title: Health expenditure growth: looking beyond the average through decomposition of the full distribution.
abstract: Explanations of growth in health expenditures have restricted attention to the mean. We explain change throughout the distribution of expenditures, providing insight into how expenditure growth and its explanation differ along the distribution. We analyse Dutch data on actual health expenditures linked to hospital discharge and mortality registers. Full distribution decomposition delivers findings that would be overlooked by examination of changes in the mean alone. The growth rate of hospital expenditures is greatest at the middle of the distribution and is driven mainly by changes in the distributions of determinants. Pharmaceutical expenditures increase most rapidly at the top of the distribution and are mainly attributable to structural changes, including technological progress, making treatment of the highest cost cases even more expensive. Changes in hospital practice styles make the largest contribution of all determinants to increased spending not only on hospital care but also on pharmaceuticals, suggesting important spill over effects.
authors.affiliation: Institute of Health Policy & Management, PO Box 1738, 3000 DR Rotterdam, The Netherlands. demeijer@bmg.eur.nl
authors.forename: Claudine
authors.initials: C
authors.lastname: de Meijer
authors.forename: Owen
authors.initials: O
authors.lastname: O'Donnell
authors.forename: Marc
authors.initials: M
authors.lastname: Koopmanschap
authors.forename: Eddy
authors.initials: E
authors.lastname: van Doorslaer
mesh_terms: D000328:Adult; D020811:Biomedical Technology / Q000191:economics / Q000706:statistics & numerical data; D003422:Critical Care / Q000191:economics / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000706:statistics & numerical data; D016527:Drug Costs / Q000706:statistics & numerical data; D004469:Economics, Hospital / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006291:Health Policy; D006801:Humans; D008297:Male; D018803:Models, Economic; D009426:Netherlands