DOI: https://doi.org/10.21203/rs.3.rs-261686/v1
Background During the past four decades, China's total health expenditure and health expenditure per capita have both experienced a dramatically increase in growth rate. It is essential to understand the driven force of this growth with the new economic context. This study aims to explore the determinants of health expenditure growth and the influencing mechanism of these determinants, with considering the productivity efficiency represented by Baumol's cost disease.
Methods Based on the longitudinal data of 30 provincial-level administrative regions in China, from 2010 to 2017, multi-variates regression models were constructed to assess the determinants, including demography, income, Baumol's cost disease, technology, their effects on per capital total health expenditure growth and the three financing sources: government, society and out-of-pocket health expenditure. Moreover, the Spatial Durbin Model was used to analyze the influence mechanism of each factor on the increase of health expenditure across provinces.
Results Among 210 province-year observations, all of the average growth rate of total health expenditure (12.78%) was much higher than the growth rate of per capita real GDP (8.06%). According to the statistical analysis, we found that:(1) Income and Baumol’s cost disease have significant positive impact on health expenditure growth(P<0.01). The impact of technical factors on government health expenditure is significantly positive. (2) The determinants affected the growth of health costs in different regions variably, the eastern region is mainly driven by Baumol's cost disease and technical factors, while the central and western regions are mainly affected by income factors and Baumol's cost disease. (3) There is a significant spatial spillover effect on the health expenditure growth between regions. The income factor and Baumol’s cost disease have a positive impact on the health expenditure growth in its own region as well as in other regions.
Conclusions Income and Baumol's cost disease significantly contributed to China health expenditure increase growth. The health expenditure determinants showed spatial varies effect and space spillover effect on the neighborhood areas. Which indicates that a reasonable salary system should be contrasted to meet the changeling from the Baumol's cost disease, and the necessary of equity in health resource allocation among provinces in China.
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Due to technical limitations, table 1 docx is only available as a download in the Supplemental Files section.
