Health Professions › General Health Professions

Global Health Care Issues

Works Count: 95718

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This cluster of papers explores the determinants of health care expenditure, focusing on the impact of an ageing population, longevity, and medical innovation. It investigates the relationship between health care spending, economic growth, and public health outcomes, with a particular emphasis on the implications for chronic disease management and government health expenditures.

Keywords

Health Care Expenditure; Ageing Population; Longevity; Health Outcomes; Economic Growth; Public Health Spending; Life Expectancy; Medical Innovation; Government Health Expenditures; Chronic Disease

Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease.

1980-11-01

Ancel Keys

Health nutrition and economic development.

1998-01-01

John Strauss , Duncan Thomas

The relationship between health and economic development is explored focusing on nutrition-based health indicators. The spotlight is placed on the inter-related feedbacks between the influence of health on productivity on … The relationship between health and economic development is explored focusing on nutrition-based health indicators. The spotlight is placed on the inter-related feedbacks between the influence of health on productivity on one hand and the influence of income on health status on the other. Disentangling causality in these relationships has preoccupied much of the literature; we evaluate different empirical strategies that have been adopted and assess the results. There is now a body of evidence based on careful empirical studies that demonstrates a causal relationship between health and labor productivity; there is also evidence that at least among the very poor additional income is spent on improved nutrition. There are two issues that have received little attention although we argue they are likely to be very important. First measurement of health is discussed in detail. Evidence is presented on how taking into account differences in the extent of measurement error is critical for interpreting the impact of health on wages. The same theme emerges in studies of the effect of income on health (specifically calorie intake). The key role of non-linearities in these relationships is highlighted and we demonstrate that a good deal of the variation in estimates of income elasticities of demand for calories can be ascribed to the role of measurement and functional form. (authors)

Healthy People 2010.

1998-01-01

Stella M. Yu

Technical efficiency in the use of health care resources: a comparison of OECD countries

2004-01-30

Donna Retzlaff‐Roberts , Cyril F. Chang , Rose M. Rubin

The burden and costs of chronic diseases in low-income and middle-income countries

2007-12-01

Dele Abegunde , Colin Mathers , Taghreed Adam +2 more

The Changing Relation between Mortality and level of Economic Development

1975-07-01

Samuel H. Preston

Summary A very simple technique has been used to shed light on a number of questions about the influence of economic level on national mortality trends and differentials. Scatter-diagrams of … Summary A very simple technique has been used to shed light on a number of questions about the influence of economic level on national mortality trends and differentials. Scatter-diagrams of the cross-sectional relation between national income per head and life expectancy are developed for three decades during the twentieth, century. The relations established appear to shift systematically during the century. In general, in order to attain a certain life expectancy between 40 and 60 a nation requires an income level almost three times greater in the 1930s than in the 1960s This shift is corroborated by a changing structure of mortality by cause of death for populations at equivalent mortality levels. The magnitude of the shifts, combined with regional income data suggests that some 75–90 per cent of the growth in life expectancy for the world as a whole over these three decades is attributable to factors exogenous to a nation's contemporary level of income Through similar techniques, improved nutrition and higher literacy can also be ruled out as important contributors. Nevertheless, the cross-sectional relation between income and life expectancy remains strong and there is some suggestion that mortality is now more responsive to variations in income levels among countries with national incomes below $400 (1963 dollars) than it was in the 1930s However, population size appears to respond so slowly to the mortality declines that typically result irom income growth that these mortality effects present little impediment to the process of economic development. Some of the variability in the cross-sectional mortality-income relation is doubtless due to variation in income distributions. Life expectancy in Venezuela, Mexico, and Colombia, countries with wide disparities in incomes, falls short of levels expected on the basis of their mean incomes. On the other hand, life expectancy in Soviet-bloc countries, where income equality is expected to be greater than average, also falls short of expected levels. Western and non-Western countries alike profited from the activity of 'exogenous' medical and public health factors. Differences between the two types of countries have been exaggerated by concentration on movements between equivalent mortality levels rather than during equivalent time periods. Recent work in historical demography suggests that the importance in Western mortality trends of endogenous factors consequent to rising standards of living has been overstated for earlier periods as well.

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Rapid health transition in China, 1990–2010: findings from the Global Burden of Disease Study 2010

2013-06-01

Gonghuan Yang , Yu Wang , Yi‐Xin Zeng +7 more

China has undergone rapid demographic and epidemiological changes in the past few decades, including striking declines in fertility and child mortality and increases in life expectancy at birth. Popular discontent … China has undergone rapid demographic and epidemiological changes in the past few decades, including striking declines in fertility and child mortality and increases in life expectancy at birth. Popular discontent with the health system has led to major reforms. To help inform these reforms, we did a comprehensive assessment of disease burden in China, how it changed between 1990 and 2010, and how China's health burden compares with other nations.We used results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) for 1990 and 2010 for China and 18 other countries in the G20 to assess rates and trends in mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE). We present results for 231 diseases and injuries and for 67 risk factors or clusters of risk factors relevant to China. We assessed relative performance of China against G20 countries (significantly better, worse, or indistinguishable from the G20 mean) with age-standardised rates and 95% uncertainty intervals.The leading causes of death in China in 2010 were stroke (1·7 million deaths, 95% UI 1·5-1·8 million), ischaemic heart disease (948,700 deaths, 774,500-1,024,600), and chronic obstructive pulmonary disease (934,000 deaths, 846,600-1,032,300). Age-standardised YLLs in China were lower in 2010 than all emerging economies in the G20, and only slightly higher than noted in the USA. China had the lowest age-standardised YLD rate in the G20 in 2010. China also ranked tenth (95% UI eighth to tenth) for HALE and 12th (11th to 13th) for life expectancy. YLLs from neonatal causes, infectious diseases, and injuries in children declined substantially between 1990 and 2010. Mental and behavioural disorders, substance use disorders, and musculoskeletal disorders were responsible for almost half of all YLDs. The fraction of DALYs from YLDs rose from 28·1% (95% UI 24·2-32·5) in 1990 to 39·4% (34·9-43·8) in 2010. Leading causes of DALYs in 2010 were cardiovascular diseases (stroke and ischaemic heart disease), cancers (lung and liver cancer), low back pain, and depression. Dietary risk factors, high blood pressure, and tobacco exposure are the risk factors that constituted the largest number of attributable DALYs in China. Ambient air pollution ranked fourth (third to fifth; the second highest in the G20) and household air pollution ranked fifth (fourth to sixth; the third highest in the G20) in terms of the age-standardised DALY rate in 2010.The rapid rise of non-communicable diseases driven by urbanisation, rising incomes, and ageing poses major challenges for China's health system, as does a shift to chronic disability. Reduction of population exposures from poor diet, high blood pressure, tobacco use, cholesterol, and fasting blood glucose are public policy priorities for China, as are the control of ambient and household air pollution. These changes will require an integrated government response to improve primary care and undertake required multisectoral action to tackle key risks. Analyses of disease burden provide a useful framework to guide policy responses to the changing disease spectrum in China.Bill & Melinda Gates Foundation.

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On the measurement of inequalities in health

1991-01-01

Adam Wagstaff , Pierella Paci , Eddy van Doorslaer

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Healthy Bodies and Thick Wallets: The Dual Relation Between Health and Economic Status

1999-05-01

James P. Smith

The first section of this paper documents the size of the association between health and one prominent economic status measure--household wealth. The next section deals with how health influences economic … The first section of this paper documents the size of the association between health and one prominent economic status measure--household wealth. The next section deals with how health influences economic status by sketching out reasons why health may alter household savings (and eventually wealth) and then providing estimates of the empirical magnitude of these effects. The third section shifts attention to the other pathway--the links between economic status and health--and summarizes major controversies and evidence surrounding these issues.

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Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study

1997-05-01

Christopher J L Murray , Alan D López

Income distribution and life expectancy.

1992-01-18

Richard G. Wilkinson

The relationship between income distribution and mortality is explored using data from published sources. Specifically the author attempts to investigate the cross sectional relation between income distribution and mortality and … The relationship between income distribution and mortality is explored using data from published sources. Specifically the author attempts to investigate the cross sectional relation between income distribution and mortality and its possible interactions with gross national product per head and to assess whether changes in income distribution over time are related to changes in mortality in developed countries. He concludes that there is clear evidence of a strong relation between a societys income distribution and the average life expectancy of its population. (EXCERPT)

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Health: United States

1986-03-28

John A. H. Lee

This annual publication for the US Department of Health and Human Services entitledHealth: United Statesis a report to Congress on the health status of the nation. The current volume, for … This annual publication for the US Department of Health and Human Services entitledHealth: United Statesis a report to Congress on the health status of the nation. The current volume, for 1984, has dropped the essays on selected topics by experts within the government. In exchange, there has been an extension of the statistical material. Over the years, these surveys were interesting and valuable. Material emerged in them, with appropriate commentary, that was not otherwise readily available. It is to be hoped that they will be continued elsewhere. The 1984 report opens with a series of about 50 short paragraphs labeled "Highlights." Each contains some snappy facts: from the life table—life expectancy has reached a new high of 74.7 years, and is still 16.8 years at age 65; from general vital statistics— the fertility rate is stable; and from data on health care utilization and resources—15% of people over

Handbook of Aging and the Social Sciences

2016-01-01

Robert H. Binstock , Ethel Shanas

The Endogenous Determination of Time Preference

1997-08-01

Gary S. Becker , Casey B. Mulligan

We model a consumer's efforts to reduce the discount on future utilities. Our analysis shows how wealth, mortality, addictions, uncertainty, and other variables affect the degree of time preference. In … We model a consumer's efforts to reduce the discount on future utilities. Our analysis shows how wealth, mortality, addictions, uncertainty, and other variables affect the degree of time preference. In addition to working out many implications of the model, we discuss evidence on consumption, savings, equilibrium, and the dynamics of inequality. We claim that most ofthat evidence is consistent with the predictions of our approach.

