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Public Expenditures in Health

Public Expenditures in Health

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Public Expenditures in Health

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Presentation Transcript

  1. Public Expenditures in Health

  2. Main Principles • Establish Market Failures • Identify beneficiaries of expenditures • Balance potential benefits with ability to deliver services

  3. Health - Market Failures • Public goods (pest control, sanitation, health education) • Externalities (infectious disease control) • Information advantage of doctors • Insurance

  4. Health - equity concerns • Inequities in health status • Inequities in benefits of services

  5. The poor are sicker than other people: Under two mortality by “wealth”- Brazil, 1996

  6. Prevalence of disease by “wealth”: India 1992-3

  7. Female 45Q15 by cause of death by income group, China 1987

  8. Health - Problems of Implementation • Management challenge • Personnel placement • Quality of services • Conscientious providers • Maintenance of facilities • Political Influence

  9. Percentage of health centers without doctors by province: Indonesia

  10. Absenteeism in primary facilities % absent

  11. Details from India

  12. Health: Complementarity/ conflict between goals • Public goods - strong complementarity • Primary health care - modest efficiency effects (varies), potentially high equity effects, difficult management • Hospitals - high efficiency, high potential but low actual equity effects, easier management(?)

  13. In Brazil, the poor have worse sanitation facilities… Percent of households with no sanitation facilities

  14. …they have less access to safe water…

  15. …and this costs the lives of their children

  16. Health: Complementarity/ conflict between goals • Public goods - strong complementarity • Primary health care - modest efficiency effects (varies), potentially high equity effects, difficult management • Hospitals - high efficiency, high potential but low actual equity effects, easier management(?)

  17. Determinants of infant mortality

  18. Philippines: Effect of public medical care Poor area Not-so-poor area

  19. Substitution between public and private providers

  20. Distribution of health care subsidies, Indonesia

  21. Health: Complementarity/ conflict between goals • Public goods - strong complementarity • Primary health care - modest efficiency effects (varies), potentially high equity effects, difficult management • Hospitals - high efficiency, high potential but low actual equity effects, easier management(?)

  22. Value of insurance as a % of expected cost

  23. Priorities in health policy