comparing the performance of health care systems an alternative approach the health care system in the united states has been diagnosed as a moribund institution by a large number of media commentators and health policy analysts continually rising health care costs and inadequate health insurance coverage for approximately thirty seven million people are cited as two of the most visible symptoms supporting their diagnosis most of these individuals see little chance for the u s health care system to recover given its present design full recovery they believe requires the successful transplant of a health care system from another country the health care systems in europe and canada where government is assigned a much larger role than in the united states are argued to offer universal health care coverage and simultaneously contain health care costs simple comparative statistics appear to support the view that the performance of the u s health care system could be improved through a new health care system design infant mortality in the united states ranked twentieth among twenty four member countries of the organization for economic cooperation and development oecd in 1988 yet health care expenditures in the united states comprised 11 8 percent of gross domestic product in 1989 while the comparable average for all oecd countries was only 7 4 percent 28 these statistics portray the u s health care system as being deficient and therefore unable to offer quality medical services at a reasonable price given the limited stock of information that exists on this issue however it is ill advised to place full blame for the seemingly dismal performance on the u s health care system the simple international comparisons fail to take into account that differences in performance are not solely due to variations in health care systems while the design of a health care system including the financing scheme reimbursement method and organization of production is indeed important because it influences how various economic technological and demographic characteristics of a country are transformed into health outcomes the performance of the health care system also depends on the magnitude of these national characteristics as well a proper analysis would try to determine how the health care system itself specifically influences the performance of health

a cluster analysis on income elasticity variations and us pharmaceutical expenditures this paper examines the relationship between household income and outpatient prescribed medicines in the usa based on a sample of 2872 privately insured patients from the 1987 nmes data set the analysis is performed on regional typologies of different socioeconomic profiles of patients only a few groups show positive income elasticity

examining structural breaks and growth rates in international health expenditures over the last decade there has been a growing interest in examining health expenditures in this paper we study the behaviour of health expenditures in the g3 countries usa the uk and japan and three european countries the uk switzerland and spain over the period 1960 2000 from a different perspective in that we examine 1 whether there is a common structural break in health expenditures across the g3 and european countries 2 whether structural breaks have slowed down health expenditure growth rates in these countries or vice versa our main findings are that 1 health expenditures share a common break in both bivariate and trivariate cases and structural breaks and break intervals suggest that either one or a combination of events second oil price shock the 1987 stock market crash and or recessions have contributed to the commonality of break in health expenditures in the g3 while the oil price shocks have been instrumental in the commonality of breaks for the european countries 2 except for the uk structural breaks have slowed down growth rates in health expenditures for the usa japan switzerland and spain

is health care a necessity or a luxury pooled estimates of income elasticity from us state level data this paper provides new evidence on the income elasticity of health care by combining stationarity and cointegration tests of health care expenditure and incomes with estimates of the cointegrating relationship between them a recently updated dataset of health care expenditures and disposable personal income for the us states for the years 1966 1998 is used the principal findings are that health care expenditures and incomes at the state level are non stationary and cointegrated dynamic ols cointegrating regressions of the pooled state time series estimate the income elasticity of health care at 0 817 to 0 844 well below unity confirming that health care expenditure even at the aggregate level is a necessity good

environmental tax policy and intergenerational distribution abstract we study the effects of environmental taxation within the context of an overlapping generations model the quality of the environment is modelled as a durable consumption good introduction of the environmental tax harms old existing generations and benefits young existing generations as well as all future generations increasing the tax in a pareto improving manner is easier the higher the pre existing tax the reverse holds if tax policy is decided by majority rule a suitably designed bond policy can be used to redistribute the efficiency gains due to the internalisation of environmental externalities across the generations

the determinants of health expenditures evidence from us state level data most macro studies of what determines health expenditures have used the same panel of oecd country level data based on a more homogeneous panel data set of us states we constructed this note applies the model selection procedure to identify the determinants of health expenditures at the state level we find that the four key factors are gross state products the proportion of the population over the age of 65 the degree of urbanization and the number of hospital beds the cross section income elasticity of health care is around 0 7 implying that health care is a necessity rather than a luxury good at the state level the relative price of health care varies significantly across states but does not appear to have real effects on the amount of resources measured in real dollars a state devotes to health care