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Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study

2014-02-26

Linda H. Aiken , Douglas M. Sloane , Luk Bruyneel +7 more

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Socioeconomic inequalities in health: Measurement, computation, and statistical inference

1997-03-01

Nanak Kakwani , Adam Wagstaff , Eddy van Doorslaer

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1. On the Concept of Health Capital and the Demand for Health

2017-09-06

Michael Grossman

The aim of this study is to construct a model of the demand for the commodity good The central proposition of the model is that health can be viewed as … The aim of this study is to construct a model of the demand for the commodity good The central proposition of the model is that health can be viewed as a durable capital stock that produces an output of healthy time. It is assumed that individuals inherit an initial stock of health that depreciates with age and can be increased by investment. In this framework, the of health depends on many other variables besides the price of medical care. It is shown that the shadow price rises with age if the rate of depreciation on the stock of health rises over the life cycle and falls with education if more educated people are more efficient producers of health. Of particular importance is the conclusion that, under certain conditions, an increase in the shadow price may simultaneously reduce the quantity of health demanded and increase the quantity of medical care demanded.

Household catastrophic health expenditure: a multicountry analysis

2003-07-01

Ke Xu , David Evans , Kei Kawabata +3 more

The burden of disease in older people and implications for health policy and practice

2014-11-06

Martin Prince , Fan Wu , Yanfei Guo +4 more

Testing for Error Correction in Panel Data*

2007-07-25

Joakim Westerlund

This paper proposes new error correction-based cointegration tests for panel data. The limiting distributions of the tests are derived and critical values provided. Our simulation results suggest that the tests … This paper proposes new error correction-based cointegration tests for panel data. The limiting distributions of the tests are derived and critical values provided. Our simulation results suggest that the tests have good small-sample properties with small size distortions and high power relative to other popular residual-based panel cointegration tests. In our empirical application, we present evidence suggesting that international healthcare expenditures and GDP are cointegrated once the possibility of an invalid common factor restriction has been accounted for.

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Disease and Development: The Effect of Life Expectancy on Economic Growth

2007-12-01

Daron Acemoğlu , Simon Johnson

We exploit the major international health improvements from the 1940s to estimate the effect of life expectancy on economic performance. We construct predicted mortality using preintervention mortality rates from various … We exploit the major international health improvements from the 1940s to estimate the effect of life expectancy on economic performance. We construct predicted mortality using preintervention mortality rates from various diseases and dates of global interventions. Predicted mortality has a large impact on changes in life expectancy starting in 1940 but no effect before 1940. Using predicted mortality as an instrument, we find that a 1 percent increase in life expectancy leads to a 1.7–2 percent increase in population. Life expectancy has a much smaller effect on total GDP, however. Consequently, there is no evidence that the large increase in life expectancy raised income per capita.

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A Single Index of Mortality and Morbidity

1971-01-01

Daniel F. Sullivan

A CONTINUING interest of the National Center for Health Statistics is the development and evaluation of new health indices suited to diverse specific purposes. No one index can reflect all … A CONTINUING interest of the National Center for Health Statistics is the development and evaluation of new health indices suited to diverse specific purposes. No one index can reflect all aspects of health, but there is considerable agreement that an index which measures some aspects of nonfatal illness as well as mortality would be desirable. A rationale for using both mortality and disability rates as the components of such an index has already been published (1). One technique for combining mortality and morbidity rates into a single index was devised and reported by Chiang in conjunction with his development of mathematical models of illness frequency, illness duration, and mortality (2). Moriyama has discussed criteria desired in an index of health and, in view of these, reviewed some approaches proposed in the literature (3). A deseription and evaluation of disability concepts and measures being considered as the basis of the morbidity component of a mortality-morbidity index appeared in a recent report (4). Another technique for merging death rates with illness rates, and some illustrative results are described in this paper. A primary objective of these studies is development of a summary measure which reflects changes over time in the health status of the nation's population. Too little is known as yet about these techniques, and in some cases about the data they employ, to permit thorough evaluation of alternative approaches to the construction of such indices. Results of studies of such measures are presented as they become available by the Center to stimulate consideration of the issues and, possibly, to stimulate further studies by those in a position to conduct related research. Some preliminary index values based upon the techniques presented in this paper have already been published for fiscal years 1958-66 (5). The estimates in this article are also preliminary. Although they relate to only a single year, they provide previously unpublished information on whites and other persons and on sex differences. These estimates are considered more accurate than earlier computations of such values.

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The Purchasing-Power Parity Doctrine: A Reappraisal

1964-12-01

Béla Balassa

The detection of psychiatric illness by questionnaire

1973-07-01

Raymond Levy

The Association Between Income and Life Expectancy in the United States, 2001-2014

2016-04-11

Raj Chetty , Michael Stepner , Sarah Abraham +5 more

The relationship between income and life expectancy is well established but remains poorly understood.To measure the level, time trend, and geographic variability in the association between income and life expectancy … The relationship between income and life expectancy is well established but remains poorly understood.To measure the level, time trend, and geographic variability in the association between income and life expectancy and to identify factors related to small area variation.Income data for the US population were obtained from 1.4 billion deidentified tax records between 1999 and 2014. Mortality data were obtained from Social Security Administration death records. These data were used to estimate race- and ethnicity-adjusted life expectancy at 40 years of age by household income percentile, sex, and geographic area, and to evaluate factors associated with differences in life expectancy.Pretax household earnings as a measure of income.Relationship between income and life expectancy; trends in life expectancy by income group; geographic variation in life expectancy levels and trends by income group; and factors associated with differences in life expectancy across areas.The sample consisted of 1,408,287,218 person-year observations for individuals aged 40 to 76 years (mean age, 53.0 years; median household earnings among working individuals, $61,175 per year). There were 4,114,380 deaths among men (mortality rate, 596.3 per 100,000) and 2,694,808 deaths among women (mortality rate, 375.1 per 100,000). The analysis yielded 4 results. First, higher income was associated with greater longevity throughout the income distribution. The gap in life expectancy between the richest 1% and poorest 1% of individuals was 14.6 years (95% CI, 14.4 to 14.8 years) for men and 10.1 years (95% CI, 9.9 to 10.3 years) for women. Second, inequality in life expectancy increased over time. Between 2001 and 2014, life expectancy increased by 2.34 years for men and 2.91 years for women in the top 5% of the income distribution, but by only 0.32 years for men and 0.04 years for women in the bottom 5% (P < .001 for the differences for both sexes). Third, life expectancy for low-income individuals varied substantially across local areas. In the bottom income quartile, life expectancy differed by approximately 4.5 years between areas with the highest and lowest longevity. Changes in life expectancy between 2001 and 2014 ranged from gains of more than 4 years to losses of more than 2 years across areas. Fourth, geographic differences in life expectancy for individuals in the lowest income quartile were significantly correlated with health behaviors such as smoking (r = -0.69, P < .001), but were not significantly correlated with access to medical care, physical environmental factors, income inequality, or labor market conditions. Life expectancy for low-income individuals was positively correlated with the local area fraction of immigrants (r = 0.72, P < .001), fraction of college graduates (r = 0.42, P < .001), and government expenditures (r = 0.57, P < .001).In the United States between 2001 and 2014, higher income was associated with greater longevity, and differences in life expectancy across income groups increased over time. However, the association between life expectancy and income varied substantially across areas; differences in longevity across income groups decreased in some areas and increased in others. The differences in life expectancy were correlated with health behaviors and local area characteristics.

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Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—United States, 1997–2001

2007-01-01

L.T. Tanoue

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Cohort Profile: The National Health Insurance Service–National Sample Cohort (NHIS-NSC), South Korea

2016-01-28

Juneyoung Lee , Ji Sung Lee , Sook-Hee Park +2 more

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Future life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble

2017-02-22

Vasilis Kontis , James E. Bennett , Colin Mathers +3 more

Projections of future mortality and life expectancy are needed to plan for health and social services and pensions. Our aim was to forecast national age-specific mortality and life expectancy using … Projections of future mortality and life expectancy are needed to plan for health and social services and pensions. Our aim was to forecast national age-specific mortality and life expectancy using an approach that takes into account the uncertainty related to the choice of forecasting model.We developed an ensemble of 21 forecasting models, all of which probabilistically contributed towards the final projections. We applied this approach to project age-specific mortality to 2030 in 35 industrialised countries with high-quality vital statistics data. We used age-specific death rates to calculate life expectancy at birth and at age 65 years, and probability of dying before age 70 years, with life table methods.Life expectancy is projected to increase in all 35 countries with a probability of at least 65% for women and 85% for men. There is a 90% probability that life expectancy at birth among South Korean women in 2030 will be higher than 86·7 years, the same as the highest worldwide life expectancy in 2012, and a 57% probability that it will be higher than 90 years. Projected female life expectancy in South Korea is followed by those in France, Spain, and Japan. There is a greater than 95% probability that life expectancy at birth among men in South Korea, Australia, and Switzerland will surpass 80 years in 2030, and a greater than 27% probability that it will surpass 85 years. Of the countries studied, the USA, Japan, Sweden, Greece, Macedonia, and Serbia have some of the lowest projected life expectancy gains for both men and women. The female life expectancy advantage over men is likely to shrink by 2030 in every country except Mexico, where female life expectancy is predicted to increase more than male life expectancy, and in Chile, France, and Greece where the two sexes will see similar gains. More than half of the projected gains in life expectancy at birth in women will be due to enhanced longevity above age 65 years.There is more than a 50% probability that by 2030, national female life expectancy will break the 90 year barrier, a level that was deemed unattainable by some at the turn of the 21st century. Our projections show continued increases in longevity, and the need for careful planning for health and social services and pensions.UK Medical Research Council and US Environmental Protection Agency.

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World report on ageing and health

2017-01-01

AB Dey

Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

2018-11-01

Hmwe Hmwe Kyu , Degu Abate , Kalkidan Hassen Abate +7 more

BackgroundHow long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over … BackgroundHow long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years.MethodsWe used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males.FindingsGlobally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1–7·8), from 65·6 years (65·3–65·8) in 1990 to 73·0 years (72·7–73·3) in 2017. The increase in years of life varied from 5·1 years (5·0–5·3) in high SDI countries to 12·0 years (11·3–12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1–33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8–15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9–6·7), from 57·0 years (54·6–59·1) in 1990 to 63·3 years (60·5–65·7) in 2017. The increase varied from 3·8 years (3·4–4·1) in high SDI countries to 10·5 years (9·8–11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4–1·7) in Saint Vincent and the Grenadines (62·4 years [59·9–64·7] in 1990 to 63·5 years [60·9–65·8] in 2017) to 23·7 years (21·9–25·6) in Eritrea (30·7 years [28·9–32·2] in 1990 to 54·4 years [51·5–57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6–2·3) in Algeria to 11·9 years (10·9–12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4–78·7]) and males (72·6 years [69·8–75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7–50·2] for females and 42·8 years [40·1–45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8–43·5) for communicable diseases and by 49·8% (47·9–51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8–43·0), although age-standardised DALY rates decreased by 18·1% (16·0–20·2).InterpretationWith increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health.FundingBill & Melinda Gates Foundation.

