Convergence : an analysis of European Union (EU) health care systems, 1960-95

The academic study of convergence within the context of the neo-classical growth model is well established and has been widely applied to macro-economic areas such as GDP income and growth rates. This thesis has investigated the presence, or otherwise, of convergence in the health care systems of the European Union over the period 1960-95. The hypothesis investigated is that membership of the EU encourages countries to converge under the influence of a range of economic, social and political factors. These include the free movement of the factors of production, the opening up of EU markets to competition, EU legislation, and common social and economic influences and goals. Convergence analyses are developed and then applied to a framework of variables for each EU country, which include health care expenditure, health outcomes, health care resources, and utilisation rates. The results confirm that convergence has occurred in most areas of the framework and reveal which countries have contributed most The results also reveal differences according to the way in which health care is financed and organised in the EU. Regression analyses were applied to determine significant associations to develop a conceptual model for the study of health care convergence in the EU. The model confirms the predictions of the neo-classical growth model in terms of income convergence, which leads to health care expenditure convergence which, along with environmental and lifestyle variables, is found to be a determinant of the observed health outcome convergence. When convergence analyses were applied to a control group of non-EU OECD countries, which share similar economic and health care characteristics, convergence was also found to be present but to a lesser degree. The thesis concludes by identifying the policy implications of the results and the areas in need of attention that, if addressed by member-state governments, will lead to greater convergence throughout the ELJ.

[1]  A. Wall.  Health Care Systems in Liberal Democracies , 2002 .

[2]  J. Nixon,et al.  Summarising economic evaluations in systematic reviews: a new approach , 2001, BMJ : British Medical Journal.

[3]  John O. S. Wilson,et al.  Cross sectional and panel estimation of convergence , 2001 .

[4]  J. Nixon.  Convergence of health care spending and health outcomes in the EUropean Union, 1960-95 , 2000 .

[5]  G. Anderson,et al.  Health spending, access, and outcomes: trends in industrialized countries. , 1999, Health affairs.

[6]  A. Kangasharju.  Relative Economic Performance in Finland: Regional Convergence, 1934‐1993 , 1999 .

[7]  R. Capolupo,et al.  Convergence in recent growth theories: a survey , 1998 .

[8]  B. Liljas,et al.  The demand for health with uncertainty and insurance. , 1998, Journal of health economics.

[9]  S. Sosvilla‐Rivero,et al.  Convergence in social protection benefits across EU countries , 1998 .

[10]  R. Carter,et al.  Is health care really a luxury? , 1997, Journal of health economics.

[11]  Gerald A. Carlino,et al.  Testing neoclassical convergence in regional incomes and earnings , 1996 .

[12]  M. Mckee,et al.  The Influence of European Law On National Health Policy , 1996 .

[13]  Alan M. Taylor.  Sources of Convergence in the Late Nineteenth Century , 1996 .

[14]  F. Chang.  Uncertainty and investment in health. , 1996, Journal of health economics.

[15]  X. Sala-i-Martin,et al.  Regional cohesion: Evidence and theories of regional growth and convergence , 1996 .

[16]  Danny Quah,et al.  Empirics for economic growth and convergence , 1996 .

[17]  Danny Quah,et al.  Twin peaks : growth and convergence in models of distribution dynamics , 1996 .

[18]  M. Chatterji,et al.  Convergence Clubs and Relative Economic Performance in Great Britain: 1977–1991 , 1996 .

[19]  A. Razin,et al.  Labour Mobility and Fiscal Coordination: Setting Growth Agenda for an Economic Union , 1996 .

[20]  W. Crown,et al.  STATE PER CAPITA INCOME CONVERGENCE SINCE 1950: SHARECROPPING'S DEMISE AND OTHER INFLUENCES* , 1995 .

[21]  Mauricio Cárdenas,et al.  Growth and convergence in Colombia: 1950–1990 , 1995 .

[22]  J. Sachs,et al.  Economic Convergence and Economic Policies , 1995 .

[23]  S. Durlauf,et al.  Interpreting Tests of the Convergence Hypothesis , 1994 .

[24]  D. Coltart,et al.  Recent advances in cardiology. , 1994, Postgraduate medical journal.

[25]  M. Drummond,et al.  Selection of End Points in Economic Evaluations of Coronary-heart-disease Interventions , 1993, Medical decision making : an international journal of the Society for Medical Decision Making.

[26]  G. Grossman,et al.  Innovation and growth in the global economy , 1993 .

[27]  A. Wagstaff,et al.  The demand for health: an empirical reformulation of the Grossman model. , 1993, Health economics.

[28]  Danny Quah,et al.  Empirical cross-section dynamics in economic growth , 1993 .

[29]  M. Stano,et al.  The Economics of Health and Health Care , 1993 .

[30]  M. Chatterji.  CONVERGENCE CLUBS AND ENDOGENOUS GROWTH , 1992 .

[31]  R. Barro,et al.  Regional growth and migration: a Japan-United States comparison. , 1992, Journal of the Japanese and international economies.

[32]  R. Barro,et al.  Capital Mobility in Neoclassical Models of Growth , 1992 .

[33]  J. Posnett,et al.  The determinants and effects of health expenditure in developed countries. , 1992, Journal of health economics.

[34]  U. Gerdtham,et al.  Price and quantity in international comparisons of health care expenditure , 1991 .