|
N |
Mean |
SD |
Min |
Max |
|
|---|---|---|---|---|---|
|
Outcome Variables |
|||||
|
dlnTHE |
210 |
0.1278 |
0.0510 |
-0.0021 |
0.2794 |
|
dlnGHE |
210 |
0.1229 |
0.0663 |
-0.0587 |
0.3074 |
|
dlnSHE |
210 |
0.1622 |
0.0855 |
-0.1923 |
0.3751 |
|
dlnOOP |
210 |
0.0946 |
0.0730 |
-0.1445 |
0.2917 |
|
Determinants |
|||||
|
dlnGDP |
210 |
0.0806 |
0.0236 |
-0.0238 |
0.1495 |
|
dlnPOP65 |
210 |
0.0348 |
0.0674 |
-0.2512 |
0.2808 |
|
BV |
210 |
0.3387 |
1.1036 |
-2.5498 |
7.1072 |
|
dlnRD |
210 |
0.0304 |
0.0679 |
-0.2559 |
0.2857 |
|
Control Variables |
|||||
|
dlnBED |
210 |
0.0608 |
0.0759 |
-0.4926 |
0.3653 |
|
dlnDOC |
210 |
0.0511 |
0.1132 |
-0.4837 |
0.5690 |
|
dlnOUTP |
210 |
0.0403 |
0.0346 |
-0.0454 |
0.1363 |
|
dlnINP |
210 |
0.0704 |
0.0469 |
-0.0364 |
0.2355 |
|
(1) |
(2) |
(3) |
(4) |
(5) |
(6) |
(7) |
|
|---|---|---|---|---|---|---|---|
|
Variables |
THE |
THE |
THE |
THE |
GHE |
SHE |
OOP |
|
dlnGDP |
0.869*** |
0.804*** |
0.799*** |
0.890*** |
1.569*** |
0.574* |
0.732** |
|
(0.194) |
(0.192) |
(0.195) |
(0.216) |
(0.319) |
(0.343) |
(0.326) |
|
|
BV |
0.0268*** |
0.0246*** |
0.0245*** |
0.0260*** |
0.0243*** |
0.0365*** |
0.0189*** |
|
(0.00383) |
(0.00378) |
(0.00386) |
(0.00405) |
(0.00571) |
(0.00697) |
(0.00568) |
|
|
dlnRD |
0.116 |
0.115 |
0.114 |
0.208** |
0.106 |
0.0984 |
|
|
(0.0721) |
(0.0720) |
(0.0730) |
(0.0927) |
(0.0992) |
(0.103) |
||
|
dlnPOP65 |
-0.0118 |
0.00139 |
0.0576 |
-0.0350 |
-0.0197 |
||
|
(0.0470) |
(0.0463) |
(0.0553) |
(0.0753) |
(0.0787) |
|||
|
dlnBED |
-0.00597 |
0.109* |
-0.0840 |
0.0546 |
|||
|
(0.0549) |
(0.0591) |
(0.0791) |
(0.0862) |
||||
|
dlnDOC |
-0.0297 |
-0.0980*** |
0.00755 |
-0.00400 |
|||
|
(0.0297) |
(0.0305) |
(0.0549) |
(0.0527) |
||||
|
dlnOUTP |
0.110 |
-0.127 |
0.122 |
0.354* |
|||
|
(0.126) |
(0.172) |
(0.226) |
(0.196) |
||||
|
dlnINP |
-0.114 |
-0.421*** |
0.0464 |
-0.101 |
|||
|
(0.0964) |
(0.116) |
(0.164) |
(0.139) |
||||
|
Constant |
0.0537*** |
0.0558*** |
0.0566*** |
0.0541*** |
0.0177 |
0.105*** |
0.0202 |
|
(0.0162) |
(0.0155) |
(0.0162) |
(0.0171) |
(0.0251) |
(0.0256) |
(0.0238) |
|
|
Observations |
210 |
210 |
210 |
210 |
210 |
210 |
210 |
|
R-squared |
0.133 |
0.166 |
0.190 |
0.199 |
0.228 |
0.144 |
0.110 |
| Note: Robust standard deviations in brackets, ***, ** and * indicate significant at the 1%, 5% and 10% levels respectively. all variables are in first differenced logarithms and at 2000 GDP price levels; adjusted Baumol variable= (real wage rate - labour productivity) * 1/(share of Baumol sector in total employment) | |||||||
|
(1) |
(2) |
(3) |
|
|---|---|---|---|
