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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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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) • Externalities (infectious disease control) • Information advantage of doctors • Insurance
Health - equity concerns • Inequities in health status • Inequities in benefits of services
Health - Problems of Implementation • Management challenge • Personnel placement • Quality of services • Conscientious providers • Maintenance of facilities • Political Influence
Percentage of health centers without doctors by province: Indonesia
Absence rates from public health care centers: Bangladesh 2002
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(?)
In Brazil, the poor have worse sanitation facilities… Percent of households with no sanitation facilities
What’s this look like in Egypt?Percentage of households with no sanitation facilities
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
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
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(?)
Philippines: Effect of public medical care Poor area Not-so-poor area
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?
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
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(?)
