76 Journal of Reviews on Global Economics, 2015, 4, 76-86
E-ISSN: 1929-7092/15 © 2015 Lifescience Global
Convergence of Health Expenditure in OECD Countries: Evidence
from a Nonlinear Asymmetric Heterogeneous Panel Unit Root Test
Didem Pekkurnaz
*
University of North Carolina at Chapel Hill (UNC-CH), Department of Economics, 107 Gardner Hall, NC
27599, USA
Abstract: This paper examines the convergence in health expenditure across 22 OECD countries between 1980 and
2012 by implementing panel unit root tests. Contribution of application of the nonlinear asymmetric heterogeneous panel
unit root test is twofold. Firstly, it relaxes the assumption of cross-sectional dependency in panel data. Secondly, it
incorporates the asymmetric nonlinear mean reversion in a panel setting. Results show that while the conventional panel
unit root test cannot reject the null hypothesis of a unit root in relative per capita health expenditures for the whole set of
countries, both the symmetric and the asymmetric nonlinear panel unit root tests indicate the stationarity of the panel.
Specifically, almost 23 percent of the countries are found to be converging by employing the nonlinear asymmetric panel
unit root test. In addition, introducing asymmetric structure helps to uncover additional converging countries which
cannot be detected using linear and nonlinear symmetric panel unit root tests.
Keywords: Health care expenditures, Convergence, Nonlinear asymmetric panel unit root tests, OECD Countries.
1. INTRODUCTION
According to the Organization for Economic
Cooperation and Development (OECD) Health
Statistics 2014, OECD average per capita health care
expenditure (US$ PPP) and health expenditure as
share of GDP have been rising over the period 2000-
2012 although there has been a decline between 2009
and 2011 due to global financial crisis. The United
States (US) has always been the country with the
highest spending on health over the period 2000-2012.
Health spending accounts for 16.9% of GDP in US in
2012, which is higher than OECD average 9.3%.
Turkey and Mexico, on the other hand, have the lowest
per capita health expenditures in 2012 (less than a
third of the OECD average). The estimated average
growth rate of per capita health expenditure across
OECD countries is 4.1% between 2000 and 2009 while
between 2009 and 2011 the growth rate is only 0.2%.
1
Although US has the highest per capita health
expenditure among OECD countries, its growth rate on
per capita health spending, in real terms, over the
period 2000-2009 is 3.4% which is less than the growth
rates of countries such as Korea and New Zealand
(9.3% and 4.5% respectively) with per capita health
expenditures lower than OECD average for the period
2000-2009.
*Address correspondence to this author at the University of North Carolina at
Chapel Hill (UNC-CH), Department of Economics, 107 Gardner Hall, NC
27599, USA; E-mail: didempnz@gmail.com
1
See OECD (2013) for details.
Countries’ spending on health care and the rate at
which it grows depend on different market and social
factors, differences in organization and financing of
health care systems, and the level of technology of
countries. Improvements in medical technologies,
population aging and rising consumer expectations
lead to increase in health expenditure growth (Huber
and Orosz 2003). Newhouse (1992) conjectures that
technological advancement is a major contributor to
health care expenditure accounting for almost 75% of
increase in health expenditures. Okunade and Murthy
(2002) econometrically test this hypothesis for US and
confirm that changes in R&D spending (proxy for the
technology) is a long run factor of rising health care
expenditure. Another factor affecting health
expenditure is population aging. Since health
expenditure per person for older people is greater than
health expenditure per person for younger people,
countries with rising older population might experience
rising health expenditure. In addition to these, different
environmental conditions and lifestyles might also
generate differences in types of diseases experienced
across countries which may lead to varying levels of
health expenditures.
Considering the differences in health expenditures
across countries, concept of convergence in health
expenditures has been investigated by many
researchers. Economic convergence is based on
neoclassical growth theory. The theory states that in
the long run countries with similar preferences and
technology will reach to a common steady state level of
income per capita. Poor countries tend to grow faster
than rich ones and eventually they will catch-up. Since
health expenditure rises when income expands, health