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Wealthier is Healthier

1996-01-01

Lant Pritchett , Lawrence H. Summers

We estimate the effect of income on health using cross-country, timeseries data on health (infant and child mortality and life expectancy) and income per capita.We use instrumental variables estimates using … We estimate the effect of income on health using cross-country, timeseries data on health (infant and child mortality and life expectancy) and income per capita.We use instrumental variables estimates using exogenous determinants of income growth to identify the pure income effect on health, isolated from reverse causation or incidental association.The long-run income elasticity of infant and child mortality in developing countries lies between -0.2 and -0.4.Using these estimates, we calculate that over a half a million child deaths in the developing world in 1990 alone can be attributed to the poor economic performance in the 1980s.

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Morbidity and Mortality Weekly Report

2011-03-01

Gordon G. Giesbrecht , G L Mcdonald , Anil Menon

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Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016–40 for 195 countries and territories

2018-10-16

Kyle J Foreman , Neal Marquez , Andrew J. Dolgert +7 more

Understanding potential trajectories in health and drivers of health is crucial to guiding long-term investments and policy implementation. Past work on forecasting has provided an incomplete landscape of future health … Understanding potential trajectories in health and drivers of health is crucial to guiding long-term investments and policy implementation. Past work on forecasting has provided an incomplete landscape of future health scenarios, highlighting a need for a more robust modelling platform from which policy options and potential health trajectories can be assessed. This study provides a novel approach to modelling life expectancy, all-cause mortality and cause of death forecasts -and alternative future scenarios-for 250 causes of death from 2016 to 2040 in 195 countries and territories.We modelled 250 causes and cause groups organised by the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) hierarchical cause structure, using GBD 2016 estimates from 1990-2016, to generate predictions for 2017-40. Our modelling framework used data from the GBD 2016 study to systematically account for the relationships between risk factors and health outcomes for 79 independent drivers of health. We developed a three-component model of cause-specific mortality: a component due to changes in risk factors and select interventions; the underlying mortality rate for each cause that is a function of income per capita, educational attainment, and total fertility rate under 25 years and time; and an autoregressive integrated moving average model for unexplained changes correlated with time. We assessed the performance by fitting models with data from 1990-2006 and using these to forecast for 2007-16. Our final model used for generating forecasts and alternative scenarios was fitted to data from 1990-2016. We used this model for 195 countries and territories to generate a reference scenario or forecast through 2040 for each measure by location. Additionally, we generated better health and worse health scenarios based on the 85th and 15th percentiles, respectively, of annualised rates of change across location-years for all the GBD risk factors, income per person, educational attainment, select intervention coverage, and total fertility rate under 25 years in the past. We used the model to generate all-cause age-sex specific mortality, life expectancy, and years of life lost (YLLs) for 250 causes. Scenarios for fertility were also generated and used in a cohort component model to generate population scenarios. For each reference forecast, better health, and worse health scenarios, we generated estimates of mortality and YLLs attributable to each risk factor in the future.Globally, most independent drivers of health were forecast to improve by 2040, but 36 were forecast to worsen. As shown by the better health scenarios, greater progress might be possible, yet for some drivers such as high body-mass index (BMI), their toll will rise in the absence of intervention. We forecasted global life expectancy to increase by 4·4 years (95% UI 2·2 to 6·4) for men and 4·4 years (2·1 to 6·4) for women by 2040, but based on better and worse health scenarios, trajectories could range from a gain of 7·8 years (5·9 to 9·8) to a non-significant loss of 0·4 years (-2·8 to 2·2) for men, and an increase of 7·2 years (5·3 to 9·1) to essentially no change (0·1 years [-2·7 to 2·5]) for women. In 2040, Japan, Singapore, Spain, and Switzerland had a forecasted life expectancy exceeding 85 years for both sexes, and 59 countries including China were projected to surpass a life expectancy of 80 years by 2040. At the same time, Central African Republic, Lesotho, Somalia, and Zimbabwe had projected life expectancies below 65 years in 2040, indicating global disparities in survival are likely to persist if current trends hold. Forecasted YLLs showed a rising toll from several non-communicable diseases (NCDs), partly driven by population growth and ageing. Differences between the reference forecast and alternative scenarios were most striking for HIV/AIDS, for which a potential increase of 120·2% (95% UI 67·2-190·3) in YLLs (nearly 118 million) was projected globally from 2016-40 under the worse health scenario. Compared with 2016, NCDs were forecast to account for a greater proportion of YLLs in all GBD regions by 2040 (67·3% of YLLs [95% UI 61·9-72·3] globally); nonetheless, in many lower-income countries, communicable, maternal, neonatal, and nutritional (CMNN) diseases still accounted for a large share of YLLs in 2040 (eg, 53·5% of YLLs [95% UI 48·3-58·5] in Sub-Saharan Africa). There were large gaps for many health risks between the reference forecast and better health scenario for attributable YLLs. In most countries, metabolic risks amenable to health care (eg, high blood pressure and high plasma fasting glucose) and risks best targeted by population-level or intersectoral interventions (eg, tobacco, high BMI, and ambient particulate matter pollution) had some of the largest differences between reference and better health scenarios. The main exception was sub-Saharan Africa, where many risks associated with poverty and lower levels of development (eg, unsafe water and sanitation, household air pollution, and child malnutrition) were projected to still account for substantive disparities between reference and better health scenarios in 2040.With the present study, we provide a robust, flexible forecasting platform from which reference forecasts and alternative health scenarios can be explored in relation to a wide range of independent drivers of health. Our reference forecast points to overall improvements through 2040 in most countries, yet the range found across better and worse health scenarios renders a precarious vision of the future-a world with accelerating progress from technical innovation but with the potential for worsening health outcomes in the absence of deliberate policy action. For some causes of YLLs, large differences between the reference forecast and alternative scenarios reflect the opportunity to accelerate gains if countries move their trajectories toward better health scenarios-or alarming challenges if countries fall behind their reference forecasts. Generally, decision makers should plan for the likely continued shift toward NCDs and target resources toward the modifiable risks that drive substantial premature mortality. If such modifiable risks are prioritised today, there is opportunity to reduce avoidable mortality in the future. However, CMNN causes and related risks will remain the predominant health priority among lower-income countries. Based on our 2040 worse health scenario, there is a real risk of HIV mortality rebounding if countries lose momentum against the HIV epidemic, jeopardising decades of progress against the disease. Continued technical innovation and increased health spending, including development assistance for health targeted to the world's poorest people, are likely to remain vital components to charting a future where all populations can live full, healthy lives.Bill & Melinda Gates Foundation.

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Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

2019-06-25

Maigeng Zhou , Haidong Wang , Xinying Zeng +7 more

BackgroundPublic health is a priority for the Chinese Government. Evidence-based decision making for health at the province level in China, which is home to a fifth of the global population, … BackgroundPublic health is a priority for the Chinese Government. Evidence-based decision making for health at the province level in China, which is home to a fifth of the global population, is of paramount importance. This analysis uses data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to help inform decision making and monitor progress on health at the province level.MethodsWe used the methods in GBD 2017 to analyse health patterns in the 34 province-level administrative units in China from 1990 to 2017. We estimated all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), summary exposure values (SEVs), and attributable risk. We compared the observed results with expected values estimated based on the Socio-demographic Index (SDI).FindingsStroke and ischaemic heart disease were the leading causes of death and DALYs at the national level in China in 2017. Age-standardised DALYs per 100 000 population decreased by 33·1% (95% uncertainty interval [UI] 29·8 to 37·4) for stroke and increased by 4·6% (–3·3 to 10·7) for ischaemic heart disease from 1990 to 2017. Age-standardised stroke, ischaemic heart disease, lung cancer, chronic obstructive pulmonary disease, and liver cancer were the five leading causes of YLLs in 2017. Musculoskeletal disorders, mental health disorders, and sense organ diseases were the three leading causes of YLDs in 2017, and high systolic blood pressure, smoking, high-sodium diet, and ambient particulate matter pollution were among the leading four risk factors contributing to deaths and DALYs. All provinces had higher than expected DALYs per 100 000 population for liver cancer, with the observed to expected ratio ranging from 2·04 to 6·88. The all-cause age-standardised DALYs per 100 000 population were lower than expected in all provinces in 2017, and among the top 20 level 3 causes were lower than expected for ischaemic heart disease, Alzheimer's disease, headache disorder, and low back pain. The largest percentage change at the national level in age-standardised SEVs among the top ten leading risk factors was in high body-mass index (185%, 95% UI 113·1 to 247·7]), followed by ambient particulate matter pollution (88·5%, 66·4 to 116·4).InterpretationChina has made substantial progress in reducing the burden of many diseases and disabilities. Strategies targeting chronic diseases, particularly in the elderly, should be prioritised in the expanding Chinese health-care system.FundingChina National Key Research and Development Program and Bill & Melinda Gates Foundation.

The Demand for Health: A Theoretical and Empirical Investigation

1975-07-01

Donald R. House , Michael Grossman

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The Determinants of Mortality

2006-05-01

David Cutler , Angus Deaton , Adriana Lleras‐Muney

The pleasures of life are worth nothing if one is not alive to experience them. Through the twentieth century in the United States and other high-income countries, growth in real … The pleasures of life are worth nothing if one is not alive to experience them. Through the twentieth century in the United States and other high-income countries, growth in real incomes was accompanied by a historically unprecedented decline in mortality rates that caused life expectancy at birth to grow by nearly 30 years. In the years just after World War II, life expectancy gaps between countries were falling across the world. Poor countries enjoyed rapid increases in life-expectancy through the 1970s, with the gains in some cases exceeding an additional year of life expectancy per year, though the HIV/AIDS epidemic and the transition in Russia and Eastern Europe have changed that situation. We investigate the determinants of the historical decline in mortality, of differences in mortality across countries, and of differences in mortality across groups within countries. A good theory of mortality should explain all of the facts we will outline. No such theory exists at present, but at the end of the paper we will sketch a tentative synthesis.

