Health Care Expenditure in the European Union Countries: New Insights about the Convergence Process
Abstract
:1. Introduction
2. Literature Review
3. Health Expenditure, Health Care Systems, and Health Reforms in Selected EU Countries
4. Methodology
4.1. Bound Unit Root Tests
4.2. Strict Stationarity Tests
5. Data and Results
5.1. Data
5.2. Main Findings
5.3. Robustness Analysis Based on New Proposed Strict Stationarity Tests
6. Conclusions and Policy Implications
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A. Main Reforms Regarding the Health Care Systems in the 6 EU Countries (1972–2013)
Country | Year | Reform |
---|---|---|
Austria | 1997 | Introduction of co-payment fee for ambulatory services (first visit) |
1998 | Setup of the Healthy Austria Fund | |
2003 | Structural reform of the regional health insurance funds | |
2005 | Health Reform Act and the establishment of the Federal Health Agency | |
2010 | Structural health fund for health insurers | |
2012 | Long-term Care Allowance Reform Act | |
Finland | 1972 | Primary Health Care Act |
1986 | “Personal doctor” system | |
1991 | Setup of the National Board of Health and the National Board of Social Welfare | |
1993 | State subsidy reform | |
2001 | The national project to ensure the future of health care | |
Germany | 1977 | First law regarding cost containment in health care |
1989 | Health Care Reform Act | |
1996 | Health Insurance Contribution Rate Relief Act | |
1999 | Statutory Health Insurance Reform Act of 2000 | |
2000 | Infection Protection Act | |
2002 | Pharmaceutical Expenditure Limitation Act | |
2007 | Act to strengthen competition in statutory health insurance | |
2009 | Introduction of the health fund | |
2011 | Act on the reform of the pharmaceutical market | |
Netherlands | 1974 | White paper on the structure of health care |
1983 | White paper on primary care | |
1987 | Dekker Plan | |
2001 | “A question of demand” initiative | |
2006 | Health Insurance Act | |
Portugal | 1974 | Nationalisation of hospitals |
1976 | The Constitution stipulating the creation of a universal, free-of-charge system | |
1979 | National health system law, creating a universal health system | |
1988 | The law on hospital management | |
1990 | The law on the fundamental principles of health | |
1999 | The national health strategy and goals | |
2003 | The creation of the Health Regulatory Agency | |
2004 | The National Health Plan | |
2008 | The charter of patients’ rights to access health care | |
2009 | The national strategy on quality in health care | |
Spain | 1978 | The Constitution establishes the right of all Spaniards to health protection |
1986 | Health Care General Act | |
1999 | The annual Budgetary Act: subsidies for employer-purchased insurance plans | |
2002 | Transfer of health competencies to the regional departments of health | |
2003 | Adoption of the Cohesion and Quality Act | |
2008 | The pact for the health system |
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Convergence 1 | Austria | Finland | Germany | Netherlands | Portugal | Spain |
---|---|---|---|---|---|---|
Overall expenditure per capita | ||||||
MIN | 12.55 | −133.80 | 420.95 | 241.12 | −1416.35 | −970.65 |
MAX | 685.50 | 355.64 | 789.52 | 1091.85 | −487.75 | −306.85 |
MEAN | 366.51 | 10.53 | 611.65 | 445.05 | −832.12 | −587.76 |
SD | 240.24 | 105.93 | 91.21 | 261.95 | 225.53 | 160.62 |
Governmental expenditure per capita | ||||||
MIN | −59.50 | −155.78 | 317.47 | 33.97 | −1240.07 | −855.67 |
MAX | 578.38 | 269.68 | 684.78 | 1235.93 | −354.92 | −212.70 |
