I18 - Health: Government Policy; Regulation; Public HealthReturn

This study aims to evaluate the effects of selected key factors on health outcomes. Unfortunately, statistical reporting in this field is not harmonized, and in some countries it is completely absent. For this reason, valuable information for health determinant analysis may be lacking or overlooked. Using two different databases, we obtained data from 61 countries for the period 2000-2015. To analyse panel data with over 660 observations, a linear mixed model was applied. This paper contributes to the health economics debate by statistically testing the relationship between health outcomes and variables such as healthcare personnel, healthcare expenditure and infrastructure. The results confirm the importance of healthcare expenditure and healthcare infrastructure. However, the size and direction of the effect vary among countries with different income levels. In regard to human resources, the number of doctors proved to have a significant effect only in lower-income countries.

Health-motivated taxes have spread over the world to reduce increasing obesity and corresponding health care costs. These taxes have not yet been implemented in the Czech Republic, in contrast to some other, mainly European countries. However, the introduction of a fat tax has been discussed frequently in the Czech Republic during the last few years; here, we provide empirical evidence in order for this public debate to be better informed. We use detailed microeconomic data to estimate the impact of potential fat taxes on household expenditure and government revenues in the Czech Republic. We evaluate the impact of three types of fat taxes: ad valorem, specific per kilogram of product and specific per kilogram of fat. We simulate these in such a way that they all raise the same budget revenues as a 10% ad valorem tax on fat-rich products. Accounting for higher food expenditures in the aggregate national accounts than in the detailed microeconomic data results into higher budget revenues, 7.3 and 6.1 billion Czech korunas, respectively. Overall we find, and thus confirm the overwhelming evidence from other countries, that fat taxes are regressive in income.

The economic approach to health promotion describes human behaviour towards preservation of individual health by methods of the economic analysis. We have developed mathematical model based on the Grossman's theory of Demand for Health (1972) showing two basic approaches. The investors prevent diseases by adopting healthy lifestyle and therefore minimize costs of healthcare. The consumers, however, depend on the healthcare system and cause further increase of its expenditures. It is also demonstrated that the latter approach leads to the increase of expenditures on maintaining the level of public health. Also the strong incidence of chronic and almost incurable non-communicable diseases excludes passive consumerism care for their own health from the rational choice. These effects vary in developing and developed countries and further burden healthcare systems for instance in the new EU Member States.

The New Rural Cooperative Medical Service System (NRCMS) in China has been established to ensure improved medical care support for all categories of Chinese peasants to offset their burden of excessive medical care expenditures. The primary aim of this paper is to identify an appropriate alternative modelling approach for the patients' medical expenditures. Data were collected from Jiaojiang city through cluster and multistage random sampling procedure, which was comprised of 4,630 enrolled rural people under NRCMS. The paper presented the first comparison of common econometric medical expenditures modelling approaches. Major findings reveal that the Generalized Linear Model (GLM) predictive accuracy appears to be better than the Finite Mixture Model (FMM) and GLM (log link) was the best performer among all approaches. It may be attributed due to the structural difference of medical expenditures between China and other developing countries compared to the developed countries. This suggests that the Chinese government may find an alternative to choose GLM approach among others to minimize the peasants' medical expenditures under NRCMS.

This paper analyses possible options how to improve the risk adjustment of the health insurance system in the Czech Republic. From the possible options it argues for including pharmaceutical cost groups (PCGs) as additional risk factors since it is an improvement that can be implemented almost instantaneously. On real data from an anonymous sickness fund it confirms that predictive performance of PCGs models is consistently better than the performance of the demographic model that is currently used. The study also describes and examines the Czech health insurance market and implications of proposed changes of policy makers. Based on experience from other countries we point to a problem of risk selection if the changes are not accompanied by a tighter regulation, specifically in the form of improved risk adjustment formula.

This paper presents an insight into problems of financing the greatest part of public services for the population - the health care. The situation in this field in two nearby countries - the Czech Republic and Austria is compared. The health status of the population and the health care bases in both countries are on a high level, and the Czech situation is approaching the somewhat better situation in Austria. The main problem in the both countries is the lack of financial resources for covering the increasing needs in health care services and medicaments. Therefore, the new ways how to balance the deficit of the system both on the revenue and expenditure sides are to be found. The reforms of the system should serve this goal. From the point of view of financial sources for health care a similar model is used in Austria and the Czech Republic, some modifications of it result from different historical development and from different economical level. These modifications and differences, together with the role of the state, insurance funds and direct payments of the population, are described in this paper. The causes of discrepancies between sources of finance and expenditures on the health care are discussed. Reforming the health care system is a long-term task. From this point of view the Austrian reform measures were prepared very well, with the needed advance before introducing them and it can serve as an example for preparation of the Czech reform. Nevertheless, many questions how to improve the financing of the health care for the benefit of patients remain still without answer and they are the matter of further research and discussions in many European countries.

The objective of this paper is to evaluate the impact of regulatory policy on the supply of outpatient services and on their geographical distribution in the Czech Republic. The analysis of regulatory policy is based on the review of literature. Trends and regional distribution were analysed quantitatively on the data for the period of 1990 to 2002. Regulation introduced in 1997 led to a financial stability of the health sector, but it did not have a great impact on the level and distribution of outpatient services. Regulatory policy can be seen as a failure if one assumes that improved quality, effectiveness, and efficiency are the objectives of the health system. The supply of outpatient services is unevenly distributed. For example, one-quarter of outpatient services in psychiatry is concentrated in the capital.

Health care reforms in the Czech Republic and in Slovakia are based on the implementation of market-based instruments into the system, namely on privatization and health insurance. Such changes, especially the change of the system of financing of health care from ""socialist"" taxation-based system to ""modern"" insurance-based one, were supported by many arguments, showing expected positive outcomes. However, after more than ten years from starting the change, health care system performance criteria in both countries have not been improved as expected. In our paper we try to examine some potential purposes of such trends, with focus on rhetoric and reality of potential of health insurance to improve the performance of health systems in transitional countries.