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Economic Status and Health in Childhood: The Origins of the Gradient

2002-11-01

Anne Case , Darren Lubotsky , Christina Paxson

The well-known positive association between health and income in adulthood has antecedents in childhood. Not only is children’s health positively related to household income, but the relationship between household income … The well-known positive association between health and income in adulthood has antecedents in childhood. Not only is children’s health positively related to household income, but the relationship between household income and children's health becomes more pronounced as children age. Part of the relationship can be explained by the arrival and impact of chronic conditions. Children from lower income households with chronic conditions have worse health than do those from higher-income households. The adverse health effects of lower income accumulate over children’s lives. Part of the intergenerational transmission of socioeconomic status may work through the impact of parents' income on children’s health.

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Healthy People 2010: Understanding and Improving Health

2000-01-01

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Health at a glance: OECD indicators

2010-05-01

Health at a Glance 2017 presents the latest comparable data and trends on key indicators of health outcomes and health systems across the 35 OECD member countries.These indicators shed light … Health at a Glance 2017 presents the latest comparable data and trends on key indicators of health outcomes and health systems across the 35 OECD member countries.These indicators shed light on the performance of health systems, with indicators reflecting health outcomes, non-medical determinants of health, the degree of access to care, the quality of care provided, and the financial and material resources devoted to health.For a subset of indicators, data are reported for partner countries, including Brazil, China, Colombia, Cost Rica, India, Indonesia, Lithuania, the Russian Federation and South Africa.The production of Health at a Glance would not have been possible without the contribution of OECD Health Data National Correspondents, Health Accounts Experts, and Health Care Quality Indicators Experts from the 35 OECD countries.

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Health Workforce Policies in OECD Countries

2016-02-04

Tackling Wasteful Spending on Health

2016-11-29

On the Concept of Health Capital and the Demand for Health

1972-03-01

Michael Grossman

Morbidity and Mortality Weekly Report

2010-12-01

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Mortality in relation to smoking: 50 years' observations on male British doctors

2004-06-22

Richard Doll , Richard Peto , Jillian Boreham +1 more

<h3>Abstract</h3> Objective To compare the hazards of cigarette smoking in men who formed their habits at different periods, and the extent of the reduction in risk when cigarette smoking is … <h3>Abstract</h3> Objective To compare the hazards of cigarette smoking in men who formed their habits at different periods, and the extent of the reduction in risk when cigarette smoking is stopped at different ages. Design Prospective study that has continued from 1951 to 2001. Setting United Kingdom. Participants 34 439 male British doctors. Information about their smoking habits was obtained in 1951, and periodically thereafter; cause specific mortality was monitored for 50 years. Main outcome measures Overall mortality by smoking habit, considering separately men born in different periods. Results The excess mortality associated with smoking chiefly involved vascular, neoplastic, and respiratory diseases that can be caused by smoking. Men born in 1900-1930 who smoked only cigarettes and continued smoking died on average about 10 years younger than lifelong non-smokers. Cessation at age 60, 50, 40, or 30 years gained, respectively, about 3, 6, 9, or 10 years of life expectancy. The excess mortality associated with cigarette smoking was less for men born in the 19th century and was greatest for men born in the 1920s. The cigarette smoker versus non-smoker probabilities of dying in middle age (35-69) were 42% ν24% (a twofold death rate ratio) for those born in 1900-1909, but were 43% ν 15% (a threefold death rate ratio) for those born in the 1920s. At older ages, the cigarette smoker versus non-smoker probabilities of surviving from age 70 to 90 were 10% ν 12% at the death rates of the 1950s (that is, among men born around the 1870s) but were 7% ν 33% (again a threefold death rate ratio) at the death rates of the 1990s (that is, among men born around the 1910s). Conclusion A substantial progressive decrease in the mortality rates among non-smokers over the past half century (due to prevention and improved treatment of disease) has been wholly outweighed, among cigarette smokers, by a progressive increase in the smoker ν non-smoker death rate ratio due to earlier and more intensive use of cigarettes. Among the men born around 1920, prolonged cigarette smoking from early adult life tripled age specific mortality rates, but cessation at age 50 halved the hazard, and cessation at age 30 avoided almost all of it.

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Mortality in relation to smoking: 20 years' observations on male British doctors.

1976-12-25

Richard Doll , Richard Peto

In 1951 the British Medical Association forwarded to all British doctors a questionnaire about their smoking habits, and 34440 men replied. With few exceptions, all men who replied in 1951 … In 1951 the British Medical Association forwarded to all British doctors a questionnaire about their smoking habits, and 34440 men replied. With few exceptions, all men who replied in 1951 have been followed for 20 years. The certified causes of all 10 072 deaths and subsequent changes in smoking habits were recorded. The ratio of the death rate among cigarette smokers to that among lifelong non-smokers of comparable age was, for men under 70 years, about 2:1, while for men over 70 years it was about 1-5:1. These ratios suggest that between a half and a third of all cigarette smokers will die because of their smoking, if the excess death rates are actually caused by smoking. To investigate whether this is the case, the relation of many different causes of death to age and tobacco consumption were examined, as were the effects of giving up smoking. Smoking caused death chiefly by heart disease among middle-aged men (and, with a less extreme relative risk, among old men,) lung cancer, chronic obstructive lung disease, and various vascular diseases. The distinctive features of this study were the completeness of follow-up, the accuracy of death certification, and the fact that the study population as a whole reduced its cigarette consumption substantially during the period of observation. As a result lung cancer grew relatively less common as the study progressed, but other cancers did not, thus illustrating in an unusual way the causal nature of the association between smoking and lung cancer.

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Global health 2035: a world converging within a generation

2013-12-01

Dean T. Jamison , Lawrence H. Summers , George A.O. Alleyne +7 more

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Making Health Spending Sustainable Means Targeting Increasingly Excessive Price Growth

2025-06-26

| Forefront Group

Coordinated care in primary health care in Poland in 2021–2024: first experiences

2025-06-25

Przemysław Szetela | Medycyna Ogólna i Nauki o Zdrowiu

Catastrophic health expenditure and chronic respiratory disease: evidence from Kenya

2025-06-25

Walter Ochieng | The Lancet Global Health

Going beyond the fifth child: Exploring the determinants of desire for more children among high parity partnered women in Uganda

2025-06-25

Godfrey Tumwizere , Yiga Joseph Douglas , Allen Kabagenyi +1 more | PLOS Global Public Health

Background Despite the extensive research on fertility desire among women worldwide, there is a dearth of literature on the desire for more children among high-parity women. This study aimed to … Background Despite the extensive research on fertility desire among women worldwide, there is a dearth of literature on the desire for more children among high-parity women. This study aimed to identify the determinants of the desire for more children among high parity partnered women in Uganda. Methods This study was based on nationally representative data from the 2016 Uganda Demographic and Health Survey. The study sample comprised of a weighted sample of 4502 women aged 15–49 years with five and more children. A complimentary log-log model was fit to identify factors associated with the desire for more children among high-parity women in Uganda at the 5% level of significance. Results The findings revealed that 21% of high parity partnered women desired more children. The odds of desire for more children were 26% higher among women without decision-making autonomy on the number of children (AOR = 1.262 95% CI 1.109-1.415) than women with decision-making autonomy, women with preference of more than 3 boys had 2 times odds of desire for more children compared to those who preferred less than three boys (AOR = 2.021, 95% CI = 1.726-2.367) while Catholic women had 80% higher odds of desire for more children (AOR = 1.896, 95% CI = 1.786-2.020) compared to Anglicans. On the other hand, the odds of having a desire for more children were 33% lower among Muslims (AOR = 0.676, 95% CI 0.559–0.817) and 21% lower among Pentecostals (AOR = 0.70895% CI = 0.598–0.837) compared to Anglicans. The odds of having a desire for more children were 75% lower among women with primary education (AOR = 0.252, 95% CI 0.062-0.441) than among those with no education. Compared to women using modern contraceptives the odds of desire for more children were 38% lower (AOR = 0.620, 95% CI 0.481- 0.865) than those with not using modern contraceptives. Women with at least five living children had 75% lower odds of desire for more children (AOR = 0.255, 95% CI 0.060-0.549) compared to those with two living children. Women with primary education had 75% reduced odds of desire for more children compared to no education (AOR = 0.252 95% CI 0.062-0.441) while women whose husbands attained at least a secondary level of education had 79% reduced odds of desire for more children (AOR = 0.210, 95% CI 0.190-0.411) compared to women whose husbands had no education. Conclusions This study recommends that Uganda’s policymakers and Programme implementers emphasize the attainment of secondary or higher education, collaborate with religious leaders to promote health education sensitive to religious beliefs and practices and empower women to challenge social norms that restrict women’s decision-making autonomy on fertility.

Impact of Limited Sample Size and Follow-up on Partitioned Survival and Multistate Modeling-Based Health Economic Models: A Simulation Study

2025-06-25

Jaclyn Beca , Kelvin Chan , David Naimark +1 more | Medical Decision Making

Background Economic models often require extrapolation of clinical time-to-event data for multiple events. Two modeling approaches in oncology that incorporate time dependency include partitioned survival models (PSM) and semi-Markov decision … Background Economic models often require extrapolation of clinical time-to-event data for multiple events. Two modeling approaches in oncology that incorporate time dependency include partitioned survival models (PSM) and semi-Markov decision models estimated using multistate modeling (MSM). The objective of this simulation study was to assess the performance of PSM and MSM across datasets with varying sample size and degrees of censoring. Methods We generated disease trajectories of progression and death for multiple hypothetical populations with advanced cancers. These populations served as the sampling pool for simulated trial cohorts with multiple sample sizes and various levels of follow-up. We estimated MSM and PSM by fitting survival models to these simulated datasets with different approaches to incorporating general population mortality (GPM) and selected best-fitting models using statistical criteria. Mean survival was compared with “true” population values to assess error. Results With near complete follow-up, both PSMs and MSMs accurately estimated mean population survival, while smaller samples and shorter follow-up times were associated with a larger error across approaches and clinical scenarios, especially for more distant clinical endpoints. MSMs were slightly more often not estimable when informed by studies with small sample sizes or short follow-up, due to low numbers at risk for the downstream transition. However, when estimable, the MSM models more commonly produced a smaller error in mean survival than the PSMs did. Conclusions Caution should be taken with all modeling approaches when the underlying data are very limited, particularly PSMs, due to the large errors produced. When estimable and for selections based on statistical criteria, MSMs performed similar to or better than PSMs in estimating mean survival with limited data. Highlights Caution should be taken with all modeling approaches when underlying data are very limited. Partitioned survival models (PSMs) can lead to significant errors, particularly with limited follow-up. Incorporating general population mortality (GPM) via internal additive hazards improved estimates of mean survival, but the effects were modest. When estimable, decision models based on multistate modeling (MSM) produced similar or smaller error in mean survival compared with PSM, but small samples or limited deaths after progression produce additional challenges for fitting MSMs; more research is needed to improve estimation of MSMs and similar state transition–based modeling methods with limited data. Future studies are needed to assess the applicability of these findings to comparative analyses estimating incremental survival benefits.