MEAN | 263.23 | 9.84 | 515.74 | 355.69 | −699.48 | −445.01 |
SD | 206.64 | 114.35 | 101.27 | 359.49 | 209.50 | 160.54 |
Private expenditure per capita | ||||||
MIN | 6.22 | −52.00 | −8.90 | −144.15 | −246.07 | −189.27 |
MAX | 177.35 | 68.35 | 200.57 | 316.23 | −57.02 | −91.83 |
MEAN | 100.52 | −2.08 | 95.92 | 86.59 | −135.43 | −145.52 |
SD | 50.34 | 35.00 | 60.47 | 123.42 | 51.72 | 28.36 |
Overall expenditure as a % of GDP | ||||||
MIN | −0.40 | −1.55 | 1.02 | −0.97 | −1.97 | −1.68 |
MAX | 1.37 | 0.93 | 2.22 | 1.32 | 0.52 | −0.55 |
MEAN | 0.49 | −0.48 | 1.64 | 0.20 | −0.77 | −1.08 |
SD | 0.53 | 0.73 | 0.37 | 0.55 | 0.76 | 0.24 |
Governmental expenditure as a % of GDP | ||||||
MIN | −0.43 | −1.38 | 0.75 | −1.15 | −2.10 | −1.42 |
MAX | 1.37 | 1.21 | 2.12 | 2.22 | 0.27 | −0.08 |
MEAN | 0.38 | −0.23 | 1.55 | 0.27 | −1.16 | −0.81 |
SD | 0.48 | 0.73 | 0.42 | 0.85 | 0.73 | 0.29 |
Private expenditure as a % of GDP | ||||||
MIN | −0.23 | −0.45 | −0.38 | −0.98 | −0.37 | −0.83 |
MAX | 0.70 | 0.03 | 0.42 | 0.55 | 1.08 | 0.22 |
MEAN | 0.14 | −0.24 | 0.10 | −0.05 | 0.41 | −0.35 |
SD | 0.23 | 0.12 | 0.20 | 0.45 | 0.39 | 0.28 |
Convergence 1 | Austria | Finland | Germany | Netherlands | Portugal | Spain |
---|---|---|---|---|---|---|
Overall expenditure per capita | ||||||
−3.245 | −6.431 | −0.208 | −1.787 | −1.076 | −2.473 | |
−1.305 | −1.796 * | −0.164 | −0.987 | −0.801 ** | −1.111 | |
−3.156 | −8.954 * | −0.879 | −1.498 | −1.150 * | −3.229 | |
−1.304 | −2.092 * | −0.439 | −0.923 | −0.833 ** | −1.310 | |
−3.035 | −9.058 * | −1.124 | −1.471 | −1.134 | −3.027 | |
−1.254 | −2.123 ** | −0.609 | −0.907 | −0.822 ** | −1.228 | |
0.413 | 0.234 * | 0.542 | 0.616 | 0.725 | 0.406 | |
Governmental expenditure per capita | ||||||
−1.927 | −5.562 | −0.275 | −3.092 | −1.282 ** | −5.267 | |
−1.041 | −1.628 | −0.183 | −1.146 | −0.826 *** | −1.729 * | |
−1.432 | −7.506 * | −1.218 | −3.402 | −1.090 ** | −0.785 | |
−0.791 | −1.868 * | −0.622 | −1.173 | −0.776 *** | −0.544 | |
−1.860 | −7.789 * | −0.994 | −3.702 | −1.076 ** | −1.434 | |
−1.025 | −1.938 * | −0.516 | −1.273 | −0.765 *** | −1.024 | |
0.551 | 0.249 * | 0.519 | 0.344 | 0.712 | 0.714 | |
Private expenditure per capita | ||||||
−8.727 ** | −4.329 | −2.557 | −2.217 | −3.035 | −1.986 | |
−2.142 ** | −1.416 | −1.125 | −0.713 | −1.267 | −0.856 | |
−7.161 * | −3.566 | −2.263 | −2.320 | −3.685 | −1.322 | |
−1.976 ** | −1.291 | −1.071 | −0.747 | −1.406 | −0.680 | |
−6.536 * | −3.411 | −2.200 | −2.254 | −3.519 | −0.616 | |
−1.803 * | −1.234 | −1.041 | −0.726 | −1.343 | −0.376 | |
0.276 | 0.362 | 0.473 | 0.322 | 0.381 | 0.610 |
Convergence 1 | Austria | Finland | Germany | Netherlands | Portugal | Spain |
---|---|---|---|---|---|---|
Overall expenditure as a % of GDP | ||||||
−6.217 * | −1.798 | −1.188 | −2.539 | −1.496 | −4.023 | |
−1.822 * | −0.912 | −0.629 | −1.275 | −0.974 | −1.275 | |
−6.204 | −1.179 | −1.116 | −1.781 | −1.417 | −4.728 | |
−1.673 * | −0.549 | −0.584 | −1.024 | −0.924 | −1.318 | |
−4.988 | −1.722 | −1.132 | −1.764 | −1.468 | −4.612 | |
−1.693 * | −0.827 | −0.542 | −1.208 | −0.907 | −1.281 | |
0.371 | 0.531 | 0.588 | 0.552 | 0.483 | 0.328 | |
Governmental expenditure as a % of GDP | ||||||
−3.252 | −1.492 | −0.685 | −3.234 | −1.481 | −4.255 | |
−1.562 * | −0.748 | −0.366 | −1.211 | −0.824 | −1.732 * | |
−3.542 | −0.892 | −0.435 | −1.946 | −1.456 | −0.196 | |
−1.536 * | −0.467 | −0.256 | −0.926 | −0.825 | −0.232 | |
−3.286 | −1.512 | −0.456 | −1.857 | −1.423 | −0.598 | |
−1.571 * | −0.865 | −0.267 | −0.883 | −0.643 | −0.725 | |
