Rouselle F. Lavado

US health care spending has continued to increase, and now accounts for more than 17% of the US economy. Despite the size and growth of this spending, little is known about how spending on each condition varies by age and across time.To systematically and comprehensively estimate US spending on personal health care and public health, according to condition, age and sex group, and type of care.Government budgets, insurance claims, facility surveys, household surveys, and official US records from 1996 through 2013 were collected and combined. In total, 183 sources of data were used to estimate spending for 155 conditions (including cancer, which was disaggregated into 29 conditions). For each record, spending was extracted, along with the age and sex of the patient, and the type of care. Spending was adjusted to reflect the health condition treated, rather than the primary diagnosis.Encounter with US health care system.National spending estimates stratified by condition, age and sex group, and type of care.From 1996 through 2013, $30.1 trillion of personal health care spending was disaggregated by 155 conditions, age and sex group, and type of care. Among these 155 conditions, diabetes had the highest health care spending in 2013, with an estimated $101.4 billion (uncertainty interval [UI], $96.7 billion-$106.5 billion) in spending, including 57.6% (UI, 53.8%-62.1%) spent on pharmaceuticals and 23.5% (UI, 21.7%-25.7%) spent on ambulatory care. Ischemic heart disease accounted for the second-highest amount of health care spending in 2013, with estimated spending of $88.1 billion (UI, $82.7 billion-$92.9 billion), and low back and neck pain accounted for the third-highest amount, with estimated health care spending of $87.6 billion (UI, $67.5 billion-$94.1 billion). The conditions with the highest spending levels varied by age, sex, type of care, and year. Personal health care spending increased for 143 of the 155 conditions from 1996 through 2013. Spending on low back and neck pain and on diabetes increased the most over the 18 years, by an estimated $57.2 billion (UI, $47.4 billion-$64.4 billion) and $64.4 billion (UI, $57.8 billion-$70.7 billion), respectively. From 1996 through 2013, spending on emergency care and retail pharmaceuticals increased at the fastest rates (6.4% [UI, 6.4%-6.4%] and 5.6% [UI, 5.6%-5.6%] annual growth rate, respectively), which were higher than annual rates for spending on inpatient care (2.8% [UI, 2.8%-2.8%] and nursing facility care (2.5% [UI, 2.5%-2.5%]).Modeled estimates of US spending on personal health care and public health showed substantial increases from 1996 through 2013; with spending on diabetes, ischemic heart disease, and low back and neck pain accounting for the highest amounts of spending by disease category. The rate of change in annual spending varied considerably among different conditions and types of care. This information may have implications for efforts to control US health care spending.

One of the most important gatherings of the world's economic leaders, the G20 Summit and ministerial meetings, takes place in June, 2019. The Summit presents a valuable opportunity to reflect on the provision and receipt of development assistance for health (DAH) and the role the G20 can have in shaping the future of health financing. The participants at the G20 Summit (ie, the world's largest providers of DAH, emerging donors, and DAH recipients) and this Summit's particular focus on global health and the Sustainable Development Goals offers a unique forum to consider the changing DAH context and its pressing questions. In this Health Policy perspective, we examined trends in DAH and its evolution over time, with a particular focus on G20 countries; pointed to persistent and emerging challenges for discussion at the G20 Summit; and highlighted key questions for G20 leaders to address to put the future of DAH on course to meet the expansive Sustainable Development Goals. Key questions include how to best focus DAH for equitable health gains, how to deliver DAH to strengthen health systems, and how to support domestic resource mobilisation and transformative partnerships for sustainable impact. These issues are discussed in the context of the growing effects of climate change, demographic and epidemiological transitions, and a global political shift towards increasing prioritisation of national interests. Although not all these questions are new, novel approaches to allocating DAH that prioritise equity, efficiency, and sustainability, particularly through domestic resource use and mobilisation are needed. Wrestling with difficult questions in a changing landscape is essential to develop a DAH financing system capable of supporting and sustaining crucial global health goals.

To quantify the effects of household expenditure survey characteristics on the estimated share of a household's expenditure devoted to health.A search was conducted for all country surveys reporting data on health expenditure and total household expenditure. Data on total expenditure and health expenditure were extracted from the surveys to generate the health expenditure share (i.e. fraction of the household expenditure devoted to health). To do this the authors relied on survey microdata or survey reports to calculate the health expenditure share for the particular instrument involved. Health expenditure share was modelled as a function of the survey's recall period, the number of health expenditure items, the number of total expenditure items, the data collection method and the placement of the health module within the survey. Data exists across space and time, so fixed effects for territory and year were included as well. The model was estimated by means of ordinary least squares regression with clustered standard errors.A one-unit increase in the number of health expenditure questions was accompanied by a 1% increase in the estimated health expenditure share. A one-unit increase in the number of non-health expenditure questions resulted in a 0.2% decrease in the estimated share. Increasing the recall period by one month was accompanied by a 6% decrease in the health expenditure share.The characteristics of a survey instrument examined in the study affect the estimate of the health expenditure share. Those characteristics need to be accounted for when comparing results across surveys within a territory and, ultimately, across territories.Quantifier les effets des caractéristiques d'une enquête sur les dépenses des ménages sur la part estimée des dépenses d'un ménage consacrée à la santé.Une étude a été menée sur toutes les données d'enquêtes nationales portant sur les dépenses de santé et les dépenses totales des ménages. Les données sur les dépenses totales et les dépenses de santé ont été extraites des enquêtes afin d'obtenir la part des dépenses de santé (c'est-à-dire la partie des dépenses des ménages consacrée à la santé). Les chercheurs ont utilisé des microdonnées ou des rapports d'enquête pour calculer la part des dépenses de santé pour cet instrument particulier. La part des dépenses de santé a été modélisée comme une fonction de la période de rappel de l'enquête, du nombre de postes de dépenses de santé, du nombre de postes de dépenses totales, de la méthode de collecte des données et de la mise en place du module de santé au sein de l'enquête. Il existe des données aussi bien géographiques que temporelles dans ce domaine, donc, les effets fixes pour un territoire et une année donnés ont également été inclus. Le modèle a été estimé avec une régression par la méthode des moindres carrés avec des erreurs standard sectorielles.Une augmentation d'une unité du nombre de questions sur les dépenses de santé a conduit à une augmentation de 1% de la part estimée des dépenses de santé. Une augmentation d'une unité du nombre de questions sur les dépenses non liées à la santé a entraîné une diminution de 0,2% de la part estimée. L'augmentation d'un mois de la période de rappel a engendré une baisse de 6% de la part des dépenses de santé.Les caractéristiques de l'instrument d'enquête examinées dans l'étude modifient l'estimation de la part des dépenses de santé. Ces caractéristiques doivent être prises en compte lors de la comparaison des résultats d'une enquête à l'intérieur d'un territoire et aussi à travers les territoires.Cuantificar los efectos de las características de las encuestas sobre el gasto de los hogares en el porcentaje estimado del gasto sanitario de un hogar.Se realizó una búsqueda de todas las encuestas nacionales que informaran acerca de datos sobre el gasto sanitario y el gasto total de los hogares. Se extrajeron dichos datos sobre gasto total y gasto sanitario de las encuestas para generar el porcentaje del gasto sanitario (es decir, la parte del gasto del hogar dedicada a la salud). Para ello, los autores confiaron en microdatos o informes de las encuestas para calcular el porcentaje del gasto sanitario en relación con el instrumento particular implicado. El porcentaje del gasto sanitario se interpretó como una función del período de recuerdo de la encuesta, el número de cuestiones sobre el gasto sanitario, el número de cuestiones sobre el gasto total, el método de recogida de los datos y la ubicación del formulario sobre la salud dentro de la encuesta. Había datos ubicados espacial y temporalmente, así que también se incluyeron los efectos fijos por territorio y año. El modelo se estimó por medio de una regresión por mínimos cuadrados ordinaria, con errores estándar reagrupados.Un incremento de una unidad en el número de cuestiones sobre gasto sanitario se vio acompañado de un aumento del 1% en el porcentaje del gasto sanitario estimado. Un incremento de una unidad en el número de cuestiones sobre gastos no sanitarios conllevó una disminución del 0,2% en el porcentaje estimado. Aumentar el período de recuerdo un mes provocó una reducción del 6% en el porcentaje del gasto sanitario.Las características de una encuesta examinada en el estudio repercuten en la estimación del porcentaje del gasto sanitario. Estas características han de tenerse en cuenta al comparar los resultados de diferentes encuestas dentro de un territorio y, en última instancia, entre territorios.تحديد كم تأثيرات خصائص الدراسات الاستقصائية للإنفاق الأسري على الحصة المقدرة للإنفاق الأسري المخصص للصحة.تم إجراء بحث في جميع الدراسات الاستقصائية للبلدان التي تبلغ ببيانات عن الإنفاق الصحي وإنفاق الأسر الإجمالي. وتم استخلاص البيانات المعنية بإجمالي الإنفاق والإنفاق الصحي من الدراسات الاستقصائية للتوصل إلى حصة الإنفاق الصحي (أي نسبة إنفاق الأسرة المخصص للصحة). وللقيام بهذا، اعتمد المؤلفون على البيانات الجزئية للدراسات الاستقصائية أو تقارير الدراسات الاستقصائية لحساب حصة الإنفاق الصحي من أجل الأداة المعنية على وجه الخصوص. وتم نمذجة حصة الإنفاق الصحي كدالة لفترة الاستدعاء الخاصة بالدراسة الاستقصائية وعدد بنود الإنفاق الصحي وعدد بنود الإنفاق الإجمالي وطريقة جمع البيانات ووضع وحدة الصحة داخل الدراسة الاستقصائية. وتواجدت البيانات عبر المكان والزمان، ولذلك تم إدراج التأثيرات الثابتة للإقليم والعام كذلك. وتم تقدير النموذج بارتداد عادي أقل تربيعاً باستخدام الأخطاء القياسية المجمعة.صاحب زيادة وحدة واحدة في عدد أسئلة الإنفاق الصحي زيادة نسبتها 1 % في حصة الإنفاق الصحي وفق التقديرات. ونجم عن زيادة وحدة واحدة في عدد أسئلة الإنفاق الصحي انخفاض نسبته 0.2 % في الحصة وفق التقديرات. وصاحب زيادة فترة الاستدعاء شهراً واحداً انخفاض نسبته 6 % في حصة الإنفاق الصحي.تؤثر خصائص أداة الدراسة الاستقصائية التي تم فحصها في هذا الدراسة على تقدير حصة الإنفاق الصحي. ولابد من إيضاح أهمية هذه الخصائص عند مقارنة النتائج عبر الدراسات الاستقصائية داخل الإقليم، وفي النهاية، عبر الأقاليم.量化家庭支出调查特性对家庭卫生专用开支估算份额的影响。对报告有关卫生支出和合计家庭支出数据的所有国家调查进行搜索。从调查中提取有关合计支出和卫生支出的数据，生成卫生支出份额（即卫生专用家庭支出的分数）。为此，作者依赖于调查微数据或调查报告来计算相关特殊工具的卫生支出份额。将卫生支出份额作为调查回忆期、卫生支出项目数、合计支出项目数、数据收集方法和调查中卫生模块布置的函数进行建模。数据存在于空间和时间，因此，对领地和年代的固定影响也同样纳入。以使用聚类标准误的普通最小二乘回归方法对模型进行估算。卫生支出问题增加一个单位，估算卫生支出份额就伴随增加1%。非卫生支出问题增加一个单位，就会导致估计份额减少0.2%。回忆期增加一个月，卫生支出份额伴随减少6%。研究中检查的调查工具特性影响了卫生支出份额的估算。在比较一个领地以及最终多个领地的调查结果时，需要将这些特性考虑在内。Количественно оценить влияние характеристик опросов домохозяйств, посвященных расходам, на оцененные доли расходов домохозяйств на здравоохранение.Был выполнен поиск всех опросов на уровне стран, в ходе которых собирались данные о расходах на здравоохранение и общих расходах домохозяйств. Сведения об общей сумме расходов и расходах на здравоохранение использовались для оценки доли расходов на здравоохранение (т.е. доли расходов домохозяйств, выделяемых на здравоохранение). Для этого авторы опирались на микроданные и отчеты опросов, описывающие для конкретных инструментов порядок расчета доли расходов на здравоохранение. Доля расходов на здравоохранение была смоделирована в виде функции от периода, припоминания, количества статей расходов на здравоохранение, общего количества статей расходов, метода сбора данных и места модуля, посвященного здравоохранению, в опросе. Данные существуют в пространстве и времени, поэтому в опрос также были включены фиксированные значения для регионов и годов. Модель параметризировалась с помощью обычного регрессионного метода наименьших квадратов с кластеризованными стандартными ошибками.Увеличение количества вопросов о расходах на здравоохранение на одну единицу сопровождалось ростом оцененной доли расходов на здравоохранение на 1%. Увеличение количества не связанных с расходами на здравоохранение вопросов сопровождалось снижением оцененной доли на 0,2%. Увеличение периода припоминания на один месяц сопровождалось снижением доли расходов на здравоохранение на 6%.Рассмотренные в исследовании характеристики инструмента проведения опроса оказывают влияние на оценку доли расходов на здравоохранение. Эти особенности необходимо учитывать при сравнении результатов различных опросов в определенном регионе, и, в конечном счете, между регионами.