ASSESSMENT OF HEALTH SYSTEM PERFORMANCE IN TÜRKİYE OVER 2000-2023: A DESCRIPTIVE INTERNATIONAL COMPARATIVE ANALYSIS

2025-06-25

İsrafil Boyacı , Rimon Ahmed | İstanbul Ticaret Üniversitesi Dış Ticaret Dergisi

This article aims to provide an assessment of the Turkish health system, which has been reformed with the Health Transformation Program 2003-2013 (HTP). The comparative performance of the transformed Turkish … This article aims to provide an assessment of the Turkish health system, which has been reformed with the Health Transformation Program 2003-2013 (HTP). The comparative performance of the transformed Turkish health system has been descriptively investigated using a sample of country-level data covering the years 2000-2023. The analyses, which contain both developed and emerging countries, reveal the level of progress and trends across the globe in the commonly used indicators about healthcare expenditure, health insurance coverage, healthcare inputs, healthcare utilization, health outcomes, and risk factors. As a result of the evaluations in this article, it has been revealed that despite lower healthcare spending, Türkiye has significantly improved the population health outcomes with relatively less healthcare spending, particularly during the HTP reform period; however, continuity of this progress has not been observed after the reform period. The findings of the article call for more investigations to address the question of whether the Turkish health system has spent less on healthcare over the last twenty years while getting more better health outcomes. Thus, this policy-relevant article points out the importance of continued investment to healthcare as well as the efficiency and productivity issues in Türkiye's healthcare system as topics that need to be researched further.

The impact of the EU–Turkey agreement on the number of lives lost at sea

2025-06-24

Irene Tafani , Massimo Riccaboni | Humanities and Social Sciences Communications

The effect of foreign aid for health and government health expenditure on the mortality rate in Zambia

2025-06-24

Sikopo Mubu | World Journal of Advanced Research and Reviews

This study investigates how foreign health aid and government health spending affect mortality rates in Zambia. Zambia’s health sector faces limited access, high disease burden, and population growth that strains … This study investigates how foreign health aid and government health spending affect mortality rates in Zambia. Zambia’s health sector faces limited access, high disease burden, and population growth that strains infrastructure. Foreign aid, especially for HIV/AIDS, malaria, and TB, has been vital. However, concerns about aid sustainability and low domestic spending necessitate examining their combined effects on health. Using a positivist, deductive, correlational design, we investigate whether foreign aid has a positive impact on health. We use secondary data (1980–2022) from the World Bank, the Bank of Zambia, and UNCTAD. Regression and Johansen cointegration analyses assess relationships among foreign aid, government spending, population growth, and mortality. Results show foreign aid significantly lowers mortality (Coef = –0.28781; Z = –6.22; P = 0.000); initiatives like PEPFAR and the Global Fund reduce deaths. However, reliance on aid may hinder domestic financing, leaving Zambia vulnerable to donor shifts. Population growth also significantly reduces mortality (Coef = –6.47965; Z = –5.13; P = 0.000), reflecting a demographic advantage. As the population ages, healthcare demand may outpace capacity, potentially reversing this trend. Government health expenditure shows no significant effect (Coef = 0.0092040; Z = 0.11; P = 0.913), suggesting inefficiencies from corruption and poor governance. Improving governance, accountability, and strategic use of public funds is essential. Findings underscore the need for policy reforms to strengthen domestic financing and prepare the healthcare system for demographic changes. Overall, these insights inform stakeholders and policymakers. Informed decisions are crucial for health improvements.

The latest impact factor of Polish Archives of Internal Medicine is a huge success of Polish clinical science

2025-06-24

Anetta Undas | Polskie Archiwum Medycyny Wewnętrznej

Association of Overweight and Obesity With Financial Burden

2025-06-23

Simar S. Bajaj , Bhav Jain , Cameron Sabet +4 more | Annals of Internal Medicine

Male Physicians’ Mortality Advantage and the “Crisis of Boys and Men”

2025-06-23

Teva D. Brender , Elizabeth Dzeng | JAMA Internal Medicine

Long-term scenarios for the development of financial-investment models of social security: threats and opportunities

2025-06-22

М. Л. Дорофеев | E-Management

Financial and investment models of social security (hereinafter referred to as FIMSS) are critical for ensuring social stability and economic resilience of the state. Amid global demographic shifts, technological advancements, … Financial and investment models of social security (hereinafter referred to as FIMSS) are critical for ensuring social stability and economic resilience of the state. Amid global demographic shifts, technological advancements, and climate challenges, there is a pressing need to adapt social security systems to emerging realities. The relevance of the study lies in the necessity to analyse the historical evolution of the FIMSS and to identify pathways for their modernisation to ensure long-term financial sustainability. The research aims to explore the transformation of the FIMSS and assess their potential in addressing contemporary social challenges based on global experience. The study employs methods of historical analysis, scenario modeling, and evaluation of the financial sustainability of the social security systems. It is found that traditional FIMSS face limitations under demographic pressures and technological shifts, with their financial stability requiring innovative risk management approaches. The results indicate that the adaptation of the FIMSS necessitates forward-looking strategies, including technology integration and reevaluation of funding sources. The proposals include optimising the social security systems through the development of universal programmes and strengthening the state’s role in managing social risks. In conclusion, the study highlights the importance of a comprehensive approach to reforming the FIMSS to meet the challenges of the 21st century.

Entropy in the Assessment of the Labour Market Situation in the Context of the Survival Analysis Methods

2025-06-21

Beata Bieszk‐Stolorz | Entropy

Since Shannon’s pioneering work, the concept of entropy has been used in many major scientific fields. It is therefore a universal concept but also defined in different ways. Entropy is … Since Shannon’s pioneering work, the concept of entropy has been used in many major scientific fields. It is therefore a universal concept but also defined in different ways. Entropy is used in studies of system complexity and to investigate the information content of probability distributions. One of the areas of its applications is human lifespan, i.e., the link between entropy and the methods of survival analysis. These methods are also used in assessing the duration of any socio-economic phenomenon. The aim of this article is to assess the market situation on the basis of the entropy of duration in unemployment. This study determines the Shannon entropy, residual entropy, past entropy, and cumulative residual entropy under the assumption of an exponential distribution of duration. Ward’s hierarchical clustering and the Dynamic Time Warping measure were used to analyse entropy and its relationship with the unemployment rate. It was shown that not all of the analysed models determine the entropy of duration in unemployment well for an exponential distribution. It was substantiated that there is a similarity between the formation of the entropy of duration in unemployment and the registered unemployment rate. It is shown that high unemployment rates in the labour market are a destabilising element of the labour market, more so than crises.

Pension Benefits Adequacy and Social Security Budget Sustainability - What Influences the Resilience of Public Pension Systems in Central and Eastern European Countries?

2025-06-20

Daniela-Nicoleta Sahlian , POPA Adriana Florina , Stãnilã Georgiana Oana +3 more | ECONOMIC COMPUTATION AND ECONOMIC CYBERNETICS STUDIES AND RESEARCH

Chronic health conditions and health-related economic inactivity in midlife: Evidence from the 1958 and 1970 British birth cohorts

2025-06-20

Laura Gimeno , Charis Bridger Staatz , Alice Goisis +2 more | medRxiv (Cold Spring Harbor Laboratory)

ABSTRACT Background Health-related economic inactivity is a growing concern in the United Kingdom but little is known about how the relationship between health and work participation has changed across cohorts. … ABSTRACT Background Health-related economic inactivity is a growing concern in the United Kingdom but little is known about how the relationship between health and work participation has changed across cohorts. Methods We used data from two British birth cohorts born in 1958 (National Child Development Study, n = 9,761) and 1970 (British Cohort Study, n = 7,336). We examined how self-reported chronic health conditions at age 42 (longstanding illness, obesity, diabetes, high blood pressure, back pain, and mental ill-health) were associated with economic activity at ages 50–54, focusing on health-related inactivity. Multinomial logistic regression models, adjusted for previous economic activity and sociodemographic characteristics, were used to estimate average marginal effects (AME). Results Poor health was more prevalent in the 1970c, including among those still working at age 50-54. Longstanding illness and mental ill-health were associated with a higher risk of health-related inactivity in both cohorts. A longstanding illness at age 42 was associated with a 6 percentage-point increase in health-related inactivity risk a decade later (AME 1958 = 5.9 [95% Confidence Interval (CI) 2.7, 9.1], AME 1970 = 6.5 [95%CI 3.4, 9.6]), and mental ill-health with a 4.5 percentage-point higher risk (AME 1958 = 4.4 [95%CI 0.9, 7.9], AME 1970 = 4.5 [95%CI 1.1, 7.8]). The magnitude of associations was similar across cohorts except for high blood pressure. Conclusions Chronic health conditions in early midlife were strongly associated with a health-related inactivity, despite contextual change. Preventing ill-health and supporting employment for those with chronic conditions is key to face the challenges of population ageing.

