scholarly journals Regional Health Accounts for Pakistan—Provincial and District Health Expenditures and the Degree of Districts Fiscal Autonomy on Health.

2009 ◽  
Vol 48 (4II) ◽  
pp. 621-634
Author(s):  
Christian Lorenz ◽  
Muhammad Khalid
Keyword(s):  
National Health ◽  
Regional Differences ◽  
Health Expenditure ◽  
Government Expenditure ◽  
Health Expenditures ◽  
Provincial Government ◽  
District Health ◽  
Fiscal Autonomy ◽  
District Government ◽  
Health Accounts

Since May 2009 the first National Health Accounts (NHA) for Pakistan have been finalised and published by Federal Bureau of Statistics (FBS) in cooperation with German Technical Cooperation (GTZ). This paper goes one step ahead the report and analyses in more detail the regional differences in health expenditure structures in Pakistan. The further analyses can be divided into four parts: health expenditures in provinces (Provincial Health Accounts, PHA),2 Punjab provincial and district governments health expenditures and its comparison with ADB figures, all districts of Pakistan and comparison between total district government and provincial government expenditure for each province; the latter calculation is applied as indication for the degree of fiscal autonomy of the districts in each province. Consequently we first analyse the provincial health expenditures by Financial Agents and compare them between the provinces which leads to very heterogeneous results (Section 2); the per capita health expenditures differ from 16 to 23 USD. Secondly, we compare NHA results on Punjab district government with available ADB results and present differences in methods as possible reasons for different results (Section 3). Third, we analyse district data of all district governments in all four Pakistani provinces on the level of detailed function codes in Section 4; the aim is to discover regional differences between districts of the same as well as of different provinces. Fourth, we analyse in Section 5 the degree of fiscal autonomy on health of the districts in each province; therefore we review the ordinance description and compare total district government with total provincial government expenditures per province. Finally we give recommendations for future rounds of NHA in Pakistan regarding formats and necessities of detailed health expenditure data collection to ensure evidence based decision-making not only on federal, but also on provincial and district level. JEL classification: H51, I1, O18, R1 Keywords: National Health Accounts, Health Expenditures, Regional Comparison, Regional Accounts, Fiscal Autonomy, Pakistan

scholarly journals Health expenditures by services and providers for 195 countries, 2000–2017

2021 ◽  
Vol 6 (7) ◽  
pp. e005799
Author(s):  
Matthew T Schneider ◽  
Angela Y Chang ◽  
Abigail Chapin ◽  
Catherine S Chen ◽  
Sawyer W Crosby ◽  
...  
Keyword(s):  
Global Health ◽  
National Health ◽  
Health Expenditure ◽  
National Level ◽  
Health Expenditures ◽  
Multivariate Regression Analysis ◽  
Uncertainty Interval ◽  
Term Care ◽  
Holistic Understanding ◽  
Health Accounts

IntroductionNational Health Accounts are a significant source of health expenditure data, designed to be comprehensive and comparable across countries. However, there is currently no single repository of this data and even when compiled major gaps persist. This research aims to provide policymakers and researchers with a single repository of available national health expenditures by healthcare functions (ie, services) and providers of such services. Leveraging these data within statistical methods, a complete set of detailed health expenditures is estimated.MethodsA methodical compilation and synthesis of all available national health expenditure reports including disaggregation by healthcare functions and providers was conducted. Using these data, a Bayesian multivariate regression analysis was implemented to estimate national-level health expenditures by the cross-classification of functions and providers for 195 countries, from 2000 to 2017.ResultsThis research used 1662 country-years and 110 070 data points of health expenditures from existing National Health Accounts. The most detailed country-year had 52% of the categories of interest reported. Of all health functions, curative care and medical goods were estimated to make up 51.4% (uncertainty interval (UI) 33.2% to 59.4%) and 17.5% (UI 13.0% to 26.9%) of total global health expenditures in 2017, respectively. Three-quarters of the global health expenditures are allocated to three categories of providers: hospital providers (35.4%, UI 30.3% to 38.9%), providers of ambulatory care (25.5%, UI 21.1% to 28.8%) and retailers of medical goods (14.4%, UI 12.4% to 16.3%). As gross domestic product increases, countries spend more on long-term care and less on preventive care.ConclusionDisaggregated estimates of health expenditures are often unavailable and unable to provide policymakers and researchers a holistic understanding of how expenditures are used. This research aggregates reported data and provides a complete time-series of estimates, with uncertainty, of health expenditures by health functions and providers between 2000 and 2017 for 195 countries.

scholarly journals A quantitative analysis of sources of changes in government expenditures on health, 2000 to 2015: what can we learn from experience to date?

