ArticleHealth economics review2023
Should we adjust health expenditure for age structure on health systems efficiency? A worldwide analysis.
Article in Health economics review, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Regional disparities and influencing factors of health production efficiency: evidence from China.BMC public health · 2025Article
- Study on the spatial and temporal differences and influencing factors of out-of-pocket payments as a share of total health expenditure in China.BMC health services research · 2025Article
- Substantial Increase in the Costs of Antineoplastic Agents in the USA from 2010 to 2021.ClinicoEconomics and outcomes research : CEOR · 2025Article
- Measuring population health using health expectancy estimates from morbidity and mortality databases.PloS one · 2024Article
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Authors and funding
6 authors.
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Abstract
introductionHealthcare expenditure, a common input used in health systems efficiency analyses is affected by population age structure. However, while age structure is usually considered to adjust health system outputs, health expenditure and other inputs are seldom adjusted. We propose methods for adjusting Health Expenditure per Capita (HEpC) for population age structure on health system efficiency analyses and assess the goodness-of-fit, correlation, reliability and disagreement of different approaches.
methodsWe performed a worldwide (188 countries) cross-sectional study of efficiency in 2015, using a stochastic frontier analysis. As single outputs, healthy life expectancy (HALE) at birth and at 65 years-old were considered in different models. We developed five models using as inputs: (1) HEpC (unadjusted); (2) age-adjusted HEpC; (3) HEpC and the proportion of 0-14, 15-64 and 65 + years-old; (4) HEpC and 5-year age-groups; and (5) HEpC ageing index. Akaike and Bayesian information criteria, Spearman's rank correlation, intraclass correlation coefficient and information-based measure of disagreement were computed.
resultsModels 1 and 2 showed the highest correlation (0.981 and 0.986 for HALE at birth and HALE at 65 years-old, respectively) and reliability (0.986 and 0.988) and the lowest disagreement (0.011 and 0.014). Model 2, with age-adjusted HEpC, presented the lowest information criteria values.
conclusionsDespite different models showing good correlation and reliability and low disagreement, there was important variability when age structure is considered that cannot be disregarded. The age-adjusted HE model provided the best goodness-of-fit and was the closest option to the current standard.
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