on stationarity and cointegration of international health expenditure and gdp this paper examines stationarity and cointegration of health expenditure and gdp for a sample of 21 oecd countries using data for the period 1960 1997 by applying a test battery that allows robust inference to be made on the stationarity and cointegration issue trend stationarity and no cointegration are tested using new country by country and panel tests not previously applied in this setting new results for country by country and panel tests of non stationarity and cointegration are presented our unit root and trend stationarity results indicate that both health expenditure and gdp are non stationary the no cointegration and cointegration results indicate that health expenditure and gdp are cointegrated

the contemporary european copper cycle the characterization of technological copper cycles abstract copper is an example of an anthropogenically utilized material that is of interest to both resource economists and environmental scientists it is a widely employed industrial metal and one that in certain forms and concentrations is moderately biotoxic it is also one that may be potentially supply limited a comprehensive accounting of the anthropogenic mobilization and use of copper must treat a series of life stages mining and processing fabrication utilization and end of life reservoirs in which copper resides include the lithosphere ore and ingot processing facilities fabricators at least a dozen major uses several intentional and default stockpiles landfills and the environment the flow rates among those reservoirs constitute the cycle if a non global cycle is being constructed imports to and exports from the region of interest must also be included in this paper we discuss the characteristics of each of the components of anthropogenic copper cycles as well as generic approaches to the acquisition and evaluation of data over space and time data quality and data utility are evaluated noting that information relevant to technology and resource policy is easier to acquire than is information relevant to human health and ecosystem concerns partly because the spatial scale required by the latter is considerably smaller and the flow rates rarely analyzed and reported despite considerable data limitations we conclude that information is sufficiently available and the data sufficiently accurate to characterize copper cycles at a variety of spatial scales

social security income and health care spending evidence from the social security notch the paper exploits social security legislation changes to identify the causal effect of social security income on out of pocket medical expenditures of the elderly using the 1986 1994 consumer expenditure survey and an instrumental variables strategy the empirical results show that health care expenditures are responsive to changes in social security income for elderly individuals with less than a high school education the estimated income elasticities are between 1 41 and 3 47 depending on the outcome measures and are statistically significant at conventional levels the findings are in contrast to existing studies that find a small income elasticity at the individual household level this article is protected by copyright all rights reserved

health care expenditures and gdp panel data unit root test results abstract this short paper presents unit root test results for time series on per capita national health care expenditures and gross domestic product in the oecd unlike the country by country test used by hansen p king a 1996 the determinants of health care expenditure a cointegration approach j health econ 15 127 137 the test we employ exploits the panel nature of the oecd data using this approach we are able to reject the null hypothesis that these series contain unit roots no single test is likely to be definitive in this rapidly evolving area of econometric research however our results help to mitigate concern that panel data analyses of national health care expenditures are misspecified

health care expenditure and gdp are they broken stationary in this paper we analyse the stationarity of the real per capita health care expenditure hce and real per capita gdp for a sample of oecd countries allowing for the presence of multiple structural breaks one novelty of the paper is that it permits the presence of structural breaks that affect both the level and the slope of the time series after the cross section dependence is accounted for we have found that these variables can be characterised as stationary processes evolving around a broken trend

the determinants of canadian provincial health expenditures evidence from a dynamic panel this article seeks to reveal the magnitude of the income elasticity of health expenditure and the impact of non income determinants of health expenditure across canada for this purpose panel data on gross domestic product the relative price of health care the share of publicly funded health expenditure the share of senior population and the life expectancy at birth have been used to investigate the determinants of canadian provincial health expenditures over a 28 year period dynamic models of health expenditure are analysed via generalized instrumental variables giv and generalized method of moments gmm results indicate that the long run income elasticity of health expenditure is substantially lower than one thus health care is far from being a luxury in canada

demand for medical care consumption and cointegration abstract this paper considers a generalized version of grossman s health capital model and derives a cointegration restriction the restriction is tested using aggregate us data and the results are consistent with the prediction of the model

price and quantity in international comparisons of health care expenditure an important omission from earlier cross national comparisons of health care expenditure has been the failure to distinguish between price and quantity using recent data on purchasing power parities the purpose of this article is to report some preliminary results regarding health care expenditure and quantity across 22 oecd countries the article concludes that contrary to what has been suggested in some recent articles the relative price of health care is not correlated to the aggregate per capita income the fraction of the national income that is devoted to health care provision increases with the per capita income regardless of whether health care is measured in terms of expenditure or quantity the relative price of health care has a rationing effect on the quantity of health care that is offered with a price alasticity close to minus one the latter finding means that the health care expenditure is not greater in countries with higherprices furthermore the differences in health care expendit

