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Russian Federation: Linking Health, Poverty and Economic Growth

Russian Federation: Linking Health, Poverty and Economic Growth. Jack Langenbrunner The World Bank Moscow July 2004. Why Invest In Health?. Poverty and Ill-health are intertwined Poorer health outcomes in/within poorer countries

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Russian Federation: Linking Health, Poverty and Economic Growth

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  1. Russian Federation:Linking Health, Poverty and Economic Growth Jack Langenbrunner The World Bank Moscow July 2004

  2. Why Invest In Health? • Poverty and Ill-health are intertwined • Poorer health outcomes in/within poorer countries • Poverty breeds ill-health (due to diet, education, transportation, etc) • Ill health keeps poor people poor • Invest in health: reduce ill health and poverty

  3. Why Invest in Health? Impact on Economic Growth • Macro-Economic Commission on Health • 10% increase in life expectancy = 0.35% growth in GDP • Productivity • 17% of productivity gains attributable to health status • Poor Outcomes • Sick leave, absenteeism, etc.

  4. Health Status Varies by Income

  5. Russia vs. Canada: Health Status

  6. Poorer Groups: More Likely to Engage in Risky Behaviors • Vodka • Cognac • Liquers • Other Spirits Several times per week or daily

  7. Russian Federation: General Health Status

  8. Probability of Russian Man Dying, Ages 15-60

  9. Re-Emergence of Infectious Diseases: AIDS • 60% 20-30 Years old • 2.3 million by 2010 • 10% drop in GDP by 2020 • Larger drops in labor supply and investments

  10. Regional Variations Growing (Infant Mortality)

  11. Finance and Delivery System: Reform Needed • Access to Services • Social Solidarity/Risk Pooling • Efficiency in Delivery • Equity • Protection of Poor and Vulnerable Groups • Pensioners

  12. Limited and Declining PublicSector Funding for Health

  13. Selected International Comparisons:Levels of Funding (% Share of GDP)

  14. Russia International Best Practice Fragmented Funding Streams Fund Rayon Budget Pooled Funds Doctor Hospital Doctor Hospital

  15. Inefficiency: Too Many Beds and Physicians

  16. Too Much Reliance on Hospital Care (admissions/1,000)

  17. Geographic Inequity: Over 7-fold Regional Variation in Funding(even after adjusting)

  18. Impact on Poor and Vulnerable Groups

  19. NOBUS Survey (1): Poor Pay More as % of Consumption

  20. NOBUS Survey (2): % of Consumption for Paid Services

  21. NOBUS Survey (3):Poor Can’t Afford to Follow Treatment Regimens

  22. Recommendations 1. Formalize informal payments • Standardized co-payment system • Explicit protections for the poor and medically vulnerable groups • Inform and educate 2. Restructure financing and delivery system • pooling, geographic formula, autonomize facilities, etc. 3. Improve Measures for Public Health • Cross sectoral strengthening • Cost-effective practices and behaviors • Increase funding for AIDS and lower price of ARVs

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