Investigating the Determinants of Healthcare Expenditures in Different Healthcare Systems

Background: The rapid growth of health expenditures is a great concern for governments at present. Objectives: The present study aimed to determine the main factors a ecting health care expenditures in countries with di erent types of the healthcare system. Methods: We studied 25 countries with di erent types of healthcare systems, including national health insurance, traditional sick-ness insurance, national health services, and mixed systems. Health expenditure per capita was estimated as a function of health care price, out-of-pocket health expenditure, income, and other exogenous factors. A random-e ects model was selected instead of a fixed-e ects model based on the Hausman test to assess the e ect of di erent factors on health expenditures. Results: Income and health care price had the greatest impacts on health expenditures in countries with national health insurance and countries with mixed health care systems, respectively. Among the variables, mortality and life expectancy had the greatest impacts on health expenditure in all types of the healthcare system. The out-of-pocket health expenditure had the most and least impacts on health expenditures in countries with mixed health care systems and countries with national health insurance systems, respectively. Conclusions: The study showed that health condition and out-of-pocket health expenditure are the most important determinants of health expenditures in all health care systems, especially the mixed health care system.