regional development or resource preservation a perspective from japanese appliance exports abstract this paper examines japanese resource outflows in the form of exported used and functional products in 2007 by quantifying the unintentional metal exports for a number of specialty metals typically used in electronics and electrical equipment we find that more than half of the indium and 20 30 of the barium lead antimony strontium zirconium silver gold and tin in domestically discarded products were not recycled in japan but rather were exported in products to be used elsewhere the destinations of these metals were mainly asian countries with rudimentary recycling technology these results demonstrate that although these metals could have been stockpiled domestically for future recovery and recycling they were instead sent to countries where recycling of these scarce metals is unlikely from a resource perspective therefore the free trade of used japanese products compromises long term domestic resource availability as it increases the quality of life in developing countries

determinants of health care expenditure in africa a cross sectional study the paper presents some quantitative evidence on the relationship between certain socioeconomic and demographic factors and per capita health care expenditure in africa first gnp per capita percentage of births attended by health staff and foreign aid received per capita together explained 78 3 of the variance in health care expenditure second per capita gnp is the most significant factor explaining differences in health care expenditure contrary to what has been found in comparisons of health care expenditure in the organization for economic cooperation and development oecd countries we found that the income elasticity is close to unity furthermore aid was consistently significant and positive in the three models estimated third variables such as crude birth rate and the population under 15 years of age as percentage of total population were not significant

health care expenditure and integration in the countries of the european union national health care differs between the member states of the european union in the quality and quantity demanded and supplied reflecting different economic structures and health care organization and delivery systems since health care expenditure depends primarily on the level of economic development and the structure of the population only convergence in economic performance and the standards of living can lead to convergence of health expenditure standards

aggregate health care expenditures and national income is health care a luxury good it is well known that a strong relationship exists between national expenditures on health care and national income this has been used to suggest that health care is a luxury good and that factors such as the type of health care delivery system in a country are of little importance in determining expenditure levels this paper argues that these implications rely upon the application of microeconomic analysis to macroeconomic data and that this is not appropriate as well as raising questions about the inferences drawn from previous studies new empirical evidence is presented which casts some doubts on previous findings international comparisons are based on purchasing power parity rather than exchange rate conversions underlining the importance of prices as well as quantities in the relationship and leading to the conclusion that the aggregate data show health care to be if anything a necessity rather than a luxury good

externalities and optimal taxation this paper reexamines the optimal tax design problem income and commodities in the presence of externalities the nature of the second best and the choice of the tax instruments are motivated by the informational structure in the economy the main results are i environmental levies linear or nonlinear differ in formula from pigouvian taxes by the expressions for the optimal tax on private goods ii externalities do not affect commodity tax formulas linear and nonlinear for private goods iii externalities do not affect the income tax structure if commodity taxes are nonlinear and affect it if commodity taxes are linear and iv a general income tax plus strictly pigouvian taxes are sufficient for efficient taxation if individuals of different types have identical marginal rates of substitution at any given consumption bundle

public private mix of health expenditure a political economy and quantitative analysis this paper constructs a simple model to examine decisions on public and private health spending under majority voting in the model agents with heterogeneous incomes choose how much to consume and spend on health care and vote for public health expenditure the health status of an agent is determined by a ces composite of public and private health expenditure the existence and uniqueness of the voting equilibrium are established a quantitative exercise reveals the importance of the relative effectiveness of public and private health expenditure and their substitutability in determining the public private mix of health expenditure and in accounting for the observed differences across a sample of 22 advanced democratic countries

equity in the finance and delivery of health care some tentative cross country comparisons textabstractequity is widely acknowledged to be an important goal in the field of health care indeed mclachlan and maynard 1982 have gone so far as to suggest that the vast majority of the population would elect for equity to be the prime consideration p 556 a view endorsed by mooney 1986 p 145 several researchers have investigated how successful their own country s delivery and or financing system is in achieving its stated equity goals in general the strategy of these studies is to compare the current situation with some ideal or target situation le grand 1978 for example in what has become a classic study in the field compares the distributions across socio economic groups of illness and public expenditure on health care in britain in 1972 and concludes that the national health service nhs has failed to achieve equity in the delivery of health care

