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Juncal CunadoUniversity of Navarra, Pamplona, Spain
Luis A. Gil -AlanaUniversity of Navarra, Pamplona, Spain
Rangan GuptaUniversity of Pretoria, Pretoria, South Africa
May 2015 AbstractThis study examines the relationship between healthcare expenditure and disposable income in the 50 US states over the period 1966-2009 using fractional integration and cointegration techniques. The degree of integration and nonlinearity of both series are found to vary considerably across states, whilst the fractional cointegration analysis suggests that a long-run relationship exists between them in only 11 out of the 50 US states. The estimated long-run income elasticity of healthcare expenditure suggests that health care is a luxury good in these states. By contrast, the short-run elasticity obtained from the regressions in first differences is in the range (0,1) for most US states, which suggests that health care is a necessity good instead. The implications of these results for health policy are also discussed.
IntroductionAccording to the OECD Health Statistics (2014), in 2012the US spent 16.9 percent of its GDP on healthcare, which is far higher than the OECD average of 9.3%, while on a per capita basis it spent more than double the OECD average. Furthermore, from 1960, US healthcare expenditure has grown five times faster than GDP (from 7.1% in the late sixties to 16.9 percent in 2012), and faster than in other OECD countries, and is projected to grow at an average rate of 5.7 percent until 2023, 1.1 percentage points faster than the expected average annual growth rate of GDP. However, its level and growth rate have not been homogeneous across the US states, as pointed out in different papers analysing regional convergence in health spending (Wang, 2009; Pantelidis, 2012, 2013). For instance, in 2009 per capita personal healthcare spending in Massachusetts ($9,278) was almost twice than in Utah ($5,031).The existing literature (starting with Kleiman, 1974 andNewhouse, 1977) has suggested that disposable income, together with other demand and supply factors such as medical technological progress or demographic trends, is one of the key drivers of healthcare demand and therefore expenditure. However, the evidence on the existence of a long-run relationship between income and healthcare expenditure, as well as the income elasticity of healthcare expenditure and the relative importance of income as one of its drivers is mixed (...