the health system, policy-makers, health administrators and medical professionals need detailed information on financing sources, health-care delivery and health-care providers.In particular, precise and disaggregated health expenditure data are required.Attempts to quantify national health expenditure began as early as 1926 in the United States of America, led by the American Medical Association. 6In the 1970s, the Organisation for Economic Co-operation and Development (OECD) led an international effort to collect consistent health expenditure data and, in the 1980s, OECD launched DataWatch, which collected data on health-care expenditure, use and outcomes from 24 OECD countries. 7To standardize data on health expenditure and resource flows, the OECD published A system of health accounts, first edition (SHA 2000) 8 in 2000 and introduced the International Classification of Health Accounts.Building on SHA 2000, the OECD worked with the World Health Organization (WHO) and Eurostat to publish A system of health accounts, 2011 edition (SHA 2011). 9The SHA framework is the most widely-used reference for health expenditure accounting.The SHA manuals give instructions on how to categorize a country's expenditure as health expenditure for a given year by defining health activities, setting time intervals and establishing residency definitions. 10Suggested data sources include budgets, censuses, surveys, tax reports, trade statistics, government documents and reports from nongovernmental organizations.OECD and individual countries have applied the SHA framework to produce information on national health expenditure in a form collectively known as national health accounts (NHAs).1][12][13] In line with the Guide to producing national health accounts released in 2003, 14 NHAs classify national expenditure on health by addressing four questions: (i) Where do health resources come from?(i.e.What is the financing source?);(ii) Who manages spending?(i.e.Who is the financing agent?); (iii) What goods and services are purchased?(i.e.What is the health function?);and (iv) Who provides which services?(i.e.Who is the health provider?).The NHAs are designed to answer these questions within a standardized framework and NHA reports are regarded as the international standard for tracking health resources. 9,12,15onsequently, NHAs can be useful for cross-country analyses.However, no complete international set of data associated with these four questions has been available to date.Forty-four countries have routinely produced NHA reports since 2010 11 -most are OECD member states.The OECD Objective To collect, compile and evaluate publicly available national health accounts (NHA) reports produced worldwide between 1996 and 2010.Methods We downloaded country-generated NHA reports from the World Health Organization global health expenditure database and the Organisation for Economic Co-operation and Development (OECD) StatExtract website.We also obtained reports from Abt Associates, through contacts in individual countries and through an online search.We compiled data in the four main types used in these reports: (i) financing source; (ii) financing agent; (iii) health function; and (iv) health provider.We combined and adjusted data to conform with OECD's first edition of A system of health accounts manual, (2000).Findings We identified 872 NHA reports from 117 countries containing a total of 2936 matrices for the four data types.Most countries did not provide complete health expenditure data: only 252 of the 872 reports contained data in all four types.Thirty-eight countries reported an average not-specified-by-kind value greater than 20% for all data types and years.Some countries reported substantial year-on-year changes in both the level and composition of health expenditure that were probably produced by data-generation processes.All study data are publicly available at http://vizhub.healthdata.org/nha/.Conclusion Data from NHA reports on health expenditure are often incomplete and, in some cases, of questionable quality.Better data would help finance ministries allocate resources to health systems, assist health ministries in allocating capital within the health sector and enable researchers to make accurate comparisons between health systems.

The COVID-19 pandemic and the resulting containment policies have hit the Philippines harder than most developing countries. The government lockdown is among the strictest in the world, and blanket school closures are the lengthiest. This article uses a novel simulation model to estimate the gendered and regional impacts of these factors on labour, income and poverty, and a case study of school closures points to the losses in employment among private school teachers and in the income of parents with young children. The authors find that the pandemic has had unprecedented implications for economic activity and has disproportionately affected women.

The report is divided into five chapters. This chapter provides background on demographic and epidemiological trends, the configuration of Ghana's health system, and health financing functions and health systems goals. It also describes Ghana's health financing system. Chapter two assesses the performance of Ghana's health system with respect to these goals through international comparisons of health outcomes, inputs, spending, and financial protection as well as time series comparisons of trends in other countries in Africa. Chapter three identifies the strengths and weaknesses of Ghana's health system, which determine Ghana's health reform baseline. Chapter four analyzes the sustainability of the National Health Insurance Scheme, or NHIS in the context of Ghana's future fiscal space, based on Ghana's new standing as a lower-middle-income country. Chapter five analyzes major structural and operational reform options that will help ensure the long-term efficacy and sustainability of the NHIS.

