Mihajlo Jakovljevic

Life expectancy and health expenditure evolution in Eastern Europe—DiD and DEA analysis

ABSTRACT Background: Exploration of long-term health expenditure and longevity trends across three major sub-regions of Eastern Europe since 1989. Methods: 24 countries were classified as EU 2004, CIS, or SEE. European Health for All Database (HFA-DB) 1989–2012 data were processed using difference-in-difference (DiD) and data envelopment analysis (DEA). Results: The strongest expenditure growth was recorded in EU 2004 followed by SEE and the CIS. A surprisingly similar longevity increase was present in SEE and EU 2004. In 1989, countries that joined EU in 2004 were relatively inefficient in the number of life-years gained yet had a lower life expectancy than the SEE region and was only slightly higher than the CIS region (DEA). By 2012 the revenue spent was roughly linear to additional life-year expectancies. Conclusion: EU 2004 members were the best performers in terms of balanced longevity increase followed by health expenditure growth. The SEE economies’ longevity gains were lagging slightly behind at a far lower cost. An extrapolated CIS expenditure to longevity increase ratio has the fastest-growing long-term promise.

Growing Burden of Non-Communicable Diseases in the Emerging Health Markets: The Case of BRICS

The blooming of incidence and prevalence of “prosperity diseases” among the broad layers of modern day populations is rather novel phenomenon in demographic history of the human race (1). Illnesses such as obesity (2), diabetes mellitus, hypertension, cerebrovascular and cardiovascular consequences of atherosclerosis, renal insufficiency, mental disorders, and even cancer are closely related to the increased longevity of most contemporary societies (3). In previous centuries, they were mostly reserved for elite social groups enjoying rather luxurious life style. Vast majority of citizens of the time were living in rural communities on the verge of poverty. Their structure of morbidity even in Europe until late 19th century was dominated by burden of infectious diseases and injury while neonatal and maternal mortality rates were huge. Industrial revolution led to the growth of living standards, invention of vaccines, and antibiotics, and ultimately development of organized publicly funded health systems. The prominent European health policy makers in the 19th century properly believed that effective public health measures will diminish huge burden of infectious diseases. Consecutively, they expected that overall costs of medical care provision should decrease substantially and ultimately reach plateau level. This second step turned out to be a great miscalculation and a surprise. Like no time in written past, people began living longer and healthier lives. But it happened at the cost. Simultaneously, from many industrialized nations, evidence were accumulating of accelerated occurrence of non-communicable diseases. Accomplishment of evidence-based medicine succeeded to control many of these initially incurable diseases, thereby transforming them into life time disorders as in the typical cases of diabetes and terminal renal insufficiency. Acute bacterial infections, dominating morbidity in the old days, were usually successfully treated within few weeks. Unlike these, chronic illnesses were bringing long-term burden for both the patients and the society. Malignant disorders with its complex treatment strategies present particularly demanding medical conditions. Cancer leaves permanent footprint in a life of a patient in terms of poor survival rates, decreased life quality, and working ability.

Evolution of the Serbian pharmaceutical market alongside socioeconomic transition.

Introduction: South-eastern European socioeconomic transition followed by extensive health systems reforms has completely changed the pharmaceuticals market landscape in the region. Serbia, as the largest Western Balkans market, may serve as an example of such changes. Methods: Descriptive trend analysis of national-level dispensing of medicines in Serbia 2004–2012 was performed. Results: Total public health expenditure in Serbia increased sharply in less than a decade (€1,175,158,679 to €1,847,971,776); public spending on pharmaceuticals doubled (€339,279,304 to €742,013,976). Market growth was primarily driven by statins, novel platelet aggregation inhibitors, monoclonal antibodies and combined preparations indicated in asthma and chronic obstructive pulmonary disease. Conclusion: The pharmaceutical market of Serbia has undergone thorough and complete transformation from within. Serious crisis of medicine supply sustainability is currently shaking Balkan health systems due to increasing public debt worsened by global recession. More responsible reimbursement policy rooted in cost–effectiveness principle is needed in years to come.