review of the literature on the determinants of healthcare expenditure this study reviews the literature on determinants of healthcare expenditure for the period 1998 to 2007 the methodology combines searches in the mesh database of pubmed with the search in the principal journals of health economics 20 primary studies were found that met the criteria for inclusion no single pattern of results is clearly identified among the 20 articles four consider income to be the principal determinant of healthcare expenditure two of them jointly with population ageing six highlight population ageing as against six others that emphasize the proximity to death the remaining six do not focus on a specific variable or focus on another variable e g technological progress or territorial decentralization 11 of the 20 articles calculate the income elasticity of demand only two of them obtaining a value greater than 1 thus cataloguing healthcare expenditure as a luxury good there is therefore no unanimity in the variables and econometric regressions of healthcare expenditure in

discrepancies in international data an application to china hong kong entrepot trade before discussing discrepancies in international data it is essential to talk about the sources of the data the principal source for global trade statistics is the united nations un that agency relies on the trade statistics reported by its member countries the obvious discrepancy in these reports is that what country a says it sends to country b is not the same as what country b says it receives from a such differences in what the exporting and importing countries report is not just a feature of developing countries these discrepancies are pervasive in industrial countries as well for example since 1989 the united states has abandoned its attempt to keep track of exports to canada and now just relies on canadian data on its imports from the united states see robert feenstra 1997 table 2 prior to this action the united states underreported its exports to canada by more than 10 percent as compared to the canadian value this illustrates the general principle that the information collected by the importer which is often collecting tariff revenues and therefore has an incentive to record imports accurately is usually viewed as more accurate than that collected by the exporter there are then two problems with the un data it contains different information from the exporting and importing countries and it is expensive at least by the standards of lowbudget academic work progress on the first of these problems has been made by statistics canada in the world trade database wtdb that agency obtains the un trade data and then attempts to resolve the differences between the exporters and importers providing a single number for the value of each disaggregate good sent from country a to b these data are distributed on cd rom but are still fairly expensive by academic standards to make progress on the second problem the statistics canada data set for an early set of years 1970 1992 is distributed by the national bureau of economic research nber for a nominal fee also in cd rom format see feenstra et al 1997 in view of the widespread use of these data distributed by the un statistics canada or the nber it is worth asking how well the statistics canada database resolves the differing reports by the exporters and importers to take a particularly important example consider u s trade with china in 1996 the united states reported a deficit with china of 39 5 billion while the chinese reported a value of the u s deficit of 10 5 billion these two figures differ by 29 billion or a factor of three times at the heart of these differing values is the treatment of goods shipped through hong kong which remains a separate entity from china for customs purposes to what extent does statistics canada resolve the differences between these reported trade values to arrive at some credible value of bilateral trade unfortunately this issue is not resolved at all the values given in the statistics canada wtdb for chinese exports to the united states are very close to those reported by china and are much less than those reported by the united states this is contrary to the general principle stated above of treating the exporter s record of trade as less accurate than the importer s record on the other hand the u s official figures for imports from china are too high because they include the feenstra department of economnics university of california davis ca 95616 haas school of business university of califomia berkeley and national bureau of economic research hai department of economics fort lewis college and china centre for economic research beijing university woo and yao department of economics university of califomia davis we thank li yan jin hongman and jiang xiaozhu from the customs general administration people s republic of china for assisting with the study from which the results reported here are drawn

is health care really a luxury much of the work which has led to a widely held view that the income elasticity of health care spending exceeds one has been based on international cross section data or on pooled cross sections and time series in this paper we re examine this view in the context of long run equilibrium relationships between non stationary time series possibly including autonomous trends our results cast doubt upon the usefulness of pooling and upon the notion of an elasticity above one

the power to tax analytical foundations of a fiscal constitution preface 1 taxation in constitutional perspective 2 natural government a model of leviathan 3 constraints on base and rate structure 4 the taxation of commodities 5 taxation through time income taxes capital taxes and public debt 6 money creation and taxation 7 the disposition of public revenues 8 the domain of politics 9 open economy federalism and taxing authority 10 toward authentic tax reform prospects and prescriptions epilogue notes selected bibliography index