[35]  J. Hurst,et al.  Reforming health care in seven European nations. , 1991, Health affairs.

[36]  U. Gerdtham,et al.  Conversion factor instability in international comparisons of health care expenditure. , 1991, Journal of health economics.

[37]  R. Levine,et al.  A Sensitivity Analysis of Cross-Country Growth Regressions , 1991 .

[38]  Costas Azariadis,et al.  You have printed the following article : A Contribution to the Empirics of Economic Growth , 2007 .

[39]  Elhanan Helpman,et al.  Trade, Knowledge Spillovers, and Growth , 1990 .

[40]  R. Lucas.  On the Mechanics of Economic Development , 1988 .

[41]  R. Barro.  Government Spending in a Simple Model of Endogeneous Growth , 1988, Journal of Political Economy.

[42]  A. Mcguire,et al.  Aggregate health care expenditures and national income. Is health care a luxury good? , 1987, Journal of health economics.

[43]  P. Romer.  Increasing Returns and Long-Run Growth , 1986, Journal of Political Economy.

[44]  P. Ippolito.  Information and the Life Cycle Consumption of Hazardous Goods , 1981 .

[45]  H. Gravelle,et al.  MORTALITY AND UNEMPLOYMENT: A CRITIQUE OF BRENNER'S TIME-SERIES ANALYSIS , 1981, The Lancet.

[46]  M. Grossman,et al.  Determinants of Pediatric Care Utilization , 1979, The Journal of human resources.

[47]  D. Salkever,et al.  Accessibility and the demand for preventive care. , 1976, Social science & medicine.

[48]  H. Luft,et al.  Factors affecting the use of physician services in a rural community. , 1976, American journal of public health.

[49]  Jan Paul Acton,et al.  Nonmonetary Factors in the Demand for Medical Services: Some Empirical Evidence , 1975, Journal of Political Economy.

[50]  J. Newhouse,et al.  Coinsurance, the Price of Time, and the Demand for Medical Services , 1974 .

[51]  M. Grossman,et al.  The Demand for Health: A Theoretical and Empirical Investigation , 1974 .

[52]  A. Buse,et al.  Goodness of Fit in Generalized Least Squares Estimation , 1973 .

[53]  P. Jucker.  [Who shall live?]. , 1973, Zeitschrift fur Krankenpflege. Revue suisse des infirmieres.

[54]  M. Grossman.  On the Concept of Health Capital and the Demand for Health , 1972, Journal of Political Economy.

[55]  David Cass,et al.  Optimum Growth in an Aggregative Model of Capital Accumulation , 1965 .

[56]  H. Hunter,et al.  Economic Backwardness in Historical Perspective , 1963 .

[57]  T. Swan,et al.  ECONOMIC GROWTH and CAPITAL ACCUMULATION , 1956 .

[58]  R. Solow.  A Contribution to the Theory of Economic Growth , 1956 .

[59]  S. Muraki,et al.  [Minimal incision abdominal aortic aneurysm repair]. , 2002, Zentralblatt fur Chirurgie.

[60]  Michael Grossman,et al.  The Human Capital Model , 2000 .

[61]  Thomas Stratman,et al.  What Do Medical Services Buy? Effects of Doctor Visits on Work Day Loss , 1999 .

[62]  D. Quah.  Ideas determining convergence clubs , 1999 .

[63]  A. Wood,et al.  Market Integration, Regionalism and the Global Economy: Openness and wage inequality in developing countries: the Latin American challenge to East Asian conventional wisdom , 1999 .

[64]  T. Hitiris.  Health care expenditure and integration in the countries of the European Union , 1997 .

[65]  Kathleen Roberts,et al.  Health care policies and Europe : the implications for practice , 1996 .

[66]  R. Klein,et al.  Big bang health care reform--does it work?: the case of Britain's 1991 National Health Service reforms. , 1995, The Milbank quarterly.

[67]  J. Persson.  Convergence in Per Capita Income and Migration Across the Swedish Counties 1906-1990 , 1995 .

[68]  A. Cochrane,et al.  Comparing welfare states : Britain in international context , 1993 .

[69]  R. Barro,et al.  Convergence across States and Regions , 1991 .

[70]  G. Esping‐Andersen,et al.  The Three Worlds of Welfare Capitalism , 1990 .

[71]  S. Dowrick,et al.  OECD Comparative Economic Growth 1950-85: Catch-Up and Convergence , 1989 .

[72]  Cletus C. Coughlin,et al.  Why have state per capita incomes diverged recently , 1988 .

[73]  B. Wolfe,et al.  Health status and medical expenditures: more evidence of a link. , 1987, Social science & medicine.

[74]  Paul M. Romer,et al.  Growth Based on Increasing Returns Due to Specialization , 1987 .

[75]  B. Wolfe,et al.  Health status and medical expenditures: is there a link? , 1986, Social science & medicine.

[76]  W. Baumol.  Productivity Growth, Convergence, and Welfare: What the Long-run Data Show , 1985 .

[77]  R. Inman.  The Family Provision of Children's Health: An Economic Analysis , 1976 .

[78]  José Maria Paganni,et al.  Evaluating the quality of medical care. , 1966, The Milbank Memorial Fund quarterly.

[79]  Tjalling C. Koopmans,et al.  On the concept of optimal economic growth , 1963 .