While rising health care expenditures as a percentage of national income is a well-known and widely documented feature across the industrialized world, it has proved difficult to quantify the effects of the underlying cost drivers. The main difficulty is to find suitable proxies to measure medical technological innovation, which is believed to be a major determinant of steadily increasing health spending. This paper’s main contribution is the use of data on approved medical devices and drugs to proxy for medical technological progress. The effects of these variables on total real per capita health spending are estimated using a panel model for 18 OECD countries covering the period 1981-2009. The results confirm the substantial cost-increasing effect of medical technology, which may account for at least 50% of the explained historical growth of spending. Excluding the approval variables causes a significant upward bias of the estimated income elasticity of health spending and negatively affects some model specification tests. Despite the overall net positive effect of technology, the effect of two subgroups of approvals on expenditure is significantly negative. These subgroups can be thought of as representing ‘incremental medical innovation’, while the positive effects are related to radically innovative pharmaceutical products and devices. The results are consistent with those reported in other studies which suggest that some new products, despite their high price when they are introduced, can ultimately save money by reducing spending on other medical interventions.
Belgium is characterised by one of the lowest employment rates of elderly workers in the European Union. Since 1997, attempts have been made to discourage elderly workers from leaving the labour market before the age of 65. In particular, two measures aimed at reducing early retirement have been introduced. The first extends the number of career years required to enter early retirement. The second, called "pension bonus", financially stimulates elderly workers to pursue employment after the age of 62. This paper provides an ex-post evaluation of the impact of these two measures on the probability of remaining employed a year later using a difference-in-differences strategy. Our data consists of individual longitudinal employment data covering the period 2000-2009. Using panel data logit models, we find first that the extension of the career length requirement had a significant impact on the probability of staying employed a year later for blue collar and low income white collar male workers aged 60-61 compared to those aged 62-64 during the period 2000-2006. Our second exercise proceeds to estimate the impact of the "pension bonus" during the period 2004-2009, in the presence of the extension of the career length requirement. Comparing the two exercises allows us to conclude that the "pension bonus" had, if any, a very limited impact on the probability of staying employed a year later for male workers aged 62-64 compared to those aged 60-61.