Econometrics", vol. 87: 115-143.
• Breyer F., Felder S. [2006], Life expectancy and health care expenditures: a new calculation for Germany using the costs of dying, "Health Policy", vol. 75, no. 2: 178-186.
• Broniatowska P., Majchrowska A., Żółkiewski Z. [2015], Minimum wage and youth unemployment in local labor markets in Poland, "Roczniki Kolegium Analiz Ekonomicznych", z. 39: 57-70.
• Cantarero Prieto D., Lago-Peñas S. [2012], Decomposing the determinants of health expenditure: the case of Spain, "European Journal of Health Economics", vol. 13, no. 1: 19-27.
• Carrion-i-Silvestre J. L. [2005], Health care expenditure and GDP: are they broken stationary? "Journal of Health Economics", vol. 24, no. 5: 839-854.
• Costa-Font J., Pons-Novell J. [2007], Public health expenditure and spatial interactions in a decentralized national health system, "Health Economics", vol. 16, no. 3: 291-306.
• Crivelli L., Filippini M., Mosca, L. [2006], Federalism and regional health care expenditures: an empirical analysis for the Swiss cantons, "Health Economics", vol. 15, no. 5: 535-541.
• Di Matteo L. [2005], The macro determinants of health expenditure in the United States and Canada: assessing the impact of income, age distribution and time, "Health Policy", vol. 71, no. 1: 23-42.
• Di Matteo L., Di Matteo R. [1998], Evidence on the determinants of Canadian provincial government health expenditures: 1965-1991, "Journal of Health Economics", vol. 17, no. 2: 211-228.
• Dormont B., Grignon M., Huber H. [2006], Health expenditure growth: reassessing the threat of ageing, "Health Economics", vol. 15, no. 9: 947-963.
• Freeman D. G. [2003], Is health care a necessity or a luxury? Pooled estimates of income elasticity from US state-level data, "Applied Economics", vol. 35, no. 5: 495-502.
• Gerdtham U., Sogaard J., Andersson F., Jonsson B. [1992], An econometric analysis of health care expenditure: a cross-section study of the OECD countries, "Journal of Health Economics", vol. 11, no. 1: 63-84.
• Göpffarth D., Kopetsch T., Schmitz H. [2016], Determinants of regional variation in health expenditures in Germany, "Health Economics", vol. 25, no. 7: 801-815.
• GUS [2017], Bank Danych Lokalnych, Warszawa, https://bdl.stat.gov.pl/BDL/start (19.02.2018).
• Herwartz H., Theilen B. [2003], The determinants of health care expenditure: testing pooling restrictions in small samples, "Health Economics", vol. 12, no. 2: 113-124.
• Hitiris T. [1997], Health care expenditure and integration in the countries of the European Union, "Applied Economics", vol. 29, no. 1: 1-6.
• Hitiris T., Posnett J. [1992], The determinants and effects of health expenditure in developed countries, "Journal of Health Economics", vol. 11, no. 2: 173-181.
• Jończyk P. [2010]. Struktura systemów oraz finansowanie opieki zdrowotnej w Polsce i na świecie, "Master of Business Administration", nr 2 (103): 116-139.
• Karatzas G. [2000], On the determination of the US aggregate health care expenditure, "Applied Economics", vol. 32, no. 9: 1085-1099.
• Kiymaz H., Akbulut Y., Demir A. [2006], Tests of stationarity and cointegration of health care expenditure and gross domestic product: an application to Turkey, "European Journal of Health Economics", vol. 7, no. 4: 285-289.
• Koenig L., Siegel J. M., Dobson A., Hearle K., Ho S., Roduwitz R. [2003], Drivers of healthcare expenditures associated with physician services, "The American Journal of Managed Care", vol. 9, no. S1: 34-42.
• Kowalczuk M., Torój A. [2015], Does it pay to pay for health? How health expenditure translate into GDP growth in OECD countries, "Roczniki Kolegium Analiz Ekonomicznych", z. 39: 103-117.
• Leu R. E. [1986], Public and private health services: complementarities and conflicts, w: Culyer A. J., Jönsson B. (red.), Public and private health services: complementarities and conflicts, Blackwell, Oxford.
