Purpose

In this paper, the authors assess the responsiveness of OOP healthcare expenditure to macro-fiscal factors, as well as to tax-based, SHI, mixed systems and voluntary PHI financing. Although the relationship between OOP expenditure, macroeconomy, aggregate public and PHI financing is well documented in the existing empirical literature, little is known for the impact of several macro-fiscal drivers and the existing health financing arrangements associated with voluntary PHI on OOP expenditure.

Design/methodology/approach

The authors gather panel data by applying three official organizations’ databases. They elaborate static and dynamic panel data methodology to a dataset of 49 European and OECD countries from 2000 to 2015.

Findings

The authors’ findings do not indicate a considerable impact of GDP growth and general government debt as a share of GDP on OOP payments. Unemployment rate presents as a positive driver of OOP payments in all three compulsory national health systems post to the 2008 economic crisis. OOP payments are significantly influenced by countries’ fiscal capacity to increase general government expenditure to GDP in SHI and mixed health systems. Additionally, study findings present that government health financing, irrespective of the different health systems structure characteristics, and OOP healthcare payments follow different directions. Voluntary PHI financing considerably counteracts OOP payments only in tax-based health systems.

Practical implications

In the backdrop of a new economic crisis associated to the COVID-19 epidemic, health policy planners have to deal with the emerging unprecedented challenges in financing of health systems, especially for these economies that have to face the fiscal capacity constraints owing to the 2008 financial crisis and its severe recession.

Originality/value

To the best of authors’ knowledge, there is no empirical consensus on the effects of macro-fiscal parameters, different compulsory health systems financing associated with the parallel voluntary PHI institution funding on OOP expenditure, for the majority of European and OECD settings.

中文翻译：

---

评估自费医疗支出对宏观财政因素和不同卫生筹资系统的反应：来自欧洲和经合组织地区的证据

目的

在本文中，作者评估了 OOP 医疗保健支出对宏观财政因素以及基于税收的 SHI、混合系统和自愿 PHI 融资的反应。尽管 OOP 支出、宏观经济、公共总量和 PHI 融资之间的关系在现有的实证文献中得到了很好的证明，但对于几个宏观财政驱动因素以及与自愿 PHI 相关的现有卫生筹资安排对 OOP 支出的影响知之甚少。

设计/方法/方法

作者通过应用三个官方组织的数据库来收集面板数据。他们针对 2000 年至 2015 年 49 个欧洲和经合组织国家的数据集详细阐述了静态和动态面板数据方法。

发现

作者的研究结果并未表明 GDP 增长和广义政府债务占 GDP 的比重对 OOP 支付有显着影响。失业率是 2008 年经济危机后所有三个强制性国家卫生系统自费支付的积极推动力。OOP 支付受到国家财政能力的显着影响，以增加 SHI 和混合卫生系统的一般政府支出占 GDP 的比例。此外，研究结果表明，无论卫生系统结构特征如何，政府卫生筹资和 OOP 医疗保健支付都遵循不同的方向。自愿 PHI 融资仅在基于税收的卫生系统中大大抵消了 OOP 支付。

实际影响

在与 COVID-19 流行病相关的新经济危机的背景下，卫生政策规划者必须应对卫生系统筹资方面新出现的前所未有的挑战，特别是对于因 2008 年金融危机而不得不面临财政能力限制的这些经济体。危机及其严重衰退。

原创性/价值

据作者所知，对于大多数欧洲和经合组织环境，宏观财政参数、与平行自愿 PHI 机构资助相关的不同强制性卫生系统融资对 OOP 支出的影响没有经验共识。