Transcript Why Invest In Health?

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
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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
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Why Invest in Health?
Impact on Economic Growth

Macro-Economic Commission on
Health
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Productivity
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10% increase in life expectancy = 0.35%
growth in GDP
17% of productivity gains attributable to
health status
Poor Outcomes

Sick leave, absenteeism, etc.
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Health Status Varies by Income
60
50
40
30
Good
20
Bad/Very Bad
10
0
Poorest
2nd
3rd
4th
Richest
Quintile Quintile Quintile
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Russia vs. Canada:
Health Status
90
80
70
60
50
40
30
20
10
0
Russia
Canada
Good or Very Good
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Poorer Groups: More Likely to
Engage in Risky Behaviors
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Vodka
Cognac
Liquers
Other Spirits
Several times
per week
or daily
80
70
60
50
40
30
20
10
0
Poorest
3rd
Quintile,
Richest
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Russian Federation:
General Health Status
80
75
Russian Federation
-prior 1.05.2004) aver
EU(15
70
CSEC(15) average
CIS(12) average
65
60
1970
_
1980
1990
2000
2010
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Probability of Russian
Man Dying, Ages 15-60
45
40
35
30
25
20
15
10
5
0
Probability of Dying, Ages 15-60 (Males)
US
Denmark
Japan
Germany
United Kingdom
France
Poland
Mexico
Brazil
Russian Federation
Turkey
Kyrgz Republic
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Re-Emergence of Infectious
Diseases: AIDS
300,000
250,000
200,000
150,000
100,000
50,000
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89
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90
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91
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99
20
00
20
01
20
02
20
03
0
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60% 20-30 Years old
2.3 million by 2010
10% drop in GDP by 2020
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Larger drops in labor supply and investments
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Regional Variations Growing
(Infant Mortality)
45
40
35
30
25
Maximum
Minimum
20
15
10
5
0
1999
2001
10
Finance and Delivery
System: Reform Needed
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Access to Services
Social Solidarity/Risk Pooling
Efficiency in Delivery
Equity
Protection of Poor and Vulnerable
Groups
• Pensioners
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Limited and Declining Public
Sector Funding for Health
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Selected International Comparisons:
Levels of Funding (% Share of GDP)
10
9
8
7
6
5
4
3
2
1
0
Denmark
France
United Kingdom
Russia
Poland
Brazil
Kyrgz Republic
Public
Private
Total
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Fragmented Funding
Streams
Russia
Budget
Doctor
Fund
International Best
Practice
Rayon
Hospital
Pooled Funds
Doctor
Hospital
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Inefficiency:
Too Many Beds and Physicians
12
10
Denmark
France
United Kingdom
Russian Federation
Poland
Brazil
Kyrgzstan
8
6
4
2
0
Beds/1000
Physicians/1000
15
Too Much Reliance on Hospital Care
(admissions/1,000)
240
220
200
180
160
140
120
1992
1993
1994
1995
1996
1997
1998
Russian Federation
CIS
Eastern Europe
EU
1999
2000
2001
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Geographic Inequity: Over 7-fold
Regional Variation in Funding
(even after adjusting)
Rubles per capita
3,000
2,500
2,000
1,500
1,000
500
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Impact on Poor and
Vulnerable Groups
100%
80%
60%
40%
20%
0%
1994 1995 1996 1997 1998 1999 2000 2001
Out-of-Payments for Pharmaceuticals
Chargeable Health Services
Voluntary Health Insurance Premiums
Public Expenditures
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NOBUS Survey (1): Poor Pay
More as % of Consumption
35
30
25
20
Top
Lowest
15
10
5
0
Drugs
Hospitals Outpatient Dental
Total
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NOBUS Survey (2): % of
Consumption for Paid Services
250
200
1
2
3
4
5
150
100
50
0
Official
Outpatient
Unofficial
OutPatient
Official
Inpatient
Unofficial
Inpatient
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NOBUS Survey (3):
Poor Can’t Afford to Follow
Treatment Regimens
Only Free
45
40
35
30
25
20
15
10
5
0
No, Due
to Lack of
Money
Poorest
Richest
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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
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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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