disentangling the heterogeneous income elasticity and dynamics of health expenditure in this article we empirically study the impact of per capita income on health care expenditure and its dynamics over time in a sample of 14 oecd countries for the period 1971 to 2009 a simple model built upon one developed by newhouse 1977 suggests that health care is a necessity in the short run but it cannot be rejected to be a luxury good in the long run our findings provide strong empirical evidence that a year s health expenditure is conditioned by the previous one interestingly our results reveal increasing income inelasticity over time along with huge heterogeneity across countries finally this article supports the hypothesis of conditional convergence in health care spending among countries in designing policies which facilitate the sustainability of national health systems we emphasize that ceteris paribus the greater the participation of public health the lower the growth rate of health spending high share of children and elderly over working age population opposite influences w

household production of health investment analysis and applications michael grossman s health investment model provides significant insights into allocations between both leisure and income and health and nonhealth goods our geometric extension i integrates labor leisure choice with the consumer s production of both health and nonhealth goods and ii distinguishes between medical expenditures and healthcare investment this provides a framework for examining the effects of changes in incomes and wages alternative insurance arrangements including managed care travel times waiting times and schooling observed differences between the income elasticities for health goods and health investment can be resolved through relative resource intensities in the production of health and nonhealth goods

new panel results on cointegration of international health expenditure and gdp this article tests for existence of cointegration between health expenditure and gdp using data from 25 oecd countries for the period 19607ndash 1997 the empirical modelling is based on a heterogeneous bivariate vector error correction panel model that allows for trending data as well as intercepts and trends in the cointegrating relations univariate country by country and panel unit root tests generally fail to reject the null of a unit root in the health expenditure and gdp variables country by country results based on the johansen multivariate likelihood based inference indicate somewhat mixed results on country specific cointegration with a rank of one found for 12 countries and a rank of zero for the remaining 13 countries application of a new panel test for cointegration rank with higher power than the individual tests indicates that health expenditure and gdp are cointegrated around linear trends

evidence on the determinants of canadian provincial government health expenditures 1965 1991 abstract real per capita provincial government expenditures on health care over the period 1965 1991 are examined using pooled time series cross section regression analysis key determinants of real per capita provincial government expenditures on health care over the period 1965 1991 are real provincial per capita income the proportion of the provincial population over age 65 and real provincial per capita federal transfer revenues established program financing had a negative and significant impact on real per capita provincial government health expenditures in newfoundland and quebec an income elasticity of 0 77 implies that health care is not a luxury good

comparing french and us hospital technologies a directional input distance function approach french and us hospital technologies are compared using directional input distance functions the aggregation properties of the directional distance function allow comparison of hospital industry level performance as well as standard firm level performance with regard to productive efficiency in addition the underlying constituents of efficiency in the short run congestion and technical inefficiency and in the long run scale inefficiency are analysed by decomposing the overall measure by virtue of using the directional distance function it is also possible to obtain an estimate of a lower bound on allocative inefficiency it is found that french and us hospitals use quite different technologies long run scale inefficiencies cause most of the french hospitals inefficiency while short run technical inefficiency is the main source of overall productive inefficiency in the us hospitals

an econometric analysis of health care expenditure a cross section study of the oecd countries this paper is an empirical examination of the determinants of aggregate health care expenditure the paper presents a systematic analysis of relationships across 19 oecd countries showing the effects of aggregate income institutional and socio demographic factors on health care expenditure the results indicate that institutional factors of the health systems in addition to per capita gross domestic product gdp contribute significantly to the explanation of the health care expenditure variation between countries for example the way physicians in outpatient care are paid and the mixture of public private funding and inpatient outpatient care

health care expenditure in the last months of life in oecd countries a considerable share of health care expenditure hce is spent for the care of the terminally ill this paper derives the demand for hce in the last 2 years of life from a model that accounts for age mortality risk and wealth the empirical tests are based on data of deceased members of a major swiss sick fund the empirical evidence confirms most of the hypotheses derived from the model i e i hce increases with closeness to death ii for retired individuals hce decreases with age and iii low income individuals as compared to high income individuals incur lower hce in the last months of life

on the determination of the us aggregate health care expenditure per capita real health care expenditure is examined against three major groups of explanatory variables economic demographic and health stock and it is found that the three groups of variables have an impact on real health care spending other subcategories such as real private and government health care pharmaceutical dental home nursing ambulatory personal medical consumption and in patient expenditures have also been examined and have been found to be affected by the explanatory variables for several subcomponents there is evidence of supplier inducement of the demographic group of variables the ageing population had an impact only on the per capita real overall and private health care outlay and pharmaceutical spending also cointegrating relationships were found and consistent estimators of the elasticities found