Diagnostic testing for SARS-CoV-2 is critical to manage the pandemic and its different waves. The requirement to pay out-of-pocket (OOP) for testing potentially represents both a financial barrier to access and, for those who manage to make the payment, a source of financial hardship, as they may be forced to reduce spending on other necessities. This study aims to assess age-related inequality in affordability of COVID-19 tests.Daily data from the Global COVID-19 Trends and Impact Survey among adult respondents across 83 countries from July 2020 to April 2021 was used to monitor age-related inequalities across three indicators: the experiences of, first, reducing spending on necessities because of paying OOP for testing, second, facing financial barriers to get tested (from January to April 2021), and third, having anxiety related to household finance in the future. Logistic regressions were used to assess the association of age with each of these.Among the population ever tested, the adjusted odds of reducing spending on necessities due to the cost of the test decreased non-linearly with age from 2.3 [CI95%: 2.1-2.5] among ages 18-24 to 1.6 [CI95%: 1.5-1.8] among ages 45-54. Among the population never tested, odds of facing any type of barrier to testing were highest among the youngest age group 2.5 [CI95%:2.4-2.5] and decreased with age. Finally, among those reporting reducing spending on necessities, the odds of reporting anxiety about their future finances decreased non-linearly with age, with the two younger groups being 2.4-2.5 times more anxious than the oldest age group. Among those reporting financial barriers due to COVID-19 test cost, there was an inverse U-shape relationship.COVID-19 testing was associated with a reduction in spending on necessities at varying levels by age. Younger people were more likely to face financial barrier to get tested. Both negative outcomes generated anxiety across all age-groups but more frequently among the younger ones. To reduce age-related inequalities in the affordability of COVID-19 test, these findings support calls for exempting everyone from paying OOP for testing and, removing other type of barriers than financial ones.

Abstract—The majority of Armenian adult males smoke, yet tobacco taxes in Armenia are among the lowest in Europe and Central Asia. Increasing taxes on tobacco is one of the most cost-effective public health interventions, but many opponents often cite regressivity as an argument against tobacco taxation. We use a mixed-methods approach to study the potential regressivity of tobacco taxation and the extent to which the regressivity argument hindered increases in tobacco taxation in Armenia. First, we pursued an extended cost-effectiveness analysis (ECEA) to assess the health, financial, and distributional consequences (by consumption quintile) of increases in the excise tax on cigarettes in Armenia. We simulated a hypothetical price hike leading to a tax rate of about 75% of the retail price of cigarettes, which would be fully passed on to consumers. Second, we conducted a series of stakeholder interviews to examine the importance of the regressivity argument and identify the factors that allowed tobacco tax increases to be adopted as public policy in Armenia. We show that increased excise taxes would bring large health and financial benefits to Armenian households. Half of tobacco-related premature deaths and 27% of associated poverty cases averted would be concentrated among the bottom 40% of the population. Though regressivity was raised as a concern at the initial stages of the policy adoption process, our qualitative stakeholder analysis indicates that the recent accession to the Eurasian Economic Union and the fiscal constraints faced by the government created a window of opportunity for tobacco taxation to be placed on the policy agenda and adopted as government policy, and the ECEA findings were an important input into the process.

The Global Burden of Disease (GBD) 2010 Study has published disability-adjusted life year (DALY) data at both regional and country levels from 1990 to 2010. Concurrently, the Institute for Health Metrics and Evaluation (IHME) has published estimates of development assistance for health (DAH) at the country-disease level for this same period of time.We use disease burden data from the GBD 2010 study and financing data from IHME to calculate ratios of DAH to DALYs across regions and diseases. We examine the magnitude of these ratios and how they have varied over time. We hypothesize that the variation in this ratio across regions would be relatively small. However, from 2006 to 2010, we find there was considerable variation in the levels of DAH per DALY across regions. For total funding, the relative standard deviation (standard deviation as a percentage of the mean) across regions was 50%. For DAH specific to HIV/AIDS, malaria and tuberculosis, the relative standard deviations were 50%, 200% and 60%, respectively. While these deviations are high, with the exception of malaria, they have decreased since the 1990s.There are no evident explanations for so much variation in funding across regions, especially holding the purpose of the funding constant. This suggests donors' allocation processes have not been particularly sensitive to disease burdens. To maximize health gains, donors should explicitly incorporate new disease burden data along with the relative costs and efficacy of interventions into their allocation process.

A critical choice facing many governments is whether to use face-to-face school closures to help control COVID-19 transmission for an extended period of time.Analysis of the policy choices involved with an epidemiological model applied to the case of the Philippines finds that school closure is of limited effectiveness compared with alternative COVID-19 control measures.• Health behavior beyond COVID-19 is strongly conditioned by education.Results indicate that long-term mortality increases due to less effective education from face-to-face closure during January to June 2021 may be 49 times higher than the number of lives saved from COVID-19 in the short run.• The present value costs of face-to-face closure are estimated to be very high at ₱1.9 trillion for the 2020-2021 school year (equivalent to over 10% of GDP).In a cost-benefit framework that generously values morbidity and mortality, costs are about 70 times higher than COVID-19 control benefits, even when adverse effects on non-COVID-19 health outcomes are not considered.• There is ample scope to use targeted measures to minimize the COVID-19 risks of face-to-face classes while benefiting overall health.

From 1999 to 2010, annual disbursements of development assistance for health for vaccinations increased from $0.5 billion to $2.0 billion (all financial values USD 2010). In its 2012 Global Vaccine Action Plan (GVAP), the World Health Assembly recommended establishing a comprehensive vaccination resource tracking system to better understand the source and recipients of these funds, and ultimately their impact on outcomes. This systematic review aims to respond to the GVAP recommendation in reviewing and assessing the state of the data and literature on vaccination resource tracking.We scrutinized all relevant vaccination resource tracking systems identified in the literature and by practitioners in the field. We examined schemes used elsewhere in the health sector and by other sectors. Informant interviews were also conducted to determine what data exists and how it might be utilized. With this information, we completed a qualitative assessment of existing approaches to vaccination resources tracking.Tracking systems provide information about some vaccine-related activity in the majority of low- and middle-income countries. Data are generally available for the period of 2006-2010. Levels of granularity vary. Interviewees were concerned about the degree of rigor used to validate the data and the lack of verification. Data are often presented in tabular form, which may be unwieldy for non-technical audiences.The schemes currently in place to track the resources available for vaccinations were fairly advanced relative to other mechanisms in the health sector. Nonetheless, the coverage, validity, and accessibility of vaccination resource tracking data could be ameliorated. Establishing improved feedback loops and verification mechanisms that connect country-level administrators and the international organizations that support reporting efforts would enhance data quality.

The paper examines the effects of nonpharmaceutical interventions on transmission of the novel coronavirus disease (COVID-19) as captured by its reproduction rate 𝑅t. Using cross-country panel data, the paper finds that while lockdown measures have strong effects on 𝑅t, gathering bans appear to be more effective than workplace and school closures. Ramping up the testing and tracing of COVID-19 cases is found to be especially effective in controlling the spread of the disease where there is greater coverage of paid sick leave benefits. Workplace and school closures are found to have large negative effects on gross domestic product compared with other measures, suggesting that a more targeted approach can be taken to keep the epidemic controlled at lower cost.

The paper attempts to provide an overview of the hospital sector in the Philippines with particular emphasis on hospitals being managed by the DOH. The paper begins with an overview of the hospital sector in the Philippines, describing the size, location, and utilization of hospital services. To assess the efficiency and effectiveness of service delivery in DOH-retained hospitals, an analysis of resource management is undertaken by examining the sources of funds, planning and budgeting cycle, uses of funds, and monitoring set-up. The paper provides a critique of recent policies concerning hospitals as outlined in the Health Sector Reform Strategy. The last section concludes and provides some policy recommendations.

Efficiency and equity are cornerstone concepts in rational service delivery in the public sector. This paper benchmarks efficiency and equity in public spending on health, education and social protection in a broad group of Asian Development Bank (ADB) member economies with varying levels of development. We describe public expenditure trends in health, education and social protection in the region. Following Herrera and Pang (2005), we conduct a formal efficiency benchmarking exercise using Data Envelopment Analysis and available input and output data from WDI, GFS, and ADB databases to deconstruct each member economy’s efficiency changes in health and education spending. We next turn to review service provision inequality within ADB economies using utilization rates and benefit incidence, and note the deficiency of pro-poor spending in some sectors.

The stochastic frontier model with heterogeneous technical efficiency explained by exogenous variables is augmented with a sparse spatial autoregressive component for a cross-section data, and a spatial-temporal component for a panel data. An estimation procedure that takes advantage of the additivity of the model is proposed, computational advantages over simultaneous maximum likelihood estimation of all parameters is exhibited. The technical efficiency estimates are comparable to existing models and estimation procedures based on maximum likelihood methods. A spatial or spatial-temporal component can improve estimates of technical efficiency in a production frontier that is usually biased downwards.