The Silent Epidemic: Loneliness as a Global Public Health Challenge

2025-06-19

Sandra Maria Conradi , Holger Cramer | Journal of Integrative and Complementary Medicine

Correction: Covid-19 mortality: the Proportionality Hypothesis

2025-06-19

Andrew J. G. Cairns , David Blake , Amy Kessler +2 more | European Actuarial Journal

Conclusion

2025-06-19

Mark L. Haas | Oxford University Press eBooks

Abstract This chapter summarizes the book’s key findings and provides policy recommendations based on these conclusions. It answers two main questions. What, if anything, can leaders do to minimize aging’s … Abstract This chapter summarizes the book’s key findings and provides policy recommendations based on these conclusions. It answers two main questions. What, if anything, can leaders do to minimize aging’s negative effects in their state? What can leaders do to intensify the positive international effects created by aging in other countries? Regarding the first question, governments’ ability to significantly reduce the harmful effects of population aging is low. Leaders will be hard-pressed to either reverse this demographic trend or counter its impact without creating other major drawbacks or costs. Policymaking regarding the second question could prove more productive: officials could try to take advantage of and even amplify the effects created by aging in other countries to boost international peace. If demographically old states tend to be less war prone, then leaders have a security-based interest in other countries becoming old. Officials, as a result, have an interest in other countries’ fertility rates declining and life expectancies rising. Effective ways that leaders can contribute to these outcomes are by adopting international policies that increase female education levels, raise standards of living, and enhance public health. Because advances in public health, women’s rights, and economic development help create the demographic conditions that significantly increase the likelihood of international peace, leaders have powerful self-interested reasons to support these outcomes abroad. An analysis based on the international effects of population aging reveals a critical instance in which self-interests and ethical obligations work in synergy and not in opposing directions.

Disappearing people: A global demographic data crisis threatens public policy

2025-06-19

Jessica Espey , Andrew J. Tatem , Dana R. Thomson | Science

Collapsing international support for population data collection is compromising government planning all around the world Collapsing international support for population data collection is compromising government planning all around the world

The Impact of Medical Insurance Penetration and Macroeconomic Factors on Healthcare Expenditure and Quality Outcomes in Saudi Arabia: An ARDL Analysis of Economic Sustainability

2025-06-18

Faten Derouez , Norah Falah Munahi Bin Shary | Sustainability

This study investigated the determinants of the Healthcare Quality Index (HQI) in Saudi Arabia over the period from 1990 to 2024. It specifically analyzed the impact of six key variables: … This study investigated the determinants of the Healthcare Quality Index (HQI) in Saudi Arabia over the period from 1990 to 2024. It specifically analyzed the impact of six key variables: Medical Insurance Penetration Rate (MIPR), Gross Domestic Product per Capita (GDP), Unemployment Rate (UR), Inflation Rate (IR), Government Healthcare Expenditure as a Percentage of GDP (GHE), and Foreign Direct Investment in the Healthcare Sector (FDI). Utilizing the Autoregressive Distributed Lag (ARDL) and Vector Error Correction Model (VECM) techniques, this research explored both the short-term dynamics and the long-term equilibrium relationships among these time-series variables, while also accounting for cointegration and potential endogeneity. This study contributes to the existing literature by applying the ARDL and VECM methodologies to comprehensively analyze the combined impact of these factors on HQI within the unique economic and social framework of Saudi Arabia, addressing a notable void in this specific context and exploring both transient fluctuations and sustained equilibrium relationships. The key findings revealed distinct influences across time horizons. In the short term, GDP and GHE significantly and positively affect HQI, whereas UR and IR demonstrate a significant negative impact. Short-term impacts of MIPR and FDI are found to be positive but not statistically significant. The long-term analysis indicates that MIPR, GHE, and FDI have a significant positive influence on HQI, while IR maintains a significant negative impact. GDP and UR effects are not statistically significant in the long term. Further analysis using Granger causality tests and VECM confirmed that MIPR, GDP, GHE, and FDI collectively Granger-cause HQI, with government healthcare expenditure playing a crucial role in correcting short-term deviations toward long-term equilibrium. This study concludes that long-term strategies focusing on expanding insurance coverage, increasing government healthcare investment, and attracting foreign direct investment are vital for significantly enhancing healthcare quality in Saudi Arabia. The sustained positive influence of these factors and the critical role of government spending in maintaining long-term stability underscore their importance for effective healthcare policy. While emphasizing these long-term drivers, policymakers should also remain cognizant of the significant negative short-term fluctuations caused by unemployment and inflation.

Spatial convergence of population ageing in Poland’s provinces in a retrospective and prospective analysis

2025-06-18

Ireneusz Kuropka , Joanna Krupowicz | Bulletin of Geography Socio-economic series

Poland’s central statistical office, Statistics Poland, forecasts that the populations of most Polish provinces will decline by 2060, as will the share of young people, while the share of old-age … Poland’s central statistical office, Statistics Poland, forecasts that the populations of most Polish provinces will decline by 2060, as will the share of young people, while the share of old-age population will increase. The population structure across Poland’s provinces is visibly disproportionate, and population ageing has two different dimensions: it is both a top-down and a bottom-up process. Aim. This study was designed to assess the advancement rate and diversity of population ageing in Poland’s provinces in the past – and in the future (up to 2040). This study used data on the share of five age groups in the overall population, referring to both the past (2002–2022) and the future (by 2040). To determine the convergence of population ageing...

Fiscal capacity and public health expenditure in the west African Economic and Monetary Union: the moderating effect of political instability

2025-06-18

Jacques Boundioa | Cogent Economics & Finance

Health Status And Delays In Referral-To-Treatment Waiting Times for Elective Admissions of Adults From Deprived Areas And Ethnic Minority Backgrounds: A Study of Healthcare Inequalities

2025-06-18

David Fluck , Emma L. Jackson , Ana Llamas-Montoya +7 more | Journal of Racial and Ethnic Health Disparities

Abstract We studied all patients (total 53,611) whose referral-to-treatment (RTT) ended in hospital admission (“ admitted pathways ”) between 01/2019 and 12/2023. Their health status and RTT waiting times were … Abstract We studied all patients (total 53,611) whose referral-to-treatment (RTT) ended in hospital admission (“ admitted pathways ”) between 01/2019 and 12/2023. Their health status and RTT waiting times were related to indices of deprivation (IMD: combined data from income, employment, education, health, crime, barriers to housing and services, and living environment) and to ethnicities (87% Caucasians; 6% South Asians; 5.1% Other Ethnicities; 0.9% Blacks; 0.7% Mixed Race; 0.3% Chinese). The risk of RTT waiting times > 18 weeks was assessed by logistic regression, adjusted for confounding factors (age, sex and number of comorbidities) and presented as odds ratios (OR) and 95% confidence intervals: least-deprived areas (IMD decile = 10) and Caucasians were reference levels. Patients’ median age (66 years, interquartile range = 51–77) was representative of “admitted pathways” UK patients. Major chronic diseases were more common amongst patients from ethnic minority and deprived backgrounds. Risks of RTT waiting times > 18 weeks for elective admissions rose progressively with increasing deprivation: OR = 1.20 (1.05–1.36), compared to the least deprived areas; and mixed race: OR = 1.39 (1.10–1.76), other ethnicities: OR = 1.15 (1.05–1.26), and all ethnic minorities: OR = 1.11 (1.05–1.18), compared to Caucasians. Our findings provide evidence for health and healthcare inequalities associated with individuals from deprived areas and ethnic minority backgrounds, particularly those of mixed race. More research and resources are needed to address these inequalities that include policy interventions to reduce barriers that hinder access to healthcare and advocating for policies that address underlying social determinants of health that reduce inequalities in education, employment and housing.

Parcel-Level Housing Conditions and Pediatric Asthma Hospital Utilization

2025-06-18

Cole Brokamp , Sarah E Ray , Qing Duan +7 more | PEDIATRICS

OBJECTIVE Pediatric hospital encounters related to asthma have been linked to failed housing inspections, but evidence at the individual- and parcel-level is absent. Our objective was to examine the impact … OBJECTIVE Pediatric hospital encounters related to asthma have been linked to failed housing inspections, but evidence at the individual- and parcel-level is absent. Our objective was to examine the impact of housing code violations on pediatric asthma exacerbations. METHODS We conducted a retrospective cohort study based on electronic health records at Cincinnati Children’s Hospital Medical Center in Hamilton County, Ohio, between July 2016 and July 2022. We followed 13 404 patients with asthma living at 22 762 unique addresses for 11 million cumulative patient-days. Study participants were exposed to poor housing conditions if they resided at a parcel within 1 year of the enforcement of a housing code infraction. Our outcome was defined as the time to asthma exacerbation (or censoring event) in days. RESULTS Overall, 66% of patients with asthma were publicly insured and lived in homes with a median market total value of $104 000 with a parcel type of mostly single-family homes (67%) but also apartments (13%) and 2- or 3-family homes (9%). A total of 1327 study participants (9.9%) experienced an asthma exacerbation during the follow-up period, and 1651 (12%) were exposed to poor housing conditions as defined by infractions of local housing codes. In proportional hazards models adjusted for public insurance and total market value by housing type, living at a parcel with a housing infraction during the previous year was associated with a 34% increased individual-level hazard for an asthma exacerbation (hazard ratio, 1.34; 95% CI, 1.08–1.67). CONCLUSION The impact of improving housing conditions merits further study.

Covid-19 Pandemisinde İstatistik Bölgelerdeki Sağlık Hizmetinin Çok Boyutlu Ölçekleme ve TOPSIS Yöntemlerine Göre Değerlendirilmesi

2025-06-18

Aslı Köse | Afyon Kocatepe Üniversitesi Sosyal Bilimler Dergisi

21.yüzyılın halk sağlığı krizi olarak nitelendirilen Covid-19 özellikle sağlık sektörü olmak üzere birçok sistemi etkilemiştir. Dünya ülkelerinde öncelikli hedef sağlık risklerini azaltıp hayatın devamlılığını sağlamak olarak belirlenmiştir. Türkiye’de 2020 yılında … 21.yüzyılın halk sağlığı krizi olarak nitelendirilen Covid-19 özellikle sağlık sektörü olmak üzere birçok sistemi etkilemiştir. Dünya ülkelerinde öncelikli hedef sağlık risklerini azaltıp hayatın devamlılığını sağlamak olarak belirlenmiştir. Türkiye’de 2020 yılında Covid-19’a yönelik ilk önlemler Mart ayında alınmaya başlamıştır. Bu çalışmanın amacı istatistik bölgelerin pandemi döneminde sağlık hizmeti kapasite, sağlık hizmeti üretimi, sağlık insan gücü parametrelerine göre değerlendirilmesidir. 2020 ve 2021 yılları sağlık istatistikleri yıllıklarından sağlık hizmeti kapasite parametreleri hastane yatak sayısı, yoğun bakım yatağı sayısı, BT cihazı sayısı, sağlık hizmeti üretimi parametresinde kişi başı hastaneye başvuru sayısı, sağlık insan gücü parametresinde ise hekim sayısı, hemşire ve ebe sayısı seçilmiştir. İstatistik bölgelerin sağlık hizmeti kapasitesi, sağlık hizmeti üretimi ve sağlık insan gücünü kapsayan 6 parametre ile çok boyutlu ölçekleme analizi ile konumları belirlenmiştir. TOPSIS yöntemi ile seçilen parametrelere göre istatistik bölgelerin sıralamaları yapılmıştır. İstatistik bölgelerin seçilen 6 parametreye göre konumlarının değerlendirildiği çok boyutlu ölçekleme analizi ile sıralamanın yapıldığı TOPSIS sonuçlarının benzer olduğu belirlenmiştir.

