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Public Expenditures in Health

Public Expenditures in Health. Main Principles. Establish Market Failures Identify beneficiaries of expenditures Balance potential benefits with ability to deliver services. Health - Market Failures. Public goods (pest control, sanitation, health education)

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Public Expenditures in Health

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

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

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

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

  9. Absence rates from public health care centers: Bangladesh 2002

  10. 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(?)

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

  12. …they have less access to safe water…

  13. …and this costs the lives of their children

  14. What’s this look like in Egypt?Percentage of households with no sanitation facilities

  15. And for Jordan?: Sanitation facilities by household wealth 100% Other Covered Dry 50% Toilet/septic 0% Toilet/sewage 1 2 3 4 5 6 7 8 9 10

  16. Jordan: Sanitation facilities by governorate 100% 80% Other 60% Covered Dry Toilet/septic 40% Toilet/sewage 20% 0% Irbid Balqa Zarqa Karak Ma'an Ajloun Aqaba Jerash Tafileh Mafraq Madaba Amman

  17. 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(?)

  18. Determinants of infant mortality

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

  20. Substitution between public and private providers

  21. Substitution between public and private providers in Jordan A 10% increase in primary health care facilities per capita (by governorate): - increases their use by 4.4% - decreases use of private facilities by 3.2% - decreases use of public hospitals by 2.6% Net effect?

  22. Distribution of health care subsidies, Indonesia

  23. Jordan: Not enough information Place of first health consultation by household wealth 100% UNRWA Gvt health ct 50% Pvt clinic Gvt hospital 0% 1 2 3 4 5 6 7 8 9 10 Pvt hospital

  24. 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(?)

  25. Value of insurance as a % of expected cost

  26. Priorities in health policy

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