• Liu D., Li R., Wang Z. [2010], Testing for structural breaks in panel varying coefficient models: with an application to OECD health expenditure, "Empirical Economics", vol. 40, no. 1: 95-118.
• Łyszczarz B., Nojszewska E. [2015], Determinanty wydatków na ochronę zdrowia w Europie, "Roczniki Kolegium Analiz Ekonomicznych", z. 39: 183-197.
• Maddala G. S. [2006], Ekonometria, Wydawnictwo Naukowe PWN, Warszawa.
• Malik A. M., Syed S. I. A. [2012], Socio-economic determinants of household out-of-pocket payments on healthcare in Pakistan, "International Journal for Equity in Health", vol. 11, nr art. 51.
• Martín J. J. M., Puerto Lopez del Amo Gonzalez M., Dolores Cano Garcia M. [2011], Review of the literature on the determinants of healthcare expenditure, "Applied Economics", vol. 43, no. 1: 19-46.
• Mosca I. [2007], Decentralization as a determinant of health care expenditure: empirical analysis for OECD countries, "Applied Economics Letters", vol. 14, no. 7: 511-515.
• Murray C. J. L., Govindaraj R., Musgrove P. [1994], National health expenditures: a global analysis, "Bulletin of the World Health Organization", vol. 72, no. 4: 623-637.
• Murthy N. R. V., Okunade A. A. [2000], Managed care, deficit financing, and aggregate health care expenditure in the United States: a cointegration analysis, "Health Care Management Science", vol. 3, no. 4: 279-285.
• Newhouse J. [1977], Medical care expenditure: a cross national survey, "The Journal of Human Resource", vol. 12, no. 1: 115-125.
• OECD [2006], Projecting OECD health and long-term care expenditures: what are the main drivers? OECD Economics Department Working Papers, no. 477.
• OECD [2017], OECD health statistics, Paris, http://www.oecd.org/els/health-systems/health-data.htm (19.02.2018).
• Piekut M., Gutkowska K. [2016], Wydatki na ochronę zdrowia w gospodarstwach domowych, "Polski Przegląd Nauk o Zdrowiu", nr 1 (46): 36-44.
• Reich O., Weins C., Schusterschitz C., Thöni M. [2012], Exploring the disparities of regional health care expenditures in Switzerland: some empirical evidence, "European Journal of Health Economics", vol. 13, no. 2: 193-202.
• Schaffer M. E. [2010], Xtivreg2: Stata module to perform extended IV/2SLS, GMM and AC/HAC, LIML and k-class regression for panel data models, http://ideas.repec.org/c/boc/bocode/s456501.html (19.02.2018).
• Seshamani M., Gray A. [2004], A longitudinal study of the effects of age and time to death on hospital costs, "Journal of Health Economics", vol. 23, no. 2: 217-235.
• Strzelecka A. [2011], Makroekonomiczne uwarunkowania wydatków publicznych na ochronę zdrowia, w: Suchecka J. (red.), Finansowanie ochrony zdrowia. Wybrane zagadnienia, Wolters Kluwer, Warszawa.
• Su T. T., Pokhrel S., Gbangou A., Flessa S. [2006], Determinants of household health expenditure on western institutional health care, "The European Journal of Health Economics", vol. 7, no. 3: 199-207.
• Thomson S., Foubister T., Mossialos E. (red.) [2009], Financing health care in European Union: challenges and policy responses, WHO Regional Office for Europe, Copenhagen.
• Wakefield J., Lyons H. [2010], Spatial aggregation and ecological fallacy, w: Gelfand A. E., Diggle P. J., Fuentes M., Guttorp P. (red.), Handbook of spatial statistics, CRC Press, Boca Raton.
• Wang Z. [2009], The determinants of health expenditures: evidence from US state-level data, "Applied Economics", vol. 41, no. 4: 429-435.
• Wasiak A., Szeląg P. [2015], Wydatki na ochronę zdrowia w Polsce na tle krajów Unii Europejskiej w latach 2007-2011, "Finanse i Prawo Finansowe. Journal of Finance and Financial Law", vol. II, nr 2: 67-85.
• Xu K., Saksena P., Holly A. [2011], The determinants of health expenditure. A country-level panel data analysis, World Health Organization, Geneva.
• Yavuz N. C., Yilanci V., Ozturk Z. A. [2013], Is health care a luxury or a necessity or both? Evidence from Turkey, "European Journal of Health Economics", vol. 14, no. 1: 5-10.

Identyfikatory

DOI

https://doi.org/10.33119/GN/100572