Transcript Public Expenditure Reviews and the Health Sector

Public Expenditures Review in
Health
Agnes Soucat, Lead Economist
1
Presentation Outline
• Efficiency Analysis and PERs
• Equity Analysis and PERs
• Public Expenditure Management and
PERs
2
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?
3
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?
4
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”
5
Contribution to Economic Growth
and Poverty Reduction ..
Improvements in health and economic take-off: changes in
Per Capita GDP and IMR in Singapore
90
35000
80
30000
70
60
25000
50
20000
40
15000
30
20
10000
10
5000
0
0
1950 1955 1960 1965 1970 1975 1980 1985 1980 1995
IMR
per
capita
GDP
Per capita 6
GDP 1990
Contribution to Economic Growth
and Poverty Reduction ..
IMR at the time of Economic Take-off in East Asia
Hong-Kong
China
Japan
Korea
Malaysia
Singapore
Taipei
Thailand
Approximate Period
of economic take-off
Average IMR for the
take-off period
IMR at take off as
% of 1960
developing
countries average
IMR at take-off
as a percentage of
1960 OECD
country average
1959-69
37
27
119
1953-63
1968-78
1965-75
1960-70
1957-67
1977-87
38
45
48
28
29
46
28
33
35
20
21
34
123
145
159
89
94
150
7
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
8
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?
9
Technical Efficiency:
• Key questions
– What is the relative weight of various subsectors
(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)
10
Technical Efficiency:
100%
80%
Central
Administration
Tertiary
60%
40%
Primary and
secondary
20%
0%
ad
h
C
ea
n
i
Gu
M
ia
n
a
it
r
u
a
11
Technical Efficiency:
Relative allocation to levels of care: Mauritania
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Administration
Tertiary
Secondary
Primary
1999
2001
2003
2005
12
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?
13
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)
14
Input Efficiency
Evolution of health budget: Mauritania
8000000
7000000
6000000
5000000
Salary
Non salary recurrent
Investment
4000000
3000000
2000000
1000000
0
1999
2001
2003
15
Presentation Outline
• Efficiency Analysis and PERs
• Equity Analysis and PERs
• Public Expenditure Management and
PERs
16
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
17
Physical Access to Essential Health
Services, Mauritania, 1999
100
90
80
90
70
80
60
50
Access
Poverty Level
70
40
60
30
20
50
10
40
0
ASS
Poorer
GOR HEG
BKN
GUI
TAG
HEC ADR
TRZ
ZEM NKC
NDB
INC
Richer
18
Availability of Nurses and Infant MortalityCameroon 1999
19
Availability of Essential Drugs per Region,
Mauritania, 1999
100
90
80
70
60
50
40
30
20
10
0
bo
u
ou
ad
i
ar
za
et
N
Tr
Da
kh
l
ra
r
Ad
hi
El
c
od
h
H
Poorer
ha
rg
ng
an
t
Ta
ak
a
di
m
G
ui
Br
ak
na
G
or
go
l
Paracetamol
AAS
Mebendazole
Amoxicillin
Richer
20
BIA India Example
Who Gets the Public Subsidy?
Share of the Public Subsidy
40.0%
33.1%
30.0%
25.6%
20.0%
13.4%
17.8%
2nd
Middle 20%
10.1%
10.0%
0.0%
Poorest
20%
Income Quitiles
4th
Richest
20%
21
Population covered by publicly funded
health insurance, Thailand 2000
70
60
50
%
40
30
20
Other insurance
(CMSBS, SSO, VHC)
10
Low income card
po
or
es
se t q
co uin
nd til
qu e
th
ird inti
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q
fo
ur ui n
th tile
ric
q
he ui n
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til
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0
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