Evaluation of Health System Performance with MULTIMOORA Method: OECD Countries

2025-06-18

Emre Yılmaz | Acibadem Universitesi Saglik Bilimleri Dergisi

Purpose: The aim of this study is to compare the health system performances of OECD countries in the light of certain health and socio-economic indicators and to make country performance … Purpose: The aim of this study is to compare the health system performances of OECD countries in the light of certain health and socio-economic indicators and to make country performance rankings with the MULTIMOORA method. Methods: Firstly, health and socio-economic indicators were determined for the performance evaluation comparisons of the countries through literature review. The data of the indicators were obtained from reliable databases and analysed by MULTIMOORA method, which is one of the multi-criteria decision-making methods. Results: According to the results of the analyses, the countries with the highest health system performance among 38 OECD countries are Japan, Sweden, Norway, Denmark and Germany, while the countries with the lowest performance are Latvia, Costa Rica, Turkey, Mexico and Colombia, respectively. Conclusion: As a result, in countries with high health system performance, access, quality and comprehensiveness of health services are ensured. Per capita expenditures for the health system are quite high. In countries with low performance, the limited resources allocated to the health system cause the service coverage index to remain low. High out-of-pocket expenditures drive especially low-income groups away from health services. In this context, low-performing countries need to improve their health systems by learning from the health systems of high-performing countries and developing strategies to overcome existing deficiencies.

Impact of the Integration of Urban and Rural Residents' Basic Medical Insurance on Residents' Consumption: An Empirical Study Based on CFPS Data

2025-06-18

Wanxin Zhang | Frontiers in Humanities and Social Sciences

This paper uses the balanced panel data of the China Family Panel Studies (CFPS) from 2010 to 2022 and applies the difference-in-differences model (DID) to conduct an empirical exploration of … This paper uses the balanced panel data of the China Family Panel Studies (CFPS) from 2010 to 2022 and applies the difference-in-differences model (DID) to conduct an empirical exploration of the impact of the integration of urban and rural medical insurance on residents' consumption. The study finds that the medical insurance co-ordination policy has significantly increased the household consumption level of rural residents, but has no significant impact on the consumption of urban residents. The mechanism analysis shows that the medical insurance co-ordination affects high-debt and high-income families more significantly through channels such as reducing the risk of medical expenses and optimizing the household consumption structure. The heterogeneity analysis shows that the policy effect is more prominent in medium-low health, medium health, high-saving families, and remote western regions. The research indicates that the medical insurance integration policy helps to narrow the urban-rural consumption gap, but it is still necessary to further optimize the system design to benefit a wider range of groups.

Revolutionizing healthcare

2025-06-18

Sushil K. Sharma , Nagaraj Subbarao , Saurabh Kumar Jha +1 more | CRC Press eBooks

Correction: Nonnationals’ Fertility and the Great Recession in Italy: A Panel Analysis of Quantum and Tempo Responses

2025-06-17

Thais García-Pereiro , Anna Paterno | Italian Economic Journal

Spillover costs

2025-06-17

Carl Rihan | Manchester University Press eBooks

The impact of population ageing on economic growth in developing countries

2025-06-17

Dekkiche Djamal | Croatian Review of Economic Business and Social Statistics

The study aims to analyse the economic effects of population ageing in Japan, Spain, Italy, the United States, South Korea, Germany, France, the United Kingdom, and Canada using the panel … The study aims to analyse the economic effects of population ageing in Japan, Spain, Italy, the United States, South Korea, Germany, France, the United Kingdom, and Canada using the panel ARDL (Autoregressive Distributed Lag) model. GDP per capita was adopted as the dependent variable, while the independent variables included the proportion of the population over 65, health expenditure, the dependency rate, and the level of investment as a proportion of GDP. The results showed varying effects of ageing on economic growth. It had a positive impact in some of the countries under study (the USA, South Korea, and Germany) and a negative impact in others (Spain, Italy, and Japan). Health spending was also found to be an economic burden, while fixed investment was shown to be critical in supporting economic growth. The study recommends improving education and training to increase productivity, embracing innovation and technology, enhancing health systems through preventive care, and implementing flexible policies, such as encouraging women's participation in the labour market and promoting migration.

Financial Crises Bring Opportunities

2025-06-17

Eduardo Bruera | Journal of Palliative Medicine

Inter-Territorial Calculations for Identifying Imbalances and Problems in Health Insurance

2025-06-17

Svetlana Badlo , Olga Tabashnikova | Bulletin of Kemerovo State University Series Political Sociological and Economic sciences

The current strategic goals in the national public healthcare require improving its quality and availability, which implies effective financial management in the compulsory health insurance system. Regional compulsory health insurance … The current strategic goals in the national public healthcare require improving its quality and availability, which implies effective financial management in the compulsory health insurance system. Regional compulsory health insurance funds provide citizens with free medical care as part of state healthcare programs. The article introduces an in-depth analysis of the revenue and expenditure budget structure of regional compulsory health insurance funds with a focus on the inter-territorial calculations. The analysis made it possible to propose a system of measures to make the funds more effective by improving their management. A review of various approaches to financial assessment revealed that the formal balance, which supposedly reflects the financial stability of the health insurance system, cannot be considered as a reliable indicator. Only an objective assessment could reveal the obscure imbalances, local financial disproportions, and issues connected with the inter-regional distribution. The authors conducted an in-depth analysis of the dynamics of the budget, income, and expenses provided by the Siberian compulsory health insurance funds in 2009–2024. The assessment of inter-territorial financial flows caused by patient migration revealed a correlation between the indicators of the outflow of patients seeking medical care in other regions and the socio-demographic factors. By optimizing the identified imbalances and increasing the medical attractiveness, regions could improve the financial and economic mechanism of their compulsory health insurance systems, as well as ensure their sustainable development.

Physician Workforce and Population Mortality: A Globally Validated Age-Structured Modeling Approach

2025-06-17

Youngmin Oh | medRxiv (Cold Spring Harbor Laboratory)

Summary Background Evaluating long-term health workforce planning requires robust and globally valid indicators. While many existing metrics, such as patient satisfaction or healthcare utilization, are inherently uncertain over long horizons, … Summary Background Evaluating long-term health workforce planning requires robust and globally valid indicators. While many existing metrics, such as patient satisfaction or healthcare utilization, are inherently uncertain over long horizons, mortality is an objective and stable metric. To analyze how physician supply impacts population health, we propose a model that links physician density to age-specific mortality rates and incorporate it to the age-sturctured dynamics. Methods We developed a unified model that links physician workforce density to age-structured mortality rates. Subsequently, we applied this model within a Lotka-McKendrick framework to simulate physician supply expansion scenarios in South Korea. The system simulates future age-specific mortality outcomes under varying physician supply scenarios, including a baseline intake of 3,058 physicians per year and an expanded intake of up to 7,058 physicians per year, projected through 2065. Findings Our model was validated using WHO mortality data including Japan, the United States, and the United Kingdom. Its validity of our model holds across all age groups in each country, as confirmed by statistical analysis with false discovery rate correction (maximum adjusted p < 0.05). Using the age-structured dynamics with the model in South Korea, we confirm that future physician density increases even under the baseline scenario (3,058 physicians per year), and that projected population sizes under the baseline and the aggressive expansion scenario (7,058 physicians per year) are not statistically different ( p > 0.07). Moreover, under the aggressive expansion scenario, the projected reductions in age-specific mortality rates by 2065 remain marginal: less than 0.27% for those under 65, less than 0.69% for ages 65–75, less than 2.75% for ages 75–84, less than 7.31% for ages 85–94, and less than 12.6% for ages 95–99. Interpretation In well-resourced health systems facing aging populations and persistently low fertility rates, further expansion of physician supply alone offers limited mortality benefits. Our findings suggest a paradigm shift: from quantity-driven to efficiency-focused workforce strategies. The proposed method is readily adaptable to other contries, offering a policy-relevant and outcome-oriented tool for long-term health workforce planning. Funding None. The funder had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Research in context Evidence before this study We searched PubMed, Web of Science, and Google Scholar for studies published between 2000 and 2024 using terms such as “physician workforce,” “healthcare workforce planning,” “medical workforce density,” and “age-structured dynamics.” Most physician workforce planning models are either utilization-based (projected service demand) or needs-based (estimated population health requirements). These models often extrapolate current health service utilization rates or population health needs into the future, typically assuming that such values remain constant over time, despite the acknowledged difficulty of forecasting long-term demand dynamics. Additionally, methodologies differ widely across countries, which hampers direct comparisons of outcomes. Some metrics, such as patient needs or preferences, are also subjective and difficult to measure consistently. In contrast, more objective indicators like mortality rates are more readily available and comparable across settings. As far as we are aware, no published model has dynamically integrated physician density—endogenously derived from workforce supply—into an age-structured framework for projecting population mortality. Added value of this study To the best of our knowledge, this study is the first to integrate a model linking physician workforce density with age-structured mortality rates into the Lotka–McKendrick framework, capturing the interaction between physicians and populations across age groups. By modeling how changes in doctor-to-population ratios affect mortality, our approach moves beyond traditional models that treat health outcomes as exogenous. This allows novel analyses of policy scenarios, such as estimating life expectancy gains from increasing physician supply. Our model provides a unified framework to project both physician workforce dynamics and population health outcomes simultaneously. Implications of all available evidence Our findings underscore the importance of explicitly linking age-structured population dynamics with physician density and mortality outcomes. Traditional models often overlook these interdependencies, risking inaccurate forecasts and limiting the relevance of cross-national comparisons. By capturing how physician supply influences mortality across age groups, our approach enables more precise, outcome-driven workforce planning.

