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Public Expenditures Review in Health. Agnes Soucat, Lead Economist. Presentation Outline. Efficiency Analysis and PERs Equity Analysis and PERs Public Expenditure Management and PERs. Efficiency Analysis and PERs. Examples Efficiency Analysis:
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Public Expenditures Review in Health Agnes Soucat, Lead Economist
Presentation Outline • Efficiency Analysis and PERs • Equity Analysis and PERs • Public Expenditure Management and PERs
Efficiency Analysis and PERs • Examples Efficiency Analysis: • Allocative efficiency: does money go to priority areas? • Technical efficiency: are the inputs minimized for a given output? • Input efficiency: Is the balance of inputs appropriate?
Allocative Efficiency • Key questions: • Is the public spending focused on pure (or nearly pure) public goods or goods with large externalities ? • Is the public spending focused on activities that contribute to increased returns in education and investments, economic growth and poverty reduction? • Is the public spending focused on activities that are most likely to benefit the poor?
Priority Programs (examples) • vector control: eg: snails, rats, mosquitos …. • environmental health : eg: toxic wastes, quality of water, clean air • communicable disease surveillance and management: eg Tuberculosis • Immunizations: “herd immunity”
Contribution to Economic Growth and Poverty Reduction .. Improvements in health and economic take-off: changes in Per Capita GDP and IMR in Singapore Per capita GDP 1990
Contribution to Economic Growth and Poverty Reduction .. IMR at the time of Economic Take-off in East Asia
Contribution to Economic Growth and Poverty Reduction .. • Nutrition in agriculture based economies • Some diseases: HIV, malaria • Child mortality, fertility reduction associated with high investment in education and low dependency ratios
Efficiency Analysis and PERs • Examples Efficiency Analysis: • Allocative efficiency: does money go to priority areas? • Technical efficiency: are the inputs minimized for a given output? • Input efficiency: Is the balance of inputs appropriate?
Technical Efficiency: • Key questions • What is the relative weight of various sub-sectors (e.g. Tertiary VS Secondary VS Primary VS outreach VS community based programs ) • What is the mix of services provided (e.g. Curative Vs Preventive)
Technical Efficiency: Relative allocation to levels of care: Mauritania
Efficiency Analysis and PERs • Examples Efficiency Analysis: • Allocative efficiency: does money go to priority areas? • Technical efficiency: are the inputs minimized for a given output? • Input efficiency: Is the balance of inputs appropriate?
Input Efficiency • Key questions: • Are recurrent cost at the level required by capital invested (eg unreliable, insufficient funding of key inputs (drugs)..) • Are Non-Salary Recurrent expenditures and the wage bill balanced? (e.g salaries crowding out other inputs, non salary recurrent “recycled” into staff incentives)
Evolution of health budget: Mauritania Input Efficiency
Presentation Outline • Efficiency Analysis and PERs • Equity Analysis and PERs • Public Expenditure Management and PERs
Equity Analysis and PERs • Examples Equity Analysis: • Physical Access • Human Resource Deployment • Availability of Drugs or other inputs • Benefit Incidence Analysis • Equity and Financing Mechanisms • Insurance Incidence • Impact of Cost Recovery
Physical Access to Essential Health Services, Mauritania, 1999 Richer Poorer
Availability of Essential Drugs per Region, Mauritania, 1999 Poorer Richer
Population covered by publicly funded health insurance, Thailand 2000