0.425 | 0.448 | 0.594 | 0.547 | 0.582 | 0.870 | |
Governmental expenditure as a % of GDP | ||||||
−5.706 * | −7.668 * | −5.112 | −2.415 | −2.978 | −2.622 | |
−1.728 * | −2.158 ** | −1.623 * | −0.772 | −1.364 | −0.916 | |
−4.725 | −2.989 | −5.629 * | −2.469 | −4.715 | −3.612 | |
−1.668 * | −1.420 | −1.630 | −0.616 | −1.565 * | −1.124 | |
−4.327 | −3.424 | −5.245 | −2.304 | −4.425 | −3.520 | |
−1.475 | −1.264 | −1.724 * | −0.736 | −1.499 | −1.132 | |
0.380 | 0.395 | 0.322 | 0.345 | 0.473 | 0.321 |
Convergence 1 | Austria | Finland | Germany | Netherlands | Portugal | Spain |
---|---|---|---|---|---|---|
Overall expenditure per capita | ||||||
KPSS | 0.531 | 0.234 | 1.053 *** | 0.289 | 1.016 *** | 0.961 *** |
IKPSS | 0.440 | 0.102 | 0.991 ** | 0.273 | 0.974 ** | 0.899 * |
XL | 1.606 | 1.331 | 2.128 ** | 1.141 | 1.923 * | 2.003 ** |
LN | 1.479 * | 1.243 | 1.691 ** | 1.114 | 1.696 *** | 1.697 *** |
Governmental expenditure per capita | ||||||
KPSS | 0.719 * | 0.426 | 1.042 *** | 0.235 | 0.940 ** | 0.789 ** |
IKPSS | 0.730 * | 0.745 ** | 0.921 ** | 0.265 | 0.985 *** | 0.746 ** |
XL | 1.567 | 2.015 ** | 2.202 ** | 1.806 | 2.065 ** | 1.685 |
LN | 1.682 *** | 1.659 *** | 1.670 ** | 1.391 | 1.691 *** | 1.567 ** |
Private expenditure per capita | ||||||
KPSS | 0.147 | 0.822 ** | 0.446 | 0.582 * | 0.513 * | 0.910 ** |
IKPSS | 0.163 | 0.945 *** | 0.430 | 0.306 | 0.188 | 0.961 ** |
XL | 1.695 | 1.835 | 1.653 | 1.928 | 1.859 ** | 1.904 |
LN | 1.273 | 1.554* | 1.415 | 1.391 | 1.455 ** | 1.697 *** |
Convergence 1 | Austria | Finland | Germany | Netherlands | Portugal | Spain |
---|---|---|---|---|---|---|
Overall expenditure as a % of GDP | ||||||
KPSS | 0.200 | 0.851 ** | 0.981 *** | 0.352 | 1.024 *** | 0.858 *** |
IKPSS | 0.128 | 0.911 ** | 0.762 ** | 0.228 | 0.950 ** | 0.671 * |
XL | 1.548 | 1.971 * | 1.864 | 1.366 | 1.925 | 1.551 |
LN | 1.363 | 1.616 ** | 1.670 ** | 1.177 | 1.682 ** | 1.646 *** |
Governmental expenditure as a % of GDP | ||||||
KPSS | 0.543 | 0.864 ** | 0.936 *** | 0.203 | 0.947 ** | 0.295 |
IKPSS | 0.478 | 0.920 ** | 0.795 ** | 0.258 | 1.054 *** | 0.128 |
XL | 1.596 | 1.922 * | 1.832 | 1.753 | 1.963 ** | 1.662 * |
LN | 1.373 | 1.696 *** | 1.657 ** | 1.348 | 1.691 *** | 1.255 |
Private expenditure as a % of GDP | ||||||
KPSS | 0.305 | 0.140 | 0.249 | 0.611 ** | 0.282 | 0.917 ** |
IKPSS | 0.242 | 0.238 | 0.173 | 0.072 | 0.260 | 0.961 ** |
XL | 1.839 * | 1.764 * | 1.196 | 1.892 | 1.934 ** | 1.890 |
LN | 1.439 ** | 1.271 | 1.182 | 1.416 * | 1.422 * | 1.697 *** |
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Albulescu, C.T. Health Care Expenditure in the European Union Countries: New Insights about the Convergence Process. Int. J. Environ. Res. Public Health 2022, 19, 1991. https://doi.org/10.3390/ijerph19041991
Albulescu CT. Health Care Expenditure in the European Union Countries: New Insights about the Convergence Process. International Journal of Environmental Research and Public Health. 2022; 19(4):1991. https://doi.org/10.3390/ijerph19041991
Chicago/Turabian StyleAlbulescu, Claudiu Tiberiu. 2022. "Health Care Expenditure in the European Union Countries: New Insights about the Convergence Process" International Journal of Environmental Research and Public Health 19, no. 4: 1991. https://doi.org/10.3390/ijerph19041991
APA StyleAlbulescu, C. T. (2022). Health Care Expenditure in the European Union Countries: New Insights about the Convergence Process. International Journal of Environmental Research and Public Health, 19(4), 1991. https://doi.org/10.3390/ijerph19041991