population and income is there a puzzle abstract this note presents wide evidence on the relationship between population and income for 125 countries for which data was available for the period 1950 2000 the main result is that there is a weak but negative relationship between population growth and per capita gdp as income increases population expands at a slower rate this relationship appears to be stronger for african countries and for asian countries before 1970

the normative economics of health care finance and provision whereas in many countries the crisis in medical care has been seen in terms of excess spending on health services in the uk it has been seen at least by most of those who manage and work in the nhs as a crisis of underfunding this has come about as the result of the government s successful attempts to restrain the rate of growth of real spending on the nhs which in turn reflects the government s belief that its principal effective weapon against what it perceives to be inefficiency in the nhs is to challenge management itself reformed and to some extent liberated by systematic financial squeezes the same concern has given rise to a host of proposals for reform of the nhs most of which involve a much greater role for private insurance private finance of other kinds such as out of pocket payments and private provision of health care itself

the determinants and effects of health expenditure in developed countries previous studies of international differences in health spending have been restricted to the use of relatively small samples of cross sectional data our objective here is to re examine the results of previous work using a sample of 560 pooled time series and cross section observations results confirm the importance of gdp as a determinant of health spending with an estimated income elasticity at or around unity but also suggest that oecd countries should not be regarded as a single homogeneous group the importance of some non income variables is also confirmed although the direct effect of these factors appears to be small

environmental taxation policy in the eu new methodology approach abstract main problem addressed in this paper is assessment of quality of current methodologies for expressing environmental tax revenue since measurements outcomes have significant influence on the future environmental policies and legislation the main goal of this paper is to analyze the existing way of measuring financial effects of environmental taxation in eu27 and propose new methodology approach based on use of ete environmental taxation efficiency as a new indicator suggested by authors the first phase of the study involves the analysis of quality of measuring two existing methodologies based on the use of gdp and total revenues in second research stage the authors apply the newly proposed methodology for determining a composite ete indicator that apart from existing indicators takes into account the environmental taxation effects per capita as an indicator unjustifiably neglected in previous methods of measuring measurement of environmental taxation by using a newly proposed composite indicator shows significant differences in ranking compared to two current methodologies in use only 6 countries showed a very similar rank regardless of the methodology applied differences by more than ten ranking positions were found in 12 countries the overall results showed significant differences in ranking of all eu 27 countries by using all four indicated methodologies which clearly points to the conclusion that further improvements are needed ete methodology limits predominant role of gdp and introduces a social component which should serve as a basis for further development of a unique methodology for establishing efficient environmental taxation implementation

is health care really a luxury in oecd countries evidence from alternative price deflators this article examines whether real health care expenditure he is a luxury or necessity for organization for economic co operation and development oecd countries over the period 1972 to 2004 within a panel unit root and panel cointegration framework to realize this objective we regress he on real gross domestic product gdp the proportion of the population aged over 65 p65 and a time trend t we first present results for 18 countries where real he per capita is obtained using a general gdp deflator for these countries we find that health care is a luxury for just one country next we present results for eight countries where real he is obtained using a specific health care price index when the general gdp deflator is replaced with a specific health care price index at least one of the gdp p65 or t coefficients for the eight countries changes in a reasonably dramatic fashion suggesting that the use of the gdp deflator introduces bias into the regression we find that he is a necessity in

health care is an individual necessity and a national luxury applying multilevel decision models to the analysis of health care expenditures health care is neither a necessity or a luxury it is both since the income elasticity varies with the level of analysis with insurance individual income elasticities are typically near zero while national health expenditure elasticities are commonly greater than 1 0 the debate over whether health care is or is not a luxury good arises primarily from the failure to specify levels of analysis clearly so as to distinguish variation within groups from variation between groups apparently contradictory empirical results are shown to be consistent with a simple nested multilevel model of health care spending

stationarity of health expenditures and gdp evidence from panel unit root tests with heterogeneous structural breaks this paper re examines the stationarity of national health care expenditures and gdp in a panel setting utilizing data from 20 oecd countries over the period from 1960 to 1997 previous research in this area has recognized the drawback of not allowing for structural breaks in their unit root tests and noted that their empirical results may not be robust we advance the literature by utilizing a recently developed panel lm unit root test that allows for heterogeneous level shifts in contrast to previous analyses that did not consider breaks our results reject the unit root null hypothesis for both series