1. Public Expenditures in Health

2. Main Principles Establish Market Failures
Identify beneficiaries of expenditures
Balance potential benefits with ability to deliver services

3. Health - Market Failures
Public goods (pest control, sanitation, health education)
Externalities (infectious disease control)
Information advantage of doctors
Insurance

4. Health - equity concerns
Inequities in health status
Inequities in benefits of services

6. The poor are sicker than other people: Under two mortality by “wealth”- Brazil, 1996

8. Prevalence of disease by “wealth”: India 1992-3

9. Female 45Q15 by cause of death by income group, China 1987

10. Health - Problems of Implementation
Management challenge
Personnel placement
Quality of services
Conscientious providers
Maintenance of facilities
Political Influence

11. Percentage of health centers without doctors by province: Indonesia
I didn’t bother to put the names.
I wanted to show correlation with income or urbanization but it didn’t work. But it is still true that there is something about the attractiveness of the area.
Irian Jaya, central Kalimantan (Borneo) - high income from logging or minerals but lousy places to live - grey are mostly poor. Light blue are Java/Bali/Sumatra nice places to live.

13. Absence rates from public health care centers: Bangladesh 2002

14. 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(?)

15. In Brazil, the poor have worse sanitation facilities…
Percent of households with no sanitation facilities

16. …they have less access to safe water…

17. …and this costs the lives of their children

18. What’s this look like in Egypt
What’s this look like in Egypt? Percentage of households with no sanitation facilities

19. And for Jordan?: Sanitation facilities by
household wealth
100%
Other
50%
Covered Dry
Toilet/septic 0%
Toilet/sewage 1 2 3 4 5 6 7 8 9 10

20. Jordan: Sanitation facilities by governorate
100%
80%
Other
60%
Covered Dry
Toilet/septic
40%
Toilet/sewage
20% 0%
Balqa
Irbid
Zarqa
Mafraq
Jerash
Ajloun
Karak
Tafileh
Ma'an
Madaba
Aqaba
Amman

21. 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(?)

22. Determinants of infant mortality

23. Philippines: Effect of public medical care
Poor area
Not-so-poor area

24. Substitution between public and private providers

25. Substitution between public and private providers in Jordan
A 10% increase in primary health care facilities per capita (by governorate):
- increases their use by 4.4%
- decreases use of private facilities by 3.2%
- decreases use of public hospitals by 2.6%
Net effect?

26. Distribution of health care subsidies, Indonesia

27. Jordan: Not enough information
Place of first health consultation by household wealth
100%
UNRWA
Gvt health ct
50%
Pvt clinic 0%
Gvt hospital 1 2 3 4 5 6 7 8 9 10
Pvt hospital

28. 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(?)

29. Value of insurance as a % of expected cost

30. Priorities in health policy