No AccessAug 2012Assessing the Prospects for Fiscal Space for Health in GhanaAuthors/Editors: George Schieber, Cheryl Cashin, Karima Saleh, Rouselle LavadoGeorge SchieberSearch for more papers by this author, Cheryl CashinSearch for more papers by this author, Karima SalehSearch for more papers by this author, Rouselle LavadoSearch for more papers by this authorhttps://doi.org/10.1596/9780821395660_CH04AboutView ChaptersPDF (0.8 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:Assesses the sustainability of the National Health Insurance Scheme (NHIS) in the context of Ghana’s future fiscal space, based on revised macroeconomic information positioning Ghana as a lower-middle-income country. Sources for fiscal space for health come under five categories: (1) conducive macroeconomic conditions; (2) the reprioritization of health within the government budget; (3) an increase in health sector-specific resources; (4) health sector-specific grants, foreign aid, and loans; and (5) an increase in the efficiency of existing government outlays. Rapid growth in utilization and total claims has posed challenges for cost containment and sustainability, in spite of the government’s commitment to strengthen the NHIS and substantially expand its coverage. Ghana has modest prospects for creating additional fiscal space for health over the next three to five years, but real growth in resources depends on the ability of the government to significantly improve its revenue collection efforts and affect major efficiency gains. Previous chapterNext chapter FiguresreferencesRecommendeddetailsCited byExploring the possible sources of fiscal space for health in India: insights from political regimesHealth Research Policy and Systems, Vol.20, No.124 March 2022Defining a Health Benefits Package: What Are the Necessary Processes?Health Systems & Reform, Vol.2, No.121 January 2016 View Published: August 2012ISBN: 978-0-8213-9566-0e-ISBN: 978-0-8213-9567-7 Copyright & Permissions Related RegionsAfricaRelated CountriesGhanaRelated TopicsHealth Nutrition and Population KeywordsHEALTH FINANCEUNIVERSAL HEALTH CAREPUBLIC HEALTHHEALTH INSURANCEHEALTH OUTCOMESAID EFFECTIVENESSGRANTSCOMMUNITY HEALTHECONOMIC GROWTHEXPENDITURESFAMILY PLANNINGHEALTH CAREHEALTH PLANNINGHEALTH POLICYHEALTH SERVICESHOSPITALSMEDICINESMORTALITYNEEDS ASSESSMENTPATIENTPATIENTSPREGNANT WOMENPUBLIC EXPENDITURESCREENINGWORKERS PDF DownloadLoading ...

Purpose The purpose of this study is to answer the research question: How do cooperative organizations perform when created by government fiat in an emerging market? Through the use of institutional and agency theory, this paper presents a comparative analysis of the efficiency of the cooperative form of organization and investor-owned firms-investigating how the social–political structures in a community affect the efficiency of cooperatives vis-à-vis investor-owned firms. This paper also attempts to offer a better understanding of how government quality and organizational size influence performance outcomes between different organizational forms specifically in the Philippines. Design Methodology Approach The empirical analysis of this study was conducted among electric distribution utilities in the Philippines. Firm-level data was generated for 133 distributors, consisting of 119 electric cooperatives and 14 investor-owned companies. Panel data regressions were ran to test all hypotheses. Findings Cooperative organizations operate at a less efficient rate than investor-owned firms in the Philippines, even when controlling for firm-specific factors such as size, customer density and profitability. In addition, the efficiency of these cooperative organizations is more strongly influenced by the quality of the local government than investor-owned firms. Originality Value Positive externalities generated by the propagation of cooperatives on local communities may be based primarily on our understanding of how cooperatives have functioned largely in western contexts. Within the context of Southeast Asia, where national socio-political structures may be more dysfunctional, this paper observes that there is an equivalent negative externality caused by the tendency of cooperatives to replicate the political mismanagement of the community around it.

As a recognition of the valuable role of private sector in the healthcare delivery system, this paper attempts to collate vital information on private hospitals in the Philippines. This paper looks at the different characteristics and structures of private hospitals sector with regard to geographical distribution, services, financing, human resource, and other information needed by policymakers, investors, and other interested stakeholders. To better understand the current health care delivery system in the country, other sections compare private hospitals vis-a-vis government-owned facilities.

The legacy of the Semashko system left Armenia with an oversized and overstaffed health system. Beginning in the 1990s the country focused on re-designing its health system in an attempt to rationalize resources. In order to improve the efficiency, access and quality of health care service provision, the Government undertook supply-side reforms. These reforms included: (a) strengthening Primary Health Care (PHC) provision; (b) downsizing excess hospital capacity; and, (c) changing provider payment mechanisms and introducing a purchaser-provider split.Armenia introduced the Basic Benefit Package (BBP) in 1999 for the socially vulnerable population to target the so-called socially important diseases. The package utilizes public resources to finance, through provider contracts, PHC and emergency services for all Armenian citizens, with co-payment exemptions for the poor and vulnerable. In addition, selected inpatient services are provided for free for the poor, vulnerable and other specific categories.Unfortunately, low public health spending levels and incomplete demand-side health financing reform have resulted in serious shortcomings in financial risk protection outcomes. Armenia’s public health financing is among the lowest in the region. High co-payments for BBP covered services, lack of in-patient care coverage for the non-vulnerable population and outpatient pharmaceuticals for all, have resulted in household out-of-pocket (OOP) spending being the predominant source of financing for health in the country. As Armenia is grappling with an aging society and a health care system struggling to adjust to morbidity and mortality epidemiological changes, its path to Universal Health Coverage (UHC) requires increased funding from prepaid pooled sources in order to sustain and make further progress on improving population health outcomes and financial risk protection.This paper examines the Armenian health system, with a focus on the BBP program. It takes stock of implemented reforms and analyzes the pending agenda. The paper is organized as follows. Section two provides a general overview of Armenia’s health system, focusing on financing and health service delivery. Section three describes the BBP program including its institutional architecture, beneficiary targeting, BBP services and fund management, and related information dissemination. Section four discusses the sustainability of the BBP program amidst economic, epidemiologic, and demographic challenges. The last section focuses on the pending agenda related to targeting, integrated care, and coverage of the non-vulnerable population.

This paper attempts to determine alternative methods of benchmarking the efficiency of electric companies to aid the regulator in crafting policies in enticing them to pursue more efficient production. This paper utilizes the data of electric cooperatives (ECs) in the Philippines, the one in charge of missionary electrification yet the smallest and most heavily indebted part of distribution sector. Using a panel composed of 119 cooperatives from 1990 to 2002, a cost function is estimated for the ECs. This estimation was used to identify appropriate cost variables that will determine the frontier. It was found out that the main cost drivers (as represented by total operating and maintenance costs) are total sales, prices of labor and capital, distribution network, transmission capacity, actual billed customers, service area, demand structure, and system losses. Based on this specification, efficiency frontiers are computed using Stochastic Frontier Analysis (SFA) and Data Envelopment Analysis (DEA). The efficiency of each cooperative was then ranked and compared for consistency checks. The SFA reports that on the average, ECs are 34 percent away from the cost frontier while that of DEA estimates 42 percent. The panel data also allowed for DEA to calculate Total Factor Productivity changes based on the Malmquist index. On the average, TFP increased by 1.7 percent from 1990 to 2002. The rankings and productivity values will prove to be useful for the energy regulator in determining efficiency targets. The fact that DEA and SFA are based on theoretically determined cost function will lead to results that are more representative of the ECs actual performance, rather than basing them on single ratios, which, when considered alongside other ratios will lead to results that are rather misleading. 1 An earlier draft of this paper was presented at the Third East West Center International Graduate Student Conference, Hawaii, February 2004. This paper is a part of the author’s master’s thesis at Hitotsubashi University, titled “Essays on Electricity Regulation in the Philippines.” The author acknowledges the help of her supervisor, Prof. Shigeki Kunieda. Thanks are also due to Mr. Hua Changchun for his valuable comments and contribution as well as to the moderators and participants of the International Conference.

This paper attempts to illustrate the quality of prenatal care services provided by different health care providers. Section I presents the introduction and overview of the study. Section II discusses important information gathered during literature review which was organized into prenatal care and its benefits, recommended practice and discussion of quality of prenatal services. Sections III and IV present the detailed objectives and methodology adapted in the study. Section V discusses the results of the analysis. Lastly, Section V and VI present the discussions and policy recommendations. Results of the study include women who are older, poorer, and with lower educational attainment received poorer quality of prenatal care compared to women who are younger, richer, and better educated. Multiparous women also received poorer quality of prenatal care. Among the health care providers, doctors provide very good quality of prenatal care while majority of midwives and nurses provide fair quality of prenatal care. Not surprisingly, majority of the traditional birth attendants provide poor quality of prenatal care.

