Impact of the economic crisis on household health expenditure in Greece: an interrupted time series analysis

Abstract

Objectives and settingThe 2008 financial crisis had a particularly severe impact on Greece. To contain spending, the government capped public health expenditure and introduced increased cost-sharing. The Greek case is important for studying the impact of recessions on health systems. This study analysed changes in household health expenditure in Greece over the economic crisis and explored whether the impact differed across socioeconomic groups.ParticipantsWe used data from the Greek Household Budget Survey for the years 2004 and 2008–2017. The dataset comprised 51 654 households, with a total of 128 111 members.DesignWe compared pre-crisis and post-crisis trends in Greek household out-of-pocket payments for healthcare from 2004 to 2017 using an interrupted time series analysis. This study explored spending in euros and as a share of total household purchases.ResultsOur results indicated that the population level trend in household health spending was reversed after the crisis began (pre-crisis trend: €0.040 decrease per quarter (95% CI: −0.785 to −0.022), post-crisis trend: €0.315 increase per quarter (95% CI: −0.004 to 0.635)). We also found that spending on inpatient services and pharmaceuticals has been increasing since the start of the crisis, whereas outpatient services expenditure has been decreasing. Across all households, out-of-pocket payments incurred a greater financial burden after the crisis relative to pre-existing trends, but the poorest households incurred a disproportionately higher burden.ConclusionsThis was the first study to use an interrupted time series analysis to assess the impact of the economic crisis on household health expenditure in Greece. Our findings suggest that there was an erosion of financial protection for Greek households as a consequence of the economic crisis. This effect was particularly pronounced among poorer households, which is indicative of a regressive financing system.

The Effect of Business Cycles on Health Expenditure: A Story of Income Inequality in China

“…Second, we divide the samples into two parts (before and after the 2008 financial crisis) to further explore whether health expenditure experiences a pro-cyclical to counter-cyclical change with business cycles in China. The 2008 financial crisis has had a profound impact on world economic development (63)(64)(65), which may affect the relationship between business cycles and health expenditure (66,67). Hence, we divide the samples into samples 2002-2008 and samples 2008-2018, and the estimation results are given in columns (3)- (6).…”

Does Economic Policy Uncertainty Matter for Healthcare Expenditure in China? A Spatial Econometric Analysis

“…However, the growth rate of per capita expenditure on health fluctuates from 8.82% in 2000 to 10.99% in 2019, and it reaches a peak of 24.94% during the global financial crisis in 2008. These results indicate that health expenditure changes with economic growth and policies ( 1 , 2 ).…”

“…Healthcare expenditure has increased rapidly with the development of China's economy in the past few decades. According to the National Bureau of Statistics of China, the ratio of total health expenditures to gross domestic product (GDP) increases from 4.57% in 2008 to 6.67% in 2019 1 . As shown in Figure 1, the per capita expenditures on health rose from 393.80 RMB in 2001 to 4,702.79 RMB in 2019, suggesting that the Chinese government increased funding to construct a more sustainable system that covers the health needs of most or all citizens.…”

“…In recent years, a large and growing body of literature has investigated the determinants of healthcare expenditure, such as business cycles (2), economic overheating (3), economic activity (4), economic crisis (1,5), and other factors (6)(7)(8)(9)(10). The most studied determinant is economic growth, which is an important demand-side driver of healthcare expenditure (2,11,12).…”

“…Estimation results of robustness tests.This table presents the robustness test results; Columns(1)(2)(3) are the results of the alternative measure of healthcare expenditure (Out_exp) based on the three spatial weight matrices, respectively; Columns(4)(5)(6) are the results of the alternative measure of EPU (EPU2) based on the three spatial weight matrices; Column(7) is the result of the endogenous test using the GMM method; The results of control variables are consistent with those in Table5, and we do not report them in this table due to space limitations; ***p < 1%, **p < 5%, and *p < 10%, respectively; t-statistics value in brackets.area (the coefficient is −0.0571, and the corresponding tvalue is −1.22). The above results indicate that EPU has significant positive effects on healthcare expenditure in the eastern and central areas, while the effects are not significant in the western area.…”