The economic impact of hypertension is large even if the effect on economic growth is not statistically significant. The direct cost including health expenditure is high. With the duration of hypertension getting longer, the expenditure is going to become greater. The drug expenses are especially huge and expand over time. The reason might be using more new brand name drugs and the higher dose or polypharmacy problems. Most of the patients come to the hospital for outpatient visits rather than inpatient visits. The mortality is decreasing especially for those aged above 61 years old. This is a good sign since the incidence proportion is high in the elderly people. To construct the growth model, this study considers the representative individual maximizing her infinite horizon utility. The results show after increasing physical capital, the health capital investment should increase to maximize their utility and boost economic growth.
While increasing the incentive of health capital, the return of health capital or the marginal
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product of health investment should be higher. By using the human capital method to estimate the economic cost for hypertension disease, the results show that the logarithm of DALY is not significant. To sum up, this study shows the heavy burden of hypertension, especially its drug expenses. Even the DALY in the growth model is not significant, DALY for the top ten diseases can be combined to be a health indicator. Further studies could construct an advanced and robust model for the relationship between health and economic growth.
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Reference
Abegunde, D. O., Mathers, C. D., Adam, T., Ortegon, M., & Strong, K. (2007). The burden and costs of chronic diseases in low income and middle income countries. The Lancet, 1929-1938.
Akobundu, E., Ju, J., & Mullins, L. B. (2006). Cost-of-Illness Studies-A review of Current Methods. Pharmacoeconomics.
American Diabetes Association. (2008). Economic Costs of Diabetes in the U.S. in 2007.
Alexandria: American Diabetes Association.
Arno, P. S., Levine, C., & Memmott, M. M. (1999). The Economic Value Of Informal Caregiving. Health Affairs, 182-188.
Bonita, R., Beaglehole, R., & Kjellstron, T. (2006). Basic Epidemiology Second Edition. Geneva:
World Health Organization.
Cervellati, M., & Sunde, U. (2005). Human Capital Formation, Life Expectancy, and the Process of Development. American Economic Association, 16533-1672.
Chakraborty, S. (2004). Endogenous lifetime and Economic Growth. Journal of Economic Theory, 119-137.
Chodick, G., Porath, A., Alapi, H., Sella, T., Flash, S., Wood, F., & Shalev, V. (2010). The Direct Medical Cost of Cardiovascular Disease, Hypertension, Diabetes, Cancer, Pregnancy and Female Infertility in a large HMO in Israel. Health Policy.
CJ, M., & AD, L. (1997). Global Mortality, Disability, and the Contribution of Risk Factors:
Global Burden of Disease Study. Lancet.
Collins, J. J., Baase, C. M., Sharda, C. E., Ozminkowski, R. J., Nicholson, S., Billotti, G. M., . . . Berger, M. L. (2005). The Assessment of Chronic Health Conditions on Work
Performance, Absence, and Total Economic Impact for Employers. Journal of Occupational and Environmental Medicine, 547-557.
Finlay, J. (2007). The Role of Health in Economic Development. Program of the global demography of aging working paper.
Goetzel, R. Z., Long, S. R., Ozminkowski, R. J., Hawkins, K., Wang, S., & Lynch, W. (2004).
Health Absence, Disability, and Presenteeism Cost Estimates of Certain Physical and Mental Health Conditions Affecting U.S. Employers. Journal of Occupational and Environmental Medicine, 396-412.
Grossman, M. (1972). On the Concept of Health Capital and the Demand for Health. Journal of Political Economy.
Hu, Y.-N., Hu, G.-C., Hsu, C.-Y., Hsieh, S.-F., & Li, C.-C. (2012). Assessment of Individual Activities of Daily Living and its Association with Self-Rated Health in Elderly People of Taiwan. International Journal of Gerontology, 117-121.
Institute for Health Metrics and Evaluation (IHME). (2010). Global Burden of Disease Study 2010 (GBD 2010) Disability Weights. Institute for Health Metrics and Evaluation (IHME).
Johns, G. (2010). Presenteeism in the workplace: A review and research agenda. Journal of Organizational Behavior, 519-542.
Kalemli-Ozcan, S., Ryder, H. E., & Weil, D. N. (2000). Mortality decline, human capital investment, and economic growth. Journal of Development Economics, 1-23.
Kay, D., Pruss, A., & Corvalan, C. (2000). Methodology for assessment of Environmental burden of disease. Buffalo: August.
31
Liu, D.-P., Wang, T.-A., Huang, W.-T., Chang, L.-Y., Wang, E.-T., Cheng, S.-H., & Ming-Ching.
(2015). Disease Burden of Enterovirus Infection in Taiwan: Implications for Vaccination policy. Vaccine.
Ministry of Health and Welfare. (2007, July 26). Ministry of Health and Welfare. Retrieved from 2.1-09_20 歲以上民眾高血壓、高血糖、高膽固醇盛行率:
https://dep.mohw.gov.tw/DOS/cp-1720-7332-113.html
Muennig, P. (2007). Cost-Effectiveness Analysis in Health: A Practical Approach 2nd Edition.