The Philippine health care system is comprised of both private and public hospitals, clinics, and health care providers, and public health units serve a huge majority of the population because of their number and accessibility to more people in terms of price and location. It is therefore important to examine the performance of these public health units and see if they could become more efficient in the delivery of health services. This study will apply data envelopment analysis (DEA) to assess the efficiency of provinces in providing health care services in order to assist the Department of Health in identifying the performance level of each province, determining the targets for improvements in securing benefits and using resources, and identifying the peers of provinces in the delivery of health care. The data used in this study are taken from the Field Health Service Information System and Philippine Health Insurance System of the Department of the Health and the Statement of Income and Expenditure of the Department of Finance. The following programs were analyzed in this study: Maternal Health Care, Child Health Care, and Environmental Sanitation. These programs’ outcomes comprise the percentage of the prevalence of contraceptive use and fully immunized children, for maternal and child health care programs; and the percentage of people who have access to potable water and sanitary toilets, for environmental sanitation. As for inputs, expenditure efficiency is analyzed by the health unit budget per capita and technical efficiency includes the number of doctors and midwives per 100,000 population and the percentage of rural health units accredited by the Philippine Health Insurance Corporation. The DEA results for efficiency expenditure shows that only 9 out of 77 provinces are efficient in providing health programs given their budgets and the average input efficiency score is 54 percent and the average output efficiency score is 87 percent. As for the DEA results for technical efficiency, 24 out of 77 provinces are efficient in providing health care programs given the percentage number of doctors, midwives, and accredited health facilities by the Philippine Health Insurance Corporation. The average input efficiency score is 79 percent and the average output efficiency score is 80 percent. This study has shown the importance of DEA in analyzing the efficiency of delivery of public health services in provinces using expenditure, number of available health care providers, and the presence of accredited rural health units vis-à-vis environmental sanitation and maternal and child health care programs. DEA can rationalize the allocation of budgets among similar health units in order to further improve the efficiency in the delivery of health services in provinces. Moreover, benchmarking using DEA results can improve the accountability of provincial health units in the utilization of their budgets in order to further increase the reach of province-based health programs which could lead to a marked improvement in the health of Filipinos.

While the national average for maternal and child health services utilization shows improvement, the Philippines is yet to achieve the MDG targets for maternal and child health. This study shows inequality in maternal and child health services utilization across economic classes and across regions. Moreover, based on regional Gini coefficient, there are various patterns of utilization and concentration of services across living standards. Interventions to increase the uptake of maternal and child health services based on these patterns are recommended.

Poverty and health are inextricably linked as the poor are always the first to suffer from degraded soil, water, and environment. For poor farmers in developing countries, inappropriate use of pesticides is known to be a serious problem. To investigate if adoption of organic agriculture leads to better health or lower expenditure on healthcare, a survey was conducted on organic and conventional rice-farming households in North and Northeast Thailand in 2006. The results show that health expenditure of conventional farmers is 56% higher than organic farmers. The burden of health expenditures is also disproportionately borne by the poor with the two poorest quintiles spending approximately 3% of discretionary expenditure on healthcare, compared with only 1.85% for the two richest quintiles. Catastrophic health expenditure is also significantly higher for conventional farmers than organic farmers. Among households with health expenditure exceeding 40% of discretionary expenditure, the percentage is 1.3% for conventional households compared to 0.25% for organic households. Although health outcomes are influenced by factors other than pesticide exposure, the results suggest that organic farmers may be in better health. Results also show that organic farmers have more to spend on other household necessities rather than having to spend more discretionary income on healthcare, implying better welfare. The results suggest that organic agriculture as a development strategy might lead to improved health, one of the foundations to sustainable poverty reduction. JEL Classification: I18, I3, Q12 ADBI Working Paper 129 Setboonsarng and Lavado

BackgroundNational health accounts (NHAs) are systems that quantify expenditures on health and address these questions: (1) How is expenditure allocated throughout the health system by agent, by provider, and by function? and (2) Who finances that expenditure?MethodsWe conducted an exhaustive search of all country-generated NHAs from 1990 to 2010. We found 934 country-year reports across 125 countries. More than half of the reports contained four core NHA matrices: (1) provider by financing agent; (2) financing agent by financing source; (3) provider by function; and (4) financing agent by function. We synthesised these data, adjusting entries when necessary according to the NHA guide of WHO.FindingsWith the exception of a few countries (France, Netherlands, Poland, and others), as the proportion of public funds provided to health grows, expenditure is more likely to take place in governmental entities. Low-income countries are not only less likely to finance the bulk of health care with public sources but also generally spend less through government agents. Not surprisingly, among providers, hospitals dominate spending, and more resources are devoted to providing inpatient services than other functions. Finally, as countries' out-of-pocket (OOP) expenditures rise, they tend to spend less on inpatient care.InterpretationNHAs are an important—but underutilised—tool for understanding health systems. Our assessment of the relation between OOP expenditure and inpatient spending leads us to hypothesise that the reliance on OOP expenditure to finance health is a significant barrier to accessing inpatient care; patients may shirk hospital stays due to the significant financial burden associated with financing that care. This analysis is only an initial dive into the rich dataset. Through further analysis, we hope to characterise health-system financing and explore trends over time in order to better understand the evolution of the relation between improvements to population health and investments in health.FundingBill & Melinda Gates Foundation. The funder had no role in writing the manuscript or the decision to submit for publication. The corresponding author had full access to all the data in the study and had the final responsibility for the decision to submit for publication.

BackgroundSince 2009, the Institute for Health Metrics and Evaluation (IHME) has released annual estimates of development assistance for health (DAH) from 1990 onward. This study updates these estimates, including preliminary results for 2011 and 2012, to explore trends in DAH over the past two decades.MethodsIHME utilises a framework that identifies the entities involved in different steps of the transfer of DAH from source to recipient countries. Our estimates account for transfers between the channels to avoid double counting. We rely on a variety of accounting methods and statistical models to generate our annual database. To identify the amount of DAH allocated to different health focus areas, we used project codes, titles, and descriptions reported by channels of funding, among other sources.FindingsTotal DAH increased 2·1% year-over-year in 2012 to US$28·1 billion from $27·4 billion, although the total in 2012 was slightly below that of 2010 ($28·2 billion). In 2012, DAH channelled through bilateral agencies decreased 4·4% to $11·5 billion, while GAVI continued to realise a very strong rate of growth to $1·8 billion. In 2010 (the most recent year for which these data are available), sub-Saharan Africa received the largest share of DAH. However, many of the countries with the highest disease burden did not receive the most DAH.InterpretationAfter a decade of rapid growth from 2001 to 2010, DAH has plateaued from 2010 to 2012. Traditional DAH channels are being forced to recalibrate policies and practices to adapt to a new global health financing landscape. This evolution in funding is occurring as new information emerges about epidemiological profiles around the world, such as the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study.FundingBill & Melinda Gates Foundation. The funders had no role in writing the manuscript or the decision to submit it for publication.

This paper is borne out of the need to address the scarcity of evidence-based studies on barangay financing. It analyzes and evaluates key issues on financing of devolved functions at the barangay level, with particular focus on fund utilization and program allocation, and proposes some policy options addressing the issues. Its key findings show: (a) a mismatch between financial capabilities and devolved functions owing to limited funds being spent mostly on personal services; (b) different priorities of barangays mean different utilization of their barangay development fund (BDF), with some of them failing to spend on important basic services such as education and health, as well as on economic development sector; (c) like other barangays, those in the study areas in Agusan del Sur and Dumaguete City are found to be highly dependent on internal revenue allotment (IRA); and (d) barangays are not addressing the misalignment of revenue and expenditure assignment, as well as the counter-equalizing and disincentive effects of IRA, by not raising enough own-source revenues in their localities and optimizing their use of corporate powers.As a policy intervention to help barangays financially and eventually matter in local service delivery, this paper proposes three major options, namely: (a) giving the barangays the option of allowing the higher local government units (LGUs) to development-enhancing services such as education and health that they themselves cannot deliver effectively and sustainably; (b) pursuing a paradigm shift in understanding and practicing barangay economic development by spending their BDF mostly on economic-enhancing activities aimed at increasing their coffers; and (c) giving incentives to barangays that excel in their own-source revenue performance and creative use of corporate powers.

While the national average for maternal and child health services utilization shows improvement, the Philippines is yet to achieve the Millennium Development Goals (MDG) targets for maternal and child health. This study shows inequality in maternal and child health services utilization across economic classes and across regions. Moreover, based on regional Gini coefficient, there are various patterns of utilization and concentration of services across living standards. Interventions to increase the uptake of maternal and child health services based on these patterns are recommended.

At present, tobacco taxes in Armenia are among the lowest in Europe and Central Asia. Global experience has shown that increasing taxes on tobacco is one of the most cost effective public health interventions. This is particularly relevant for Armenia, where smoking is among the leading risk factors of mortality among the population. Methods: We conducted an extended cost-effectiveness analysis (ECEA) to assess the health, financial, and distributional consequences of increases in the excise tax on cigarettes in Armenia.

