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

Countries vary widely with respect to the share of government spending on health, a metric that can serve as a proxy for the extent to which health is prioritized by governments. World Health Organization (WHO) data estimate that, in 2011, health&#...

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Bibliographic Details
Main Authors:	Tandon, Ajay, Fleisher, Lisa, Li, Rong, Yap, Wei Aun
Format:	Working Paper
Language:	English en_US
Published:	World Bank, Washington, DC 2014
Subjects:	ABILITY TO PAY ABSENTEEISM ACCOUNTABILITY ADVERSE CONSEQUENCES AGGREGATE EXPENDITURES AGGREGATE SPENDING ALCOHOL CONSUMPTION ALLOCATION ALLOCATION CHOICES ALLOCATIVE EFFICIENCY ARTICLE BUDGET ALLOCATIONS BUDGET CONSTRAINT BUDGET CONSTRAINTS BUDGET RESOURCES BUDGET SUPPORT BUDGETARY ALLOCATIONS BUDGETARY CONSTRAINTS BUDGETARY POLICY BUDGETARY TARGETS CENTRAL GOVERNMENT CENTRAL GOVERNMENT BUDGET CHILD HEALTH COMMUNICABLE DISEASES DATA ANALYSIS DEBT DEBT CRISIS DEBT INTEREST DEBT LIMITS DELIVERY SYSTEMS DEMOCRATIC GOVERNMENTS DEMOCRATIC SOCIETIES DEVELOPING COUNTRIES DONOR ASSISTANCE DONOR FINANCING DONOR FUNDING ECONOMIC GROWTH ECONOMIC REVIEW EFFECTS OF CORRUPTION EFFICIENCY GAINS EFFICIENT ALLOCATIONS EXPENDITURE LEVELS EXPENDITURES EXTERNAL AID EXTERNAL DEBT EXTERNALITIES FAMILIES FINANCES FINANCIAL BARRIERS FINANCIAL RESOURCES FINANCIAL SUSTAINABILITY FINANCING HEALTH CARE FISCAL CAPACITY FISCAL CONSTRAINTS FISCAL CRISIS FISCAL HEALTH FISCAL IMPLICATIONS FISCAL POLICY FISCAL PRESSURES FREE CHOICE FUNGIBILITY GASOLINE TAXES GENERAL REVENUES GENERAL TAXES GOVERNMENT BUDGET GOVERNMENT BUDGETS GOVERNMENT EXPENDITURE GOVERNMENT EXPENDITURES GOVERNMENT POLICY GOVERNMENT REVENUE GOVERNMENT REVENUES GOVERNMENT SPENDING GROWTH RATE HEALTH AFFAIRS HEALTH CARE HEALTH CARE COSTS HEALTH CARE FINANCING HEALTH CARE SERVICES HEALTH COVERAGE HEALTH ECONOMICS HEALTH EDUCATION HEALTH EXPENDITURE HEALTH EXPENDITURE PER CAPITA HEALTH EXPENDITURES HEALTH EXPENDITURES PER CAPITA HEALTH FINANCING HEALTH INSURANCE HEALTH INSURANCE FUND HEALTH INSURANCE SCHEMES HEALTH INTERVENTIONS HEALTH MANAGEMENT HEALTH MINISTRIES HEALTH ORGANIZATION HEALTH OUTCOMES HEALTH POLICY HEALTH PROMOTION HEALTH PROMOTION ACTIVITIES HEALTH REFORM HEALTH SECTOR HEALTH SERVICES HEALTH SHARE HEALTH SYSTEM HEALTH SYSTEM PERFORMANCE HEALTH SYSTEMS HEALTH WORKERS HIGHER GOVERNMENT SPENDING HIV/AIDS HOSPITALS HUMAN DEVELOPMENT INCOME INCOME COUNTRIES INCOME ELASTICITY INCOME TAX INDEXES INFECTIOUS DISEASES INFLATION INFORMAL SECTOR INFORMATION ASYMMETRIES INSURANCE INSURANCE PREMIUM INSURANCE PREMIUMS INTEREST PAYMENTS INTERNATIONAL BANK INTERVENTION INVESTING LABOR MARKETS LEVELS OF PUBLIC SPENDING LOW INCOME LOW-INCOME COUNTRIES MACROECONOMIC CONSTRAINTS MACROECONOMIC POLICY MARGINAL BENEFIT MARKET FAILURE MARKET FAILURES MEDICAL BENEFIT MEDICAL SERVICES MENTAL HEALTH MERIT GOOD MILITARY EXPENDITURES MILITARY SPENDING MONETARY POLICY MORTALITY MUNICIPAL GOVERNMENTS MUNICIPALITIES NATIONAL DEFENSE NATIONAL HEALTH NATIONAL HEALTH INSURANCE NATIONAL HEALTH INSURANCE FUND NATIONAL INCOME NATURAL DISASTER NEGATIVE EXTERNALITIES NUTRITION PAYROLL TAX PAYROLL TAXES POLICY COMMITMENTS POLICY RESEARCH POLITICAL ECONOMY POLITICIANS PRIMARY CARE PRIVATE GOODS PRIVATE SECTOR PROGRAMS PROVISION OF HEALTH SERVICES PUBLIC CHOICE PUBLIC CHOICE THEORY PUBLIC DEBT PUBLIC DEMAND PUBLIC ECONOMICS PUBLIC EXPENDITURE PUBLIC EXPENDITURES PUBLIC FINANCE PUBLIC FINANCE THEORY PUBLIC GOODS PUBLIC HEALTH PUBLIC HEALTH SPENDING PUBLIC POLICIES PUBLIC PROVIDERS PUBLIC RESOURCES PUBLIC SECTOR PUBLIC SPENDING QUALITY OF PUBLIC SPENDING RECURRENT EXPENDITURES REFORM EFFORTS REFORM PROCESS RESOURCE ALLOCATIONS REVENUE INCREASES SANITATION SHARE OF HEALTH SPENDING SHARE OF PUBLIC SPENDING SIZE OF GOVERNMENT SMOKING SOCIAL BENEFITS SOCIAL HEALTH INSURANCE SOCIAL INSURANCE SOCIAL PROTECTION SOCIAL SECURITY SOCIAL SECURITY SCHEME SOCIAL WELFARE STATE BUDGET TAX ADMINISTRATION TAX EXPENDITURE TAX REFORM TAX REVENUE TAX REVENUES TOTAL EXPENDITURE TOTAL SPENDING TRUST FUND TUBERCULOSIS WORKERS
Online Access:	http://documents.worldbank.org/curated/en/2014/01/19204376/reprioritizing-government-spending-health-pushing-elephant-up-stairs http://hdl.handle.net/10986/17824