Jossey-Bass.
National Health Insurance Administration. (2016). 2016-2017 National Helth Insurance Annual Report. Taipei: National Health Insurance Administration.
Porta, M. (2014). A Dictionary of Epidemiology (5th ed.). Oxford: Oxford University Press.
Ruiz-Hernandez, Tellez-Plaza, Dominguez-Lucas, Pichler, Martin-Escudero, Martinez-Garcia, . . . Redon. (2018). Population Attributable Risk for Cardiovascular Disease Associated With Hypertension. Results from the Hortega Follow-up study. Journal of Hypertension, e27.
Solow, R. M. (1956). A Contribution to the Theory of Economic Growth. Quarterly Journal of Economics.
The Reporter. (2020, March 9). The Reporter. Retrieved from 病床邊的照護危機:
https://www.twreporter.org/topics/nursing-aide-crisis-of-taking-care Weil, D. N. (2009). Economic Growth Second edition. Boston: Pearson.
World Health Organization. (2019, March 7). World Health Organization. Retrieved from Metrics: Disability-Adjusted Life Year (DALY):
https://www.who.int/healthinfo/global_burden_disease/metrics_daly/en/
World Health Organization. (2020, March 8). Disease burden and mortality estimates. Retrieved from WHO Web site:
https://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html World Health Organization. (2020, March 8). Hypertension. Retrieved from WHO Web site:
https://www.who.int/health-topics/hypertension/
勞動部. (2010). 國民長期照護需求調查. 勞動部. Retrieved from 最新消息.
張國維. (2011). 誰需要長期照顧？慢性疾病擴張的討論. 社區發展季刊, 426-444.
衛生福利部健康保險署. (2010, February 9). 衛生福利部健康保險署. Retrieved from 健保公
布98 年藥費前十名藥品，三高用藥佔八成:
https://www.nhi.gov.tw/News_Content.aspx?n=FC05EB85BD57C709&sms=587F1A3D 9A03E2AD&s=9129ECBFC31F42E2
陳美美, 林眉均, & 吳培滋. (2007). 以藥物經濟學觀點探討我國高血壓病患用藥之合理性.
台北: 衛生福利部.
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Appendix A. The Lagrange Methods for the Simulation
The Lagrange function is noted as follow:
L = ∑ 𝛽𝑡−1𝑢(𝑐𝑡, 𝑡𝑙𝑡) + 𝜆𝑡∑ 𝛽𝑡−1(𝑎𝑡+ (1 − 𝑡𝑙− 𝑡ℎ)𝑤𝑡+ (1 + 𝑟𝑡−1)𝐼𝑘𝑡−1 + (1 + 𝑟ℎ𝑡−1)(𝑡ℎ𝑡𝐺ℎ𝑡+ 𝐸𝑥𝑝ℎ) − 𝑐𝑡− 𝐼𝑘𝑡− (𝑡ℎ𝑡𝐺ℎ𝑡+ 𝐸𝑥𝑝ℎ)) First-order condition:
𝑢𝑐(𝑐𝑡, 𝑡𝑙) = 𝜆𝑡 𝜆𝑡 is the marginal utility of consumption.
𝑢𝑡𝑙(𝑐𝑡, 𝑡𝑙) = 𝜆𝑡𝑤𝑡
The marginal utility of leisure is equal to the opportunity cost of work.
𝜆𝑡= 𝛽𝜆𝑡+1(1 + 𝑟𝑡)
The marginal utility of consumption must equal to the utility discounted in the future.
𝑟ℎ𝑡−1Ght = 𝜆𝑡𝑤𝑡
The opportunity cost of working equal to the opportunity cost of investing health capital.
𝑟ℎ𝑡= 𝑟 − πt−1+ 𝛿𝑡
The relationship between the return from investing in health and physical capital; πt is the percentage rate of change in marginal cost invest in health. 𝛿𝑡 stands for the depreciation for the physical capital.
Take these equations back into the budget constraint then done.
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2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Average Drug Expense per person
Age0~16 Age16~31 Age31~46
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Average Indirect Cost by Male (Follow from 2001)
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Average Indirect Cost by Female (Follow from 2001)
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Average Drug Expense per person (follow from 2001)
Age0~16 Age16~31 Age31~46 Age46~61 Age61~76 Age76~
Figure 24 Average drug expense per person (cohort follow from 2001) Figure 19 Average indirect cost among male (cohort follow from 2001)
3000000
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Indirect Cost by Female
Age16~31 Age31~46 Age46~61 Age61~76 Age76~
Figure 21 Indirect cost among female (cross-sectional) 3000000
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Indirect Cost by Male
Age16~31 Age31~46 Age46~61 Age61~76 Age76~
Figure 22 Indirect cost among male (cross-sectional)
Figure 20 Average indirect cost among female (cohort follow form 2001)
Figure 23 Average drug expense per person (cross-sectional)
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Figure 25 The ratio of IPD over OPD
700000
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2014 2015 2016 2017
Emergency bed day
Figure 26 Emergency bed day
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Appendix C. NHID Application Form
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