More than 20 percent of children under the age of 5 in Tajikistan are stunted. A large literature finds that stunting and undernutrition in early childhood are commonly the result of several contributing environmental, food, hygiene, and health-related factors. However, quantifying these interactions is usually not possible due to the difficulty of collecting sufficient data on each dimension in a single survey. To address this issue, we integrated the samples of two separate nationally representative surveys conducted simultaneously in Tajikistan in late 2016. This design allows analysis of the determinants of undernutrition in a unified framework. The results show strong associations between undernutrition and the number of food calories consumed, food diversity, access to water, sanitation and hygiene (WASH) services, access to health services, and care practices. Consistent with previous studies, the results also show that overlapping adequacies are associated with much reduced stunting risk. The findings suggest that: i) nutritioninterventions addressing multiple risk factors may promote better outcomes than focusingon any single deprivation, ii) there is need for programs addressing food inadequacy, bothin the form of the number of calories consumed and the diversity of food consumed, iii)promoting food adequacy alone is likely not sufficient to generate large reductions inmalnutrition, and iv) interventions should predominantly focus on rural areas where risksof malnutrition are substantially higher.

The efficiency of 119 electric cooperatives in the Philippines from 1990-2002 is analyzed using a stochastic frontier model augmented with spatial-temporal terms, addressing the underestimation of technical efficiency usually encountered among maximum-likelihood based methods. The model is also robust to the choice of environmental variables that will be included in the inefficiency equation provided that the spatial distance measure substantially captures the efficiency-enhancing factors. The average of estimated technical efficiency is 0.86. The growth in technical efficiency of 1-2% per year is explained by the slow adjustment process in the operation of the cooperatives lacking the medium to feedback production outcomes in the previous year to their operation cycle in the following year. Medium-sized cooperatives need to organize for strategic competitive advantage and to facilitate attainment of production efficiency.

The study attempts to empirically examine whether the adoption of organic farming practices leads to better health. As a proxy for health status, a comparison of the health expenditure patterns of organic and conventional rice-farming households in North and Northeast Thailand is done. Using data from a 2006 household survey covering 626 households in eight provinces, we calculate catastrophic health expenditures as out-of-pocket (OOP) medical expenditures exceeding a specified percentage of the household budget. [ADBI WP 129].

We use cross-country panel data to examine the effects of a variety of nonpharmaceutical interventions used by governments to suppress the spread of coronavirus disease (COVID-19). We find that while lockdown measures lead to reductions in disease transmission rates as captured by the reproduction number, R_t, gathering bans appear to be more effective than workplace and school closures, both of which are associated with large declines in gross domestic product. Further, our estimates suggest that stay-at-home orders are less effective in countries with larger family size and in developing economies. We also find that incentives are very important, as efforts at ramping up testing and tracing COVID-19 cases are more effective in controlling the spread of disease in countries with greater coverage of paid sick leave benefits. As future waves of the disease emerge, the use of more targeted and better incentivized measures can help keep the epidemic controlled at lower economic cost.

This paper attempts to provide some empirical evidence on the effects of social security on savings mobilization of households. While it has been empirically established in developed countries that pension system has important effects on savings, no important study has been established yet in the Philippines. Following Feldstein’s model, consumption and savings function using a household survey data was estimated. This study aims to contribute to the pension literature by using the Kaplan-Meier duration model to estimate survival probabilities. The findings indicate that there is a negative effect of pension on household savings. The Social Security System and the Government Service Insurance System are viewed by current contributors as future wealth and thus, they tend to consume more now and save less than they would have if there were no pension.

This policy note is part of the World Bank's Programmatic Public Expenditure Review (PER) work program for FY2012-2014. The PER consists of a series of fiscal policy notes, which aim at providing the Government of Tajikistan with recommendations to strengthen budgetary processes and analysis. This policy note, the sixth in the series continues the fiscal policy dialogue conducted in the previous notes. It is structured as follows. Chapter 2 sets a macro-fiscal context for the analysis with a particular focus on fiscal policy challenges. Chapter 3 analyzes the composition and trends in capital expenditures to identify issues and offer solutions for improving efficiency of capital spending. Chapter 4 reviews a public investment management process in Tajikistan to identify weaknesses in the capital budgeting cycle (planning, budgeting, implementation, and audit), and to recommend measures and remedies to address shortcomings in these processes. Chapter 5 provides the main conclusions: 1) although Tajikistan has enjoyed high economic growth and substantial external assistance, increasing uncertainties about the global environment and the Russian growth outlook put Tajikistan's growth prospects at high risk, and the fiscal space will be very tight; 2) Tajikistan needs to address both equity and sector allocation efficiency issues to better mobilize resources in support of national priorities; 3) analysis of the public investment management system suggests that lack of a unified methodological framework, fragmentation, and poor institutional links discourage efficient use of limited domestic resources and attraction of external financing; and 4) the proposed reforms need to be sequenced to take into account implementation capacity and expected benefits. This note provides detailed recommendations to the Government regarding public investment management.

Sustainable development takes place in an environment of good governance. This chapter provides an estimate of good governance index using the Data Envelopment Analysis (DEA) method using data from Philippine provinces. We illustrate how DEA can be used to provide insights on how provinces can improve on various indicators of governance. Aside from identifying peers, DEA is also able to estimate targets, which can serve as a guide for central governments in holding provinces accountable. This chapter shows that DEA is not used only for efficiency measurement but also applied to other applications in benchmarking and index generation, including non-profit sectors such as public agencies.

Efficiency and equity are cornerstones in rational service delivery in the public sector. This paper benchmarks efficiency and equity in public spending on health, education and social protection in a broad group of ADB member economies. The paper describes public expenditure trends in health, education, and social protection in the region. Following Herrera and Pang (2005), a formal efficiency benchmarking exercise is conducted using Data Envelopment Analysis and available input and output data from World Development Indicators, Government Finance Statistics, and ADB databases to deconstruct each member economy’s efficiency changes in health and education spending. The paper then reviews service provision inequality within ADB economies using utilization rates and benefit incidence, and notes the deficiency of pro-poor spending in some sectors.

The Philippines is one of the biggest pharmaceutical markets in the ASEAN region, next only to Indonesia and Thailand. It is a lifeline to thousands of Filipino workers and a significant contributor in terms of value of output. This industry is one of the fastest growing industries in the country. Meanwhile, its output, drugs and medicines, account for 46 percent of the total medical out-of-pocket expenses of Philippine households. For poorer people, this percentage goes up to 55 percent. Making essential drugs and medicines more affordable especially to the poor and underserved is one of the Millennium Development Goals (MDGs). It is therefore essential to examine the profile of the pharmaceutical industry in the country to better understand the supply chain of drugs and medicines for policy formulation purposes. Using administrative data from agencies that have regulative powers over the industry, a profile of the Philippine pharmaceutical industry was developed. As of December 2009, the Food and Drug Administration’s records show that there are 284 drug manufacturers, 438 drug traders, 634 drug importers, 4,719 drug distributors of which 3,956 are wholesalers, and 32,538 retail outlets. Manufacturing is dominated by multinational brand originator giants and numerous local generics/branded generics producers. Meanwhile, trading is done by few large companies and thousands of small retail outlets. The industry players are diverse and formulating policies therefore must take into consideration how each player may be affected by policy issuances.

BackgroundThe World Health Assembly's Global Vaccine Action Plan details a number of goals to extend the benefits of immunisations to all. Accomplishing these goals will require an efficient use of funds, but currently no system exists to track expenditure on vaccines at a global level.MethodsThis study evaluated existing efforts at tracking immunisation expenditure along with resource monitoring schemes in other health and non-health sectors. The objective was to assess how future tracking schemes could build off existing mechanisms and whether innovative approaches developed in other fields could be applied to the area of vaccinations. We conducted a comprehensive literature review and interviews with experts in the field.FindingsWe found that the data produced by current reporting systems could be markedly improved in terms of accuracy, usability, and timeliness. Currently, reporting systems are evaluated by their usefulness for country-level stakeholders, but data are not subject to serious validation. Based on our discussion and the review of other tracking efforts, we developed a validation framework. Operationalisation of this framework consists of tying together three distinct resource components. First, we propose tracking data related to financing immunisations. Second, because vaccinations depend on physical commodities, such as vaccines and syringes, which are tracked well through trade and procurement databases, we propose linking the financing data to physical goods and services. Lastly, we propose triangulating these data with information on immunisation coverage as a way to verify the deployment of the resources supplied.InterpretationCurrent immunisation resource tracking efforts can be improved with the generation of reliable estimates on an annual basis and the deployment of a validation framework that ensures resources are used effectively to advance vaccination coverage rates.FundingThis work was supported by a grant “Tracking vaccine resource flows in low and lower-middle income countries” from ISGlobal at the Barcelona Institute for Global Health. The funder had no role in writing the manuscript or the decision to submit it for publication.