|
Variables |
Eastern Region |
Central Region |
Western Region |
|
dlnGDP |
0.372 |
1.028** |
1.201*** |
|
(0.377) |
(0.475) |
(0.292) |
|
|
BV |
0.0173** |
0.0384*** |
0.0268*** |
|
(0.00693) |
(0.0127) |
(0.00678) |
|
|
dlnPOP65 |
-0.0620 |
-0.0128 |
0.135 |
|
(0.0642) |
(0.109) |
(0.0847) |
|
|
dlnRD |
0.292*** |
-0.0956 |
0.0867 |
|
(0.0997) |
(0.0963) |
(0.120) |
|
|
dlnBED |
0.00859 |
0.181 |
-0.0275 |
|
(0.0592) |
(0.185) |
(0.181) |
|
|
dlnDOC |
-0.0285 |
0.0103 |
-0.0643 |
|
(0.0364) |
(0.116) |
(0.104) |
|
|
dlnOUTP |
0.0173 |
0.437** |
-0.162 |
|
(0.160) |
(0.198) |
(0.285) |
|
|
dlnINP |
-0.0176 |
-0.259 |
-0.173 |
|
(0.140) |
(0.182) |
(0.178) |
|
|
Constant |
0.0854*** |
0.0288 |
0.0432 |
|
(0.0287) |
(0.0401) |
(0.0281) |
|
|
Observations |
77 |
56 |
77 |
|
R-squared |
0.299 |
0.267 |
0.253 |
|
Number of prov |
11 |
8 |
11 |
|
Note: Robust standard deviations in brackets, ***, ** and * indicate significant at the 1%, 5% and 10% levels respectively. |
|||
|
Fixed effects |
Fixed effects |
Fixed effects |
Fixed effects |
Random effects |
Random effects |
Random effects |
Random effects |
|
|---|---|---|---|---|---|---|---|---|
|
Variables |
THE |
GHE |
SHE |
OOP |
THE |
GHE |
SHE |
OOP |
|
dlnPOP65 |
0.0278 |
0.117*** |
-0.00911 |
0.00212 |
0.0193 |
0.113*** |
-0.0538 |
0.0052 |
|
(0.0536) |
(0.0334) |
(0.0725) |
(0.0936) |
(0.0541) |
(0.0401) |
(0.0718) |
(0.0941) |
|
|
dlnGDP |
0.732** |
-0.0151 |
1.237** |
0.606 |
0.533** |
0.278 |
1.151*** |
0.308 |
|
(0.35) |
(0.473) |
(0.546) |
(0.546) |
(0.27) |
(0.325) |
(0.426) |
(0.465) |
|
|
BV |
0.0310*** |
0.0219*** |
0.0439*** |
0.0254*** |
0.0257*** |
0.0205*** |
0.0368*** |
0.0215*** |
|
(0.00518) |
(0.00633) |
(0.0087) |
(0.00681) |
(0.00388) |
(0.00536) |
(0.00606) |
(0.00511) |
|
|
dlnRD |
0.181*** |
0.157* |
0.275*** |
0.147 |
0.151*** |
0.253*** |
0.155** |
0.103 |
|
(0.0679) |
(0.0924) |
(0.0743) |
(0.0912) |
(0.0571) |
(0.0707) |
(0.0639) |
(0.0763) |
|
|
dlnBED |
0.00906 |
0.176* |
-0.203** |
0.162** |
0.00982 |
0.154** |
-0.141 |
0.112 |
|
(0.0542) |
(0.0907) |
(0.101) |
(0.0699) |
(0.063) |
(0.0673) |
(0.106) |
(0.0971) |
|
|
dlnDOC |
-0.0221 |
-0.0886*** |
0.0193 |
-0.00863 |
-0.0235 |
-0.0824*** |
0.0353 |
-0.0199 |
|
(0.0273) |
(0.0201) |
(0.0481) |
(0.0502) |
(0.0309) |
(0.0174) |
(0.0459) |
(0.0601) |
|
|
dlnOUTP |
0.167 |
-0.232 |
0.409 |
0.484* |
-0.0272 |
-0.441*** |
0.229 |
0.139 |
|
(0.133) |
(0.184) |
(0.312) |
(0.256) |
(0.126) |
(0.154) |
(0.276) |
(0.199) |
|
|
dlnINP |
-0.0926 |
-0.204 |
0.278 |
-0.506** |
0.00698 |
-0.0891 |
0.302 |
-0.323** |
|
(0.174) |
(0.159) |
(0.299) |