Allocative Efficiency and Distributive Equity in Healthcare Resource Allocation: A Multiregional Comparative Study of China’s Guangxi Region with AI-Enhanced Insights

2025-06-16

Lanhua Luo , Hui Wang , L. Jiang | International Journal of High Speed Electronics and Systems

Artificial Intelligence (AI) can enhance the allocation of medical resources through demand forecasting, optimization of resource allocation efficiency, and regulation of equity. Based on an analysis of medical resource allocation … Artificial Intelligence (AI) can enhance the allocation of medical resources through demand forecasting, optimization of resource allocation efficiency, and regulation of equity. Based on an analysis of medical resource allocation in Guangxi from 2019 to 2022, this study proposes a new productivity empowerment pathway centered on AI. A dataset covering population, economy, and geography was built. Data Envelopment Analysis and Gini coefficient assessments revealed an overall allocation efficiency of 0.9460, with the Western River Economic Belt showing the highest stability despite declining total factor productivity. In 2022, Beibu Gulf’s medical institution Gini coefficient reached 0.4317, while the 2020 bed and healthcare personnel allocation exceeded the 0.5 warning threshold. Spatial agglomeration analysis identified structural contradictions: “regional surplus–economic shortage” in Beibu Gulf and “regional shortage–economic surplus” in western Guangxi. To address these, a three-level strategy is proposed: policy-level dynamic systems guiding resource redistribution via hierarchical diagnosis and insurance adjustments; talent-level regional training programs; and technology-level development of a three-tier intelligent network connecting tertiary hospitals, county medical communities, and primary healthcare to advance AI-driven collaboration and lesion identification, improving both efficiency and equity.

Linking mother’s demographic disadvantages with children’s demographic outcomes in India: a pseudo cohort study

2025-06-16

Anjali Singh , Dil Bahadur Rahut , Kaushalendra Kumar Singh | Population Health Metrics

Many studies have recognized that a woman's reproductive history influences the survival status of her fetus and the newborn. In the esteemed literature of demography, abundant evidence acknowledges the linkage … Many studies have recognized that a woman's reproductive history influences the survival status of her fetus and the newborn. In the esteemed literature of demography, abundant evidence acknowledges the linkage between maternal exposure to offspring and their associated adult outcomes and the other way around. This study examines the link between maternal risk factors at birth and long-term outcomes for daughters in India. Using national health survey data, it focuses on three maternal risks: young age, high parity, and short birth intervals. Applying regression analysis to cohort data, the study finds these early-life disadvantages are associated with daughters experiencing stunted growth, undernutrition, child mortality, and low birth weight, as well as limited education and employment. Conversely, daughters of educated mothers have better outcomes, highlighting the importance of maternal education. The pseudo-cohort approach provides valuable longitudinal insights from cross-sectional surveys. The study underscores the need for policies promoting healthy reproductive practices and education access to improve long-term outcomes for women in India.

Partial or Limited Frail Elder Waivers in Massachusetts—Minimizing Costs and Need for Institutional Care in Later Life

2025-06-16

Elaine Eliopoulos , Christine Carter , Chris Gilleard +1 more | Journal of Science Policy & Governance

Massachusetts will experience an exponential increase in adults living into advanced old age over the next several decades. Medicare and Medicaid costs to fund institutional care continue to rise. The … Massachusetts will experience an exponential increase in adults living into advanced old age over the next several decades. Medicare and Medicaid costs to fund institutional care continue to rise. The Frail Elder Waiver program presents an opportunity to reduce institutional costs by providing essential support at home to older people who would otherwise require institutional care. These supports would allow the individual to remain at home longer and avoid or delay the need for institutional care. Eligibility for the waiver requires that individuals over 65 meet specific clinical requirements that may be safely managed at home with specific services. These services may include such essentials as environmental accessibility adaptation, medication assistance, supportive day programming, and home-delivered meals. Revising the waiver program to allow limited or partial services prior to the onset of substantial limitations would result in economic and quality of life gains.

Inequalities in Quality-Adjusted Life Expectancy in Australia by Educational Attainment

2025-06-16

Sheridan E Rodda , Melanie Lloyd , Jennifer Welsh +3 more | PharmacoEconomics

Summary measures such as quality-adjusted life expectancy (QALE) are increasingly used to monitor health inequalities. Socioeconomic inequalities in health are well documented in Australia, including inequalities by education. However, estimates … Summary measures such as quality-adjusted life expectancy (QALE) are increasingly used to monitor health inequalities. Socioeconomic inequalities in health are well documented in Australia, including inequalities by education. However, estimates for QALE by level of education are lacking for Australia. We aimed to provide QALE stratified by age and sex across levels of educational attainment for the Australian population aged 25 years and above. We categorized educational attainment as low (completed year 11 or below), intermediate (completed year 12 and/or other non-tertiary or vocational qualification) or high (completed a bachelor's degree or above). Mean Short-Form Six-Dimension health utility was estimated for sex- and education-specific subgroups from the Household, Income and Labour Dynamics in Australia survey (2022). We constructed life tables using age-sex-education-specific mortality rates for 2019 obtained from linked 2016 Census and Death Registrations data. Health utility was incorporated into the life tables to derive age- and sex-specific QALE across education levels. At age 25 years, males with high education had 7.3 years greater life expectancy than those with low education (61.0 versus 53.7 years undiscounted) and larger QALE (39.9 versus 28.8 years undiscounted), a gap of 11.1 years (39% relative difference). Females aged 25 years with a high level of education experienced 3.9 years greater life expectancy (LE; 63.1 versus 59.2 years, undiscounted) and an additional 7.6 years of QALE (36.9 versus 29.3 years, undiscounted), compared with those with low education, a 26% relative difference in QALE. Significant disparities in QALE by educational attainment exist in Australia. These findings can inform policies aimed at reducing health inequity by guiding resource allocation and supporting future equity-informative economic evaluations.

How effective are VAT reforms in improving healthy dietary choices by EU consumers?

2025-06-16

Beatrice Farkas , Ignácio Pérez Domínguez , Simone Pieralli +1 more | Economía Agraria y Recursos Naturales

Governments are increasingly considering fiscal instruments to improve dietary health. This paper quantifies the medium-term impacts on European food markets of a differentiated VAT policy that promotes healthy food consumption … Governments are increasingly considering fiscal instruments to improve dietary health. This paper quantifies the medium-term impacts on European food markets of a differentiated VAT policy that promotes healthy food consumption while discouraging intake of less nutritious products. Scenarios involve reduced VAT on grains, pulses, and poultry, and increased rates on beef, pork, sugar, and highfat dairy. Our results show a significant decline in domestic consumption of targeted foods. However, part of this reduction is exported to other markets – a phenomenon described as “health leakage,” raising questions about the broader effectiveness of such fiscal interventions.

1191-P: Social Determinants of Health Barriers—Differences between Public vs. Private Insurance

2025-06-13

JASMINE ROBERTS , SARAH L. HOLLY , ROXANNA E. VELASQUEZ +3 more | Diabetes

Introduction and Objective: Social determinants of health (SDOH) barriers can significantly impact the support needed for a new diabetes diagnosis. Families with public insurance often face additional socioeconomic barriers, potentially … Introduction and Objective: Social determinants of health (SDOH) barriers can significantly impact the support needed for a new diabetes diagnosis. Families with public insurance often face additional socioeconomic barriers, potentially limiting access to medical care and resources. SDOH screening was implemented in newly diagnosed diabetes patients and characteristics and differences between insurance types were studied. Methods: A large academic center launched a standardized SDOH screen at the time of diabetes diagnosis. Caregivers who identify barriers are provided with a list of tailored resources and ongoing support from a Diabetes Health Coach. Comparisons among T1D new onset patients were made to assess patterns and prevalence of identified barriers between private and public insurance. Results: 87 SDOH screens were completed over 14 months (n=45 public insurance; n= 42 private insurance). Barriers were identified in 36% (n=16) of those with public insurance compared to 17% (n=7) of those with private. Mental health and food insecurity were the most identified barriers, regardless of insurance. However, patients with public insurance were more likely to endorse a mental health barrier (25% vs 10%) and food insecurity (32% vs 7%). 14% (n=1) of privately and 69% (n=11) of publicly insured patients reported more than one barrier. Only publicly insured patients endorsed health literacy, employment, transportation, and financial barriers. Conclusion: Patients with public insurance were more than twice as likely to identify barriers compared to those with private insurance. Of the most identified barriers, those with public insurance identified them at higher rates than those with private insurance. Patients with public insurance are more likely to experience social and economic barriers. These results underscore the need for SDOH screening and tailored resource allocation, particularly for patients in underserved communities in order to improve equity in diabetes care. Disclosure J. Roberts: None. S.L. Holly: None. R.E. Velasquez: None. L. DeAnna: None. D. Patrick: None. S. Majidi: Speaker's Bureau; Sanofi. Funding CareFirst Blue Cross Blue Shield

An Actuarial Perspective on the Discrepancies in Health Insurance Pricing: Evidence from India

2025-06-13

N. K. Rathee , Rupel Nargunam | Research Square (Research Square)

<title>Abstract</title> This study investigates the actuarial fairness of pricing health insurance policies by examining discrepancies within the Indian health insurance and their impact on medical costs. Health insurance helps an … <title>Abstract</title> This study investigates the actuarial fairness of pricing health insurance policies by examining discrepancies within the Indian health insurance and their impact on medical costs. Health insurance helps an individual in financing their medical expenses, for a fee called premium which is typically the reflection of expected cost of medical services. However, discrepancies such as misinformation, accessibility to health care services, hospital quality and Inconsistencies in claims processing, increase costs associated with health care of individuals participating in the health insurance, thereby challenging the fairness of these policies. Structural Equation Modelling (SEM) has been employed to develop latent variables representing these discrepancies and Hierarchical Linear Modelling (HLM) has been used to assess their effect on the cost of medical care. The findings of this study suggest the presence of discrepancies in the Indian health insurance sector and the results support the significant impact on the increase in medical expenses. The study concludes with policy recommendations aimed at enhancing the efficiency, effectiveness and fairness of the health insurance policies in India

Mortalidad prematura evitable y efectividad del sistema sanitario para reducirla durante el siglo xxi en España según la comunidad autónoma

2025-06-13

Marta Donat , Gregorio Barrio , Juan Miguel Guerras +4 more | Medicina Clínica