What happens when cooperative organizations are created by government fiat in an emerging market? Cooperatives in developed countries originate from the ability of local communities to solve social problems. The associated skills generated by cooperative formation encourage positive spillovers that enable a virtuous cycle of improved civic capacity and even more cooperative formation. However, in emerging markets, cooperatives may be generated by government decree rather than optimal social forces. As such, these cooperatives may instead suffer from the negative spillovers from the socio-political dysfunctions of their surrounding environment. Through an analysis of the performance of electric cooperatives in the Philippines, we find that not only are cooperatives less efficient than their investor- owned counterparts, their performance is also more sensitive to the quality of the local government that surrounds them. We similarly discover positive efficiency gains for firms that operate in areas with larger communities of cooperatives.

No AccessAug 2012Ghana’s Health Financing: A Performance AssessmentAuthors/Editors: George Schieber, Cheryl Cashin, Karima Saleh, Rouselle LavadoGeorge SchieberSearch for more papers by this author, Cheryl CashinSearch for more papers by this author, Karima SalehSearch for more papers by this author, Rouselle LavadoSearch for more papers by this authorhttps://doi.org/10.1596/9780821395660_CH02AboutView ChaptersPDF (2.2 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:Assesses the performance of Ghana’s health system in terms of three measures: (1) changes over time and relative to relevant African comparators in health outcomes, delivery system capacity, health spending, and—for the latest available year (2009)—benchmarking Ghana’s performance relative to similar income and health spending global comparator countries; (2) financial protection, equity, and benefit incidence by income class; and (3) consumer satisfaction and responsiveness. Ghana is one of the few low- and middle-income countries in Africa to begin publically financing care to the poor and other vulnerable groups by imposing a payroll tax on public and private formal sector employees, obtaining subsidized premiums from informal sector workers, and earmarking 2.5 percentage points of the country’s value added tax (VAT) to help support the system. Universal health insurance reform can improve health outcomes, provide financial protection, ensure equity, and be responsive to consumers while achieving long-run financial sustainability. Previous chapterNext chapter FiguresreferencesRecommendeddetails View Published: August 2012ISBN: 978-0-8213-9566-0e-ISBN: 978-0-8213-9567-7 Copyright & Permissions Related RegionsAfricaRelated CountriesGhanaRelated TopicsHealth Nutrition and Population KeywordsHEALTH FINANCEUNIVERSAL HEALTH CAREPUBLIC HEALTHHEALTH INSURANCEHEALTH OUTCOMESVULNERABLE GROUPSVALUE-ADDED TAX (VAT)PERFORMANCE EVALUATIONBIRTH ATTENDANTBIRTH ATTENDANTSCOMMUNITY HEALTHHEALTH CAREHEALTH MANAGEMENTHEALTH PLANNINGHEALTH SERVICESHOSPITALSLIFE EXPECTANCYLIVING CONDITIONSMORTALITYNURSESPATIENTPATIENTSPHARMACISTSPHYSICIANSPREGNANCYPREGNANT WOMENWORKERS PDF DownloadLoading ...

No AccessAug 2012Options for Reforming Health FinancingAuthors/Editors: George Schieber, Cheryl Cashin, Karima Saleh, Rouselle LavadoGeorge SchieberSearch for more papers by this author, Cheryl CashinSearch for more papers by this author, Karima SalehSearch for more papers by this author, Rouselle LavadoSearch for more papers by this authorhttps://doi.org/10.1596/9780821395660_CH05AboutView ChaptersPDF (0.5 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:Describes options for dealing with design and implementation problems in Ghana’s health financing system with principal focus on the National Health Insurance Scheme (NHIS) and the structural and operational reforms needed to ensure its medium- to long-term financial viability in terms of both revenues and expenditures.An example for Sub-Saharan Africa—and for low- and middle-income countries throughout the world—Ghana has transitioned from a supply-side, budget driven health system to a demand-side financing system, and many aspects of the NHIS can be considered model good practice, as Ghana has made remarkable progressin establishing stable and diverse funding sources for the NHIS.The NHIS faces challenges, however in (1)current expenditure patterns; (2) enrollment inequities; (3) proposed continued expansions; and(4) unsustainable implementation problems, resulting ina serious threat of insolvency by 2013 without needed fundamental reforms in administrative systems, eligibility requirements, benefit package structure, and provider payment methods. Previous chapter FiguresreferencesRecommendeddetails View Published: August 2012ISBN: 978-0-8213-9566-0e-ISBN: 978-0-8213-9567-7 Copyright & Permissions Related RegionsAfricaRelated CountriesGhanaRelated TopicsHealth Nutrition and Population KeywordsHEALTH FINANCEUNIVERSAL HEALTH CAREPUBLIC HEALTHHEALTH INSURANCEHEALTH OUTCOMESHEALTH REFORMALCOHOL CONSUMPTIONDECISION MAKINGGENERAL PRACTITIONERSHEALTH CAREHEALTH CARE PROFESSIONALSHEALTH MANAGEMENTHEALTH PLANNINGHEALTH SERVICESHOSPITALSINTERVENTIONMEDICINESPATIENTPATIENT CHOICEPATIENTSPHYSICIANSPREGNANT WOMENSCREENINGWORKERS PDF DownloadLoading ...

No AccessAug 2012Strengths and Weaknesses of Ghana’s Health SystemAuthors/Editors: George Schieber, Cheryl Cashin, Karima Saleh, Rouselle LavadoGeorge SchieberSearch for more papers by this author, Cheryl CashinSearch for more papers by this author, Karima SalehSearch for more papers by this author, Rouselle LavadoSearch for more papers by this authorhttps://doi.org/10.1596/9780821395660_CH03AboutView ChaptersPDF (0.3 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:Identifies the strengths and weaknesses of Ghana’s health system in three broad areas: (1) governance, management, and organization; (2) delivery system, pharmaceuticals, and public health; and (3) financing. Ghana’s well-developed, highly decentralized, and evolving health system operates on an integrated three-level (national, regional, and district) scheme and incorporates a community-level health delivery system.Improving health outcomes, financial protection, and consumer responsiveness in an equitable, efficient, and sustainable manner requires a well-functioning delivery system of human and physical infrastructure that includes reasonably priced, available, and effective pharmaceuticals and well-functioning public health programs that target the major disease burdens and are tightly coordinated with the National Health Insurance Scheme (NHIS) basic benefits package. Ghana has come a long way toward developing a modern health care delivery system, improving the availability of effective drugs, and operating effective public health programs but continues to grapple with interrelated management, delivery system, and financing issues. Previous chapterNext chapter FiguresreferencesRecommendeddetails View Published: August 2012ISBN: 978-0-8213-9566-0e-ISBN: 978-0-8213-9567-7 Copyright & Permissions Related RegionsAfricaRelated CountriesGhanaRelated TopicsHealth Nutrition and Population KeywordsHEALTH FINANCEUNIVERSAL HEALTH CAREPUBLIC HEALTHHEALTH INSURANCEHEALTH OUTCOMESHEALTH REFORMCHILD NUTRITIONCOMMUNITY HEALTHDECISION MAKINGHEALTH CAREHEALTH MANAGEMENTHEALTH PLANNINGHEALTH POLICYHEALTH SERVICESHOSPITALSHUMAN RESOURCE MANAGEMENTIMMUNIZATIONINJURIESINTERVENTIONMEDICINESMORTALITYNURSESPHYSICIANSWORKERS PDF DownloadLoading ...

The report is divided into five chapters. This chapter provides background on demographic and epidemiological trends, the configuration of Ghana's health system, and health financing functions and health systems goals. It also describes Ghana's health financing system. Chapter two assesses the performance of Ghana's health system with respect to these goals through international comparisons of health outcomes, inputs, spending, and financial protection as well as time series comparisons of trends in other countries in Africa. Chapter three identifies the strengths and weaknesses of Ghana's health system, which determine Ghana's health reform baseline. Chapter four analyzes the sustainability of the National Health Insurance Scheme, or NHIS in the context of Ghana's future fiscal space, based on Ghana's new standing as a lower-middle-income country. Chapter five analyzes major structural and operational reform options that will help ensure the long-term efficacy and sustainability of the NHIS.