2019 ◽  
Vol 3 ◽  
pp. 5 ◽  
Author(s):  
Helen Saxenian ◽  
Ipchita Bharali ◽  
Osondu Ogbuoji ◽  
Gavin Yamey
Keyword(s):  
Economic Growth ◽  
Health Expenditure ◽  
Government Expenditure ◽  
Health Expenditures ◽  
Government Expenditures ◽  
Government Budget ◽  
Tax Base ◽  
Current Health ◽  
Domestic Sources ◽  
The Government

Background: Achieving universal health coverage (UHC) requires increased domestic financing of health by low-income countries (LICs) and middle-income countries (MICs). It is critical to understand how much governments have devoted to health from their own sources and how much growth might be realistic over time. Methods: Using data from WHO’s Global Health Expenditure Database, we examined how the composition of current health expenditure changed by financing source and the main sources of growth in health expenditures from 2000-2015. We also disaggregated how much growth in government expenditures on health from domestic sources was due to economic growth, growth in the tax base, reallocations in government expenditures towards health, and the interactions of these factors. Results: Lower MICs (LMICs) and upper MICs (UMICs), as a group, saw a significant reduction in out-of-pocket expenditures and a significant growth in government expenditures on health from domestic sources as a share of current health expenditures over the period. This trend indicates likely progress in the pathway to UHC. For LICs, these trends were much more muted. Growth in government expenditure on health from domestic sources was driven primarily by economic growth in LICs, LMICs, and UMICs. Growth in government expenditure on health due to a strengthened tax base was most important in UMICs. For high-income countries, where economic growth was relatively slower and tax bases were already strong, the largest driver of growth in government expenditure on health from domestic sources was reallocation of the government budget towards health. Conclusions: Given these findings from 2000-2015, discussions about a government’s ability to reallocate to health from its overall budget need to be evidence based and pragmatic.  Dialogue on domestic resource mobilization needs to emphasize overall economic growth and growth in the tax base as well as the share of health in the government budget.

scholarly journals Does government expenditure reduce inequalities in infant mortality rates in low- and middle-income countries?: A time-series, ecological analysis of 48 countries from 1993 to 2013

2018 ◽  
Vol 14 (2) ◽  
pp. 249-273 ◽  
Author(s):  
Peter Baker ◽  
Thomas Hone ◽  
Aaron Reeves ◽  
Mauricio Avendano ◽  
Christopher Millett
Keyword(s):  
Infant Mortality ◽  
Health Expenditure ◽  
Fixed Effects ◽  
Government Expenditure ◽  
Health Expenditures ◽  
Mortality Rates ◽  
Demographic And Health Surveys ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

AbstractInequalities in infant mortality rates (IMRs) are rising in some low- and middle-income countries (LMICs) and decreasing in others, but the explanation for these divergent trends is unclear. We investigate whether government expenditures and redistribution are associated with reductions in inequalities in IMRs. We estimated country-level fixed-effects panel regressions for 48 LMICs (142 country observations). Slope and Relative Indices of Inequality in IMRs (SII and RII) were calculated from Demographic and Health Surveys between 1993 and 2013. RII and SII were regressed on government expenditure (total, health and non-health) and redistribution, controlling for gross domestic product (GDP), private health expenditures, a democracy indicator, country fixed effects and time. Mean SII and RII was 39.12 and 0.69, respectively. In multivariate models, a 1 percentage point increase in total government expenditure (% of GDP) was associated with a decrease in SII of −2.468 [95% confidence intervals (CIs): −4.190, −0.746] and RII of −0.026 (95% CIs: −0.048, −0.004). Lower inequalities were associated with higher non-health government expenditure, but not higher government health expenditure. Associations with inequalities were non-significant for GDP, government redistribution, and private health expenditure. Understanding how non-health government expenditure reduces inequalities in IMR, and why health expenditures may not, will accelerate progress towards the Sustainable Development Goals.

The role of coalition parties and local government expenditure: Evidence from the developing country

2021 ◽  
Vol 5 (2) ◽  
pp. 82-89
Author(s):  
Harumi Puspa Rizky ◽  
Doddy Setiawan ◽  
Jaka Winarna
Keyword(s):  
Local Government ◽  
Health Expenditure ◽  
Research Question ◽  
Government Expenditure ◽  
Health Expenditures ◽  
Education And Health ◽  
Negative Effect ◽  
Local Government Expenditure ◽  
The Republic

This study aims at examining the role of coalition parties on local government expenditure. The coalition parties are comprised of several parties that support the regional head in the local government. Specifically, this study focuses on two important aspects of local government expenditure: education and health expenditure. The research question of the study is “Does the coalition parties have a significant effect on the local government expenditure?”. The independent variable of the study is coalition parties that support elected regional heads. The dependent variable is local government expenditure, which consists of education and health expenditures. The sample of the study was the local government in the Republic of Indonesia from the 2016–2018 period. There are 632 observations as the sample of the study. The results revealed that coalition parties have a negative effect on education and health expenditure. The higher percentage of coalition parties has decreased the local government expenditure on both education and health expenditures. The result of the study shows that coalition parties have a significant effect on the local government expenditure. This study confirms Lewis and Hendrawan’s (2019) argument that coalition parties have used their discretion to influence the regional heads’ decisions on the local government expenditure

scholarly journals Measuring inequalities in the selected indicators of National Health Accounts from 2008 to 2016: evidence from Iran

