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

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

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

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

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

10. Percentage of health centers without doctors by province: Indonesia

11. Absenteeism in primary facilities % absent

12. Details from India

13. 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(?)

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

15. …they have less access to safe water…

16. …and this costs the lives of their children

17. 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(?)

18. Determinants of infant mortality

19. Philippines: Effect of public medical care Poor areaNot-so-poor area

20. Substitution between public and private providers

21. Distribution of health care subsidies, Indonesia

23. 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(?)

24. Value of insurance as a % of expected cost

25. Priorities in health policy