(0.226) |
(0.116) |
(0.109) |
(0.233) |
(0.155) |
|
|
W*dlnPOP65 |
0.0912 |
-0.104 |
0.908 |
-0.0771 |
-0.384* |
-0.467 |
-0.369 |
-0.223 |
|
(0.426) |
(0.37) |
(0.674) |
(0.521) |
(0.202) |
(0.296) |
(0.323) |
(0.359) |
|
|
W*dlnGDP |
5.165*** |
-2.931 |
12.33*** |
4.878 |
1.651** |
1.730* |
0.308 |
0.509 |
|
(1.503) |
(2.782) |
(3.304) |
(3.553) |
(0.657) |
(0.996) |
(0.826) |
(0.932) |
|
|
W*BV |
0.115*** |
0.0193 |
0.227*** |
0.105* |
0.0108 |
-0.000971 |
0.0342 |
-0.0125 |
|
(0.0364) |
(0.0384) |
(0.0645) |
(0.0583) |
(0.0125) |
(0.0151) |
(0.0219) |
(0.0144) |
|
|
W*dlnRD |
0.965* |
-0.0538 |
1.826** |
0.739 |
1.016*** |
0.403 |
1.385*** |
0.868** |
|
(0.576) |
(0.597) |
(0.788) |
(0.626) |
(0.325) |
(0.369) |
(0.348) |
(0.362) |
|
|
W*dlnBED |
0.763 |
0.619 |
-0.412 |
1.953*** |
0.0733 |
0.0322 |
-0.0833 |
0.459 |
|
(0.483) |
(0.442) |
(0.669) |
(0.672) |
(0.269) |
(0.352) |
(0.466) |
(0.432) |
|
|
W*dlnDOC |
-0.376* |
-0.155 |
-0.198 |
-0.711** |
-0.145 |
-0.0509 |
-0.313 |
-0.106 |
|
(0.215) |
(0.18) |
(0.303) |
(0.306) |
(0.149) |
(0.13) |
(0.237) |
(0.239) |
|
|
W*dlnOUTP |
2.026* |
1.182 |
2.225 |
4.084** |
-0.751** |
-0.082 |
-1.065* |
-0.273 |
|
(1.208) |
(1.364) |
(1.964) |
(1.94) |
(0.382) |
(0.578) |
(0.646) |
(0.643) |
|
|
W*dlnINP |
-1.654 |
-1.444* |
-1.058 |
-2.985** |
-0.341 |
-0.468 |
-0.469 |
0.0966 |
|
(1.111) |
(0.758) |
(1.861) |
(1.383) |
(0.235) |
(0.315) |
(0.372) |
(0.454) |
|
|
rho |
-0.434** |
-0.666** |
-0.890*** |
-0.467*** |
-0.087 |
0.412*** |
-0.377* |
0.14 |
|
(0.205) |
(0.261) |
(0.225) |
(0.175) |
(0.178) |
(0.134) |
(0.197) |
(0.106) |
|
|
lgt_theta |
14.84*** |
14.73*** |
17.67*** |
16.26*** |
||||
|
(0.217) |
(0.372) |
(0.257) |
(0.32) |
|||||
|
sigma2_e |
0.00151*** |
0.00168*** |
0.00467*** |
0.00357*** |
0.00177*** |
0.00212*** |
0.00561*** |
0.00441*** |
|
(0.00019) |
(0.000302) |
(0.000595) |
(0.000546) |
(0.000228) |
(0.000374) |
(0.000714) |
(0.000601) |
|
|
Constant |
-0.00657 |
-0.0434 |
0.137*** |
-0.0152 |
||||
|
(0.0283) |
(0.0485) |
(0.0447) |
(0.0405) |
|||||
|
Observations |
210 |
210 |
210 |
210 |
210 |
210 |
210 |
210 |
|
R-squared |
0.193 |
0.007 |
0.032 |
0.087 |
0.316 |
0.512 |
0.217 |
0.165 |
|
Number of prov |
30 |
30 |
30 |
30 |
30 |
30 |
30 |
30 |
| Note: Robust standard deviations in brackets, ***, ** and * indicate significant at the 1%, 5% and 10% levels respectively. | ||||||||
|
THE |
GHE |
SHE |
OOP |
|||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
(1) |
(2) |
(3) |
(4) |
(5) |
(6) |
(7) |
(8) |
(9) |
(10) |
(11) |
(12) |
|
|
Variables |
Direct effects |
Indirect effects |
Total effects |