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Mohammad Hossein Mehrolhassani ◽  
Vahid Yazdi-Feyzabadi ◽  
Marzieh Lashkari
Keyword(s):  
National Health ◽  
Service Providers ◽  
National Development ◽  
Health Resources ◽  
Health Expenditures ◽  
Health Financing ◽  
Evidence Base ◽  
Average Deviation ◽  
Health Accounts ◽  
Disparity Index

Abstract Background Increase in total health expenditures is one of the main challenges of health systems worldwide, and its inequality is considered as a concern in global arena especially developing countries. This study aims to measure inequality in the distribution of selected indicators of national health accounts across the Iranian provinces. Methods In this study, the data on health financing agents from provincial health accounts from 2008 to 2016 were collected. Gini coefficient (GC) was used to measure inequality. The population and the number of service providers in each province were the bases to measure the GC. The Coefficient of Variation (CV) and the Rate Ratio (RR) were used to determine the dispersion and variation across the provinces. Disparity index was employed to measure the average deviation of the out-of-pocket (OOP) proportion from the desired OOP proportion presented in national development plans (NDPs) of Iran. Results The distribution of resources using both bases were unequal, especially in OOP, with the highest rate over the years studied, ranging from 0.50 to 0.59. The inequality in public resources was lower, with Health Insurance Organization dropping from 0.42 to 0.40 over the years. CV and RR also confirmed the inequality in health resources distribution. In the years 2014 and 2015, the lowest and highest levels were 0.22 and 0.39, respectively. The values of disparity index for OOP had a fluctuating trend ranging from 37.01 to 65.85%. Conclusion Inequality in the distribution of public health expenditures was moderate to high. Moreover, inequality in private health expenditures was higher than public one. Distribution of OOP spent by households at provincial level showed a high inequality. It is suggested that inequality measures to be considered in NDPs to illustrate how resources are distributed at the geographical level. NHA framework can help to provide robust evidence base for policymaking.

scholarly journals Assessment of financial flow in the health system of Serbia in a period 2003-2006

2010 ◽  
Vol 67 (5) ◽  
pp. 397-402 ◽  
Author(s):  
Milena Gajic-Stevanovic ◽  
Nevenka Teodorovic ◽  
Snezana Dimitrijevic ◽  
Dragan Jovanovic
Keyword(s):  
Health Services ◽  
Health System ◽  
National Health ◽  
Health Expenditures ◽  
Financial Resources ◽  
Healthcare Expenditures ◽  
State Institutions ◽  
European Unity ◽  
Financial Flow ◽  
Health Accounts

Background/Aim. The main goal of every health policy is not merely the establishment of the health system sustainability, but the accessibility of health services to the whole population, as well. This objective is shared in European Union countries, and the consequence is the implementation of National Health Accounts (NHA). NHA, as a tool for evidence-based management, provides data regarding financial flow in health at national level and alows international comparability. The aim of this study was to determine Serbian overall health spending patterns by National Health Accounts, and to determine health care indices to provide policy makers with internationally comparable health indicators. Methods. A retrospective analysis of healthcare expenditures was obtained from the published final financial reports of relevant state institutions during a period of 2003 to 2006. The various sources of data on healthcare expenditures were connected according to instructions by the OECD 'A System of Health Accounts (SHA)' Version 1.0. Results. The obtained results showed: health expenditures in Serbia made up 8.6%, 8.3%, 8.7% and 9 % of the GDP in 2003, 2004, 2005 and 2006, respectively; the Health Insurance Fund was a predominant financing source of the public sector with 93% in 2006; the largest part of the total health expenditures went towards hospitals and for health services; the expenditure per capita in 2006 was 365 US$; Serbian population finances the state institutions 'out of pocket' with 21.28% of their sources, which was 7.3% of the total healthcare expenditures, and the private institutions with 78.72% of their financial sources, which is 27% of the total healthcare expenditures. In 2006 Serbia allocated financial resources out of GDP in the amount similar to the European Unity, while comparing to the countries of the region, these funds were less only than in Bosnia and Herzegovina. This allocating of financial resources in total, however, was low as the consequence of relatively low level of GDP in Serbia. Conclusion. Establishing NHA provided a pattern of national healtcare spending and allowed a comparison of healthcare system in Serbia with the systems of other countries. Analysing a period 2003- 2006 revealed a similarity between Serbia and the countries of the European Unity in regard to the level of average financial resources allocation for healthcare expressed as a percentage of GDP, as well as in regard to financiers in the system of healthcare. A high purchasing power disparity, however, in healthcare services was observed between the population of Serbia and other European countries.

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