Contemporary Generic Market in Japan – Key Conditions to Successful Evolution

The Japanese pharmaceutical market, the world’s second largest, is traditionally renowned for the domination of patented drugs and the weakest generics share among major established economies. An in-depth observation of published evidence in Japanese/English language provided closer insight into current trends in Japanese domestic legislation and pharmaceutical market development. Recent governmental interventions have resulted in significant expansion of the generic medicines market size. Substantial savings due to generic substitution of patent-protected drugs have already been achieved and are likely to increase in future. Nationwide population aging threatening sustainable healthcare funding is contributing to the relevance of generic policy success. Serious long-term challenges to the modest Japanese generic manufacturing capacities will be posed by foreign pharmaceutical industries particularly the ones based in emerging BRIC economies.

BRIC's growing share of global health spending and their diverging pathways

Post-cold war developments and accelerated pace of globalization among many changes led to the creation of so called emerging markets. These classical national economies represent few among large number of developing world countries, which are distinguished by their exceptionally strong promise of rapid and long-term stable growth of gross domestic product. Either we assess it on nominal or purchase power parity (PPP) terms, four distinct economies obviously lay ahead all other rapidly developing global markets. Acronym BRIC (Brazil, Russia, India, China) forged to describe these countries brought glory to its creator Jim O’Neil, Goldman Sachs’ economist of the time (1). Since his first insight back in 2001 global recession (2) and ongoing developments were changing prospects for all four individual markets. Nevertheless, strong positive growth trend remained their common feature although with quite substantial differences in pace and balance of overall economy development (3). BRIC’s share in global wealth grew tremendously effectively quadrupling itself over past decade (4). Joint growth of this group of countries, heavily dominated by China, will remain long-term trend with clear forecasts at least up to the middle of twenty-first century (5).

Comparison of historical medical spending patterns among the BRICS and G7.

Abstract Objective: The past few decades have been marked by a bold increase in national health spending across the globe. Rather successful health reforms in leading emerging markets such as BRICS reveal a reshaping of their medical care-related expenditures. There is a scarcity of evidence explaining differences in long-term medical spending patterns between top ranked G7 traditional welfare economies and the BRICS nations. Methods: A retrospective observational study was conducted on a longitudinal WHO Global Health Expenditure data-set based on the National Health Accounts (NHA) system. Data were presented in a simple descriptive manner, pointing out health expenditure dynamics and differences between the two country groups (BRICS and G7) and individual nations in a 1995–2013 time horizon. Results: Average total per capita health spending still remains substantially higher among G7 (4747 Purchase Power Parity (PPP)

Editorial : Health Care Financing and Affordability in the Emerging Global Markets

PPP in 2013) compared to the BRICS (1004

Health Financing Constrained by Population Aging - An Opportunity to Learn from Japanese Experience / Finansiranje Zdravstvene Zaštite U Uslovima Starenja Popualcije - Prilika Da Učimo Na Japanskom Iskustvu

PPP in 2013) nations. The percentage point share of G7 in global health expenditure (million current PPP international

The Key Role of the Leading Emerging Bric Markets in the Future of Global Health Care

US) has been falling constantly since 1995 (from 65% in 1995 to 53.2% in 2013), while in BRICS nations it grew (from 10.7% in 1995 to 20.2% in 2013). Chinese national level medical spending exceeded significantly that of all G7 members except the US in terms of current

Health Economics at the Crossroads of Centuries – From the Past to the Future

PPP in 2013. Conclusions: Within a limited time horizon of only 19 years it appears that the share of global medical spending by the leading emerging markets has been growing steadily. Simultaneously, the world’s richest countries’ global share has been falling constantly, although it continues to dominate the landscape. If the contemporary global economic mainstream continues, the BRICS per capita will most likely reach or exceed the OECD average in future decades. Rising out-of-pocket expenses threatening affordability of medical care to poor citizens among the BRICS nations and a too low percentage of GDP in India remain the most notable setbacks of these developments.