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Summary:	Countries vary widely with respect to the share of government spending on health, a metric that can serve as a proxy for the extent to which health is prioritized by governments. World Health Organization (WHO) data estimate that, in 2011, health's share of aggregate government expenditure in the 170 countries for which data were available averaged 12 percent. However, country differences were striking: ranging from a low of 1 percent in Myanmar to a high of 28 percent in Costa Rica. Some of the observed differences in health's share of government spending across countries are unsurprisingly related to differences in national income. However, significant variations exist in health's share of government spending even after controlling for national income. This paper provides a global overview of health's share of government spending and summarizes key theoretical and empirical perspectives on allocation of public resources to health vis-a-vis other sectors from the perspective of reprioritization, one of the modalities for realizing fiscal space for health. Theory and cross-country empirical analyses do not provide clear, cut explanations for the observed variations in government prioritization of health. Standard economic theory arguments that are often used to justify public financing for health are equally applicable to many other sectors including defense, education, and infrastructure. To date, empirical work on prioritization has been sparse: available cross-country econometric analyses suggests that factors such as democratization, lower levels of corruption, ethnolinguistic homogeneity, and more women in public office are correlated with higher shares of public spending on health; however, these findings are not robust and are sensitive to model specification. Evidence from case studies suggests that country-specific political economy considerations are key, and that results-focused reform efforts, in particular efforts to explicitly expand the breadth and depth of health coverage as opposed to efforts focused only on government budgetary targets, are more likely to result in sustained and politically-feasible prioritization of health from a fiscal space perspective.

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

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