Direct effects |
Indirect effects |
Total effects |
Direct effects |
Indirect effects |
Total effects |
Direct effects |
Indirect effects |
Total effects |
|
dlnPOP65 |
0.0285 |
0.103 |
0.131 |
0.123*** |
-0.0847 |
0.0380 |
-0.0377 |
0.548 |
0.511 |
0.00694 |
-0.0171 |
-0.0101 |
|
(0.0541) |
(0.311) |
(0.321) |
(0.0375) |
(0.243) |
(0.234) |
(0.0700) |
(0.380) |
(0.390) |
(0.0935) |
(0.365) |
(0.402) |
|
|
dlnGDP |
0.629* |
3.699*** |
4.327*** |
0.0444 |
-1.742 |
-1.698 |
0.834 |
6.508*** |
7.342*** |
0.496 |
3.492 |
3.988 |
|
(0.349) |
(1.336) |
(1.300) |
(0.478) |
(1.742) |
(1.609) |
(0.561) |
(1.906) |
(1.878) |
(0.560) |
(2.732) |
(2.529) |
|
|
BV |
0.0296*** |
0.0783*** |
0.108*** |
0.0223*** |
0.00533 |
0.0276 |
0.0379*** |
0.110*** |
0.148*** |
0.0241*** |
0.0705* |
0.0946** |
|
(0.00460) |
(0.0299) |
(0.0314) |
(0.00587) |
(0.0238) |
(0.0254) |
(0.00797) |
(0.0399) |
(0.0413) |
(0.00634) |
(0.0422) |
(0.0417) |
|
|
dlnRD |
0.164** |
0.671 |
0.835* |
0.159* |
-0.0899 |
0.0687 |
0.223*** |
0.920** |
1.143*** |
0.133 |
0.479 |
0.611 |
|
(0.0653) |
(0.414) |
(0.446) |
(0.0934) |
(0.384) |
(0.370) |
(0.0600) |
(0.409) |
(0.423) |
(0.0844) |
(0.439) |
(0.477) |
|
|
dlnBED |
-0.00317 |
0.548 |
0.545 |
0.163* |
0.308 |
0.471* |
-0.191* |
-0.149 |
-0.340 |
0.130* |
1.334** |
1.464*** |
|
(0.0568) |
(0.369) |
(0.356) |
(0.0890) |
(0.249) |
(0.281) |
(0.111) |
(0.398) |
(0.353) |
(0.0738) |
(0.547) |
(0.524) |
|
|
dlnDOC |
-0.0150 |
-0.263 |
-0.278* |
-0.0855*** |
-0.0539 |
-0.139 |
0.0273 |
-0.117 |
-0.0899 |
0.00544 |
-0.496** |
-0.491** |
|
(0.0297) |
(0.173) |
(0.157) |
(0.0196) |
(0.109) |
(0.112) |
(0.0548) |
(0.195) |
(0.167) |
(0.0523) |
(0.240) |
(0.217) |
|
|
dlnOUTP |
0.135 |
1.488* |
1.623* |
-0.262 |
0.858 |
0.595 |
0.341 |
1.142 |
1.483 |
0.406 |
2.808** |
3.215** |
|
(0.139) |
(0.904) |
(0.949) |
(0.183) |
(0.839) |
(0.898) |
(0.312) |
(1.117) |
(1.201) |
(0.260) |
(1.422) |
(1.586) |
|
|
dlnINP |
-0.0698 |
-1.186 |
-1.256 |
-0.183 |
-0.772* |
-0.955** |
0.309 |
-0.702 |
-0.393 |
-0.460* |
-1.987* |
-2.448** |
|
(0.189) |
(0.877) |
(0.810) |
(0.150) |
(0.448) |
(0.475) |
(0.338) |
(1.150) |
(0.990) |
(0.252) |
(1.179) |
(1.054) |
|
| Note: Columns 1–3 show growth in real health expenditure per capita, columns 4–6 show growth in real government health expenditure per capita, columns 7–9 show growth in real social health expenditure per capita, and columns 10–12 show growth in personal cash health expenditure per capita. Robust standard deviations are in parentheses, with ***, ** and * indicating significant at the 1%, 5% and 10% levels respectively. | ||||||||||||