Public Expenditures in Health and Education卫生和教育的公共支出.pptVIP

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Public Expenditures in Health and Education卫生和教育的公共支出.ppt

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Public Expenditures in Health and Education卫生和教育的公共支出

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) Externalities (infectious disease control) Information advantage of doctors Insurance Health - equity concerns Inequities in health status Inequities in benefits of services The poor are sicker than other people: Under two mortality by “wealth”- Brazil, 1996 Prevalence of disease by “wealth”: India 1992-3 Female 45Q15 by cause of death by income group, China 1987 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 Absenteeism in primary facilities Details from India 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… …they have less access to safe water… …and this costs the lives of their children 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(?) Determinants of infant mortality Philippines: Effect of public medical care Substitution between public and private providers Distribution of health care subsidies, Indonesia Health: Complementarity/ conflict between goals Public goods - strong complementarity Primary health care - modest efficiency effects (varies), potentially high equity effects, difficult m