Reprioritizing Government Spending on Health : Pushing an Elephant Up the Stairs?

Tandon, Ajay ; Fleisher, Lisa ; Li, Rong ; Yap, Wei Aun

World Bank, Washington, DC

关键词: ABILITY TO PAY;    ABSENTEEISM;    ACCOUNTABILITY;    ADVERSE CONSEQUENCES;    AGGREGATE EXPENDITURES;   

RP-ID  :  85773

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

Countries vary widely with respect tothe share of government spending on health, a metric thatcan serve as a proxy for the extent to which health isprioritized by governments. World Health Organization (WHO)data estimate that, in 2011, health's share ofaggregate government expenditure in the 170 countries forwhich data were available averaged 12 percent. However,country differences were striking: ranging from a low of 1percent in Myanmar to a high of 28 percent in Costa Rica.Some of the observed differences in health's share ofgovernment spending across countries are unsurprisinglyrelated to differences in national income. However,significant variations exist in health's share ofgovernment spending even after controlling for nationalincome. This paper provides a global overview ofhealth's share of government spending and summarizeskey theoretical and empirical perspectives on allocation ofpublic resources to health vis-a-vis other sectors from theperspective of reprioritization, one of the modalities forrealizing fiscal space for health. Theory and cross-countryempirical analyses do not provide clear, cut explanationsfor the observed variations in government prioritization ofhealth. Standard economic theory arguments that are oftenused to justify public financing for health are equallyapplicable to many other sectors including defense,education, and infrastructure. To date, empirical work onprioritization has been sparse: available cross-countryeconometric analyses suggests that factors such asdemocratization, lower levels of corruption, ethnolinguistichomogeneity, and more women in public office are correlatedwith higher shares of public spending on health; however,these findings are not robust and are sensitive to modelspecification. Evidence from case studies suggests thatcountry-specific political economy considerations are key,and that results-focused reform efforts, in particularefforts to explicitly expand the breadth and depth of healthcoverage as opposed to efforts focused only on governmentbudgetary targets, are more likely to result in sustainedand politically-feasible prioritization of health from afiscal space perspective.