No AccessAug 2012OverviewAuthors/Editors: George Schieber, Cheryl Cashin, Karima Saleh, Rouselle LavadoGeorge SchieberSearch for more papers by this author, Cheryl CashinSearch for more papers by this author, Karima SalehSearch for more papers by this author, Rouselle LavadoSearch for more papers by this authorhttps://doi.org/10.1596/9780821395660_OverView ChaptersAboutPDF (0.3 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:Summarizes Ghana’s health financing system, with a special emphasis on its National Health Insurance Scheme (NHIS), using extensive international benchmarking to assess the financial protection/equity of the system (at both the macro and micro levels), and to analyze Ghana’s fiscal space since its reclassification as a lower-middle-income country in November 2010.Often considered an example of global “good practice,” Ghana is one of only a handful of emerging market countries in Africa to actively start implementing universal health insurance coverage by providing formal coverage to its vulnerable population groups. Ghana’s health system has both important strengths and weaknesses in (1) governance, management, and organization;(2) delivery system, pharmaceuticals, and public health; and(3) financing, and while options for health reform depend on Ghana’s future available fiscal space, several potential options exist for increasing revenues and improving expenditure efficiency in the context of broader reforms of the health systems. Previous chapterNext chapter FiguresreferencesRecommendeddetails View Published: August 2012ISBN: 978-0-8213-9566-0e-ISBN: 978-0-8213-9567-7 Copyright & Permissions Related RegionsAfricaRelated CountriesGhanaRelated TopicsHealth Nutrition and Population KeywordsHEALTH FINANCEUNIVERSAL HEALTH CAREPUBLIC HEALTHHEALTH INSURANCECHILD NUTRITIONCOMMUNICABLE DISEASESDECISION MAKINGHEALTH CAREHEALTH FINANCINGHEALTH MANAGEMENTHEALTH OUTCOMESHEALTH POLICYIMMUNIZATIONINCOMEINJURIESLIFE EXPECTANCYMEDICINESMORTALITYNATIONAL HEALTH INSURANCENURSESPHYSICIANSUNIVERSAL HEALTH INSURANCE COVERAGEWORKERS PDF downloadLoading ...

No AccessAug 2012IntroductionAuthors/Editors: George Schieber, Cheryl Cashin, Karima Saleh, Rouselle LavadoGeorge SchieberSearch for more papers by this author, Cheryl CashinSearch for more papers by this author, Karima SalehSearch for more papers by this author, Rouselle LavadoSearch for more papers by this authorhttps://doi.org/10.1596/9780821395660_CH01AboutView ChaptersPDF (1 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:Provides background on (1) demographic and epidemiological trends in Ghana; (2) the configuration of Ghana’s health system, its goals, and the functions of health financing; and (3) Ghana’s health financing system.Ghana’s demographics and epidemiological situations determine not only the health system’s future needs/demands but also of the ability of its population to support them. The population will increase from 24.3 million in 2010 to 33.8 million in 2030, and with declining birth ratesand increasing life expectancy, Ghana’s health system must grow to meet the increasing demands of a growing and changing population. Priorities include effectively raising revenue, pooling risk, and purchasing services in order to improve equity, efficiency, and sustainability of health outcomes.The National Health Insurance Scheme accounts for 30–40 percent of all public spending on health, proving its efficiency and sustainability a major national concern; health outcomes, financial protection, and consumer responsiveness matter greatly. Previous chapterNext chapter FiguresreferencesRecommendeddetails View Published: August 2012ISBN: 978-0-8213-9566-0e-ISBN: 978-0-8213-9567-7 Copyright & Permissions Related RegionsAfricaRelated CountriesGhanaRelated TopicsHealth Nutrition and Population KeywordsDEMOGRAPHICSHEALTH FINANCEUNIVERSAL HEALTH CAREPUBLIC HEALTHHEALTH INSURANCEEPIDEMIOLOGYBIRTH ATTENDANTSCOMMUNICABLE DISEASESCOMMUNITY HEALTHHEALTH CAREHEALTH OUTCOMESHEALTH PLANNINGHEALTH PROMOTIONHEALTH SERVICESHOSPITALSINJURIESINTERNATIONAL COMPARISONSLIFE EXPECTANCYNURSESNUTRITIONOCCUPATIONAL SAFETYPATIENTPSYCHIATRIC HOSPITALSWORKERS PDF DownloadLoading ...

This paper, which is borne out of the need to address scarcity of evidence-based studies on barangay financing, analyzes and evaluates key issues on financing of devolved functions at the barangay level, with particular focus on fund utilization and program allocation, and proposes some policy options addressing the issues. Its key findings include : (i) there is a mismatch between financial capabilities and devolved functions owing to limited funds being spent mostly on personal services, with little money left to finance these functions; (ii) different priorities of barangays mean different utilization of their Barangay Development Fund (BDF), with some of them failing to spend on important basic services such as education and health, as well as on economic development sector; (iii) like other barangays, those in the study areas in Agusan del Sur and Dumaguete City are found to be highly IRA- dependent, with IRA comprising 85 to 97 percent of total income; (iv) barangays are not addressing the misalignment of revenue and expenditure assignment, as well as the counter-equalizing and disincentive effects of IRA, by not raising enough own-source revenues in their localities and optimizing their use of corporate powers (as evidenced by zero percentage on borrowings, for example). As a policy intervention strategy to help barangays financially and eventually matter in local service delivery, this paper proposes three major options, namely : (i) giving the barangays the option of allowing the higher LGUs to deliver the development-enhancing services such as education and health that they themselves cannot deliver effectively and sustainably; (ii) making a paradigm shift in understanding and practicing barangay economic development by spending their BDF mostly on economic-enhancing activities aimed at increasing their coffers which would eventually enable them to fund other sectoral responsibilities; and (iii) giving incentives to barangays that excel in their own-source revenue performance and creative use of corporate powers.

Resumen La pandemia de COVID‐19 y las políticas de contención asociadas han afectado más a Filipinas que a la mayoría de los países en desarrollo por aplicar confinamientos de los más estrictos del mundo, y cierres generales de escuelas de los más prolongados. Con un modelo de simulación novedoso, se estiman los efectos de estos factores por sector, región administrativa y género en los niveles de empleo, ingresos y pobreza, con particular atención al empleo de los docentes y a los ingresos de las personas con hijos pequeños en relación con el cierre de escuelas. Se constata que la pandemia tiene repercusiones sin precedentes en la actividad económica y afecta desproporcionadamente a las mujeres.

Résumé Les Philippines ont souffert plus que la plupart des autres pays en développement de la pandémie de COVID‐19 et des restrictions concomitantes, à savoir, notamment, un confinement très strict et une fermeture prolongée des écoles. Les auteurs proposent un modèle original pour estimer l'effet de ces mesures sur le travail, le revenu et la pauvreté selon le sexe et la région. Une étude de cas leur permet d’établir par ailleurs que les fermetures d’école ont nui à l'emploi dans l'enseignement privé et au revenu des parents de jeunes enfants. Ils concluent que la pandémie a eu des retombées économiques sans précédent et pénalisé les femmes.

Sick Leave as a Tool for COVID-19 Control KEY POINTS • Paid sick leave (PSL) can help contain the spread of infectious diseases such as COVID-19, and protect workers from loss of income due to sickness.> Modeling finds that a PSL program in the Philippines that encourages symptomatic workers to self-isolate could reduce the overall mortality from COVID-19 by as much as 50%.> Econometric analysis finds that economies that provide PSL coupled with tracing further reduce the number of infections, with 10 infected individuals infecting 2 fewer other people on average.• A new normal combining PSL with expanded contact tracing, testing, and isolation could control the COVID-19 epidemic.• The costs-financial and administrative-of a special COVID-19-related PSL program are manageable, at a fraction of a percent of gross domestic product.NO.

The paper aims to use the Data Envelopment Analysis to examine the relative efficiency of provinces in providing primary health care programs. While many studies in the past analyzed the efficiency of hospitals using various performance indicators, studies on efficiency of primary health care provision is not so common. Hensher (2001) in his report for the Commission on Macroeconomics and Health found that there were very few studies that look at primary health care efficiencies although indicators such as pre-natal care access, immunization rates, among others, are readily available in most countries. This study also hopes to illustrate the usefulness as a tool to benchmark provinces to pursue efficiency improvements at the local level. By focusing at the level of provinces, this study hopes to bring down efficiency improvements at the level that can be readily managed by policy makers. Four programs of the Department of Health were evaluated: Maternal Care Program, Expanded Program on Immunization, Control of Diarrheal Diseases Program, and Vitamin-A Supplementation Program. For Maternal Care Program, the outcome indicators are three or more prenatal care visits, and 2 or more tetanus toxoid injections. The Expanded Program on Immunization is based on diarrhea cases (among 0-59 months old) given oral rehydration salts. Outcome indicators for Vitamin A supplementation are infants, children, and lactating mothers given Vitamin-A drops. The inputs utilized were the number of doctors, nurses, midwives, Barangay health workers, and Barangay health stations per 100,000 population. The data is from the Field Health Service Information System of the Department of Health in 2002. Results show that 17 out of 75 provinces are efficient in providing Maternal Care Programs given their medical staff and facilities. Input efficiency score is 70 percent while output efficiency score is 79 percent. Fifteen provinces were efficient in the immunization program. On average, input usage can be reduced by 30 percent while immunization outcomes can be increased further by 20 percent. Provinces are least efficient in providing the Control of Diarrheal Diseases Program with only ten efficient provinces. Input efficiency score is 65 percent while output efficiency score is 48 percent. On the other hand, provinces are most efficient in providing Vitamin A to infants, children and lactating mothers with 20 efficient provinces. The program has the highest input and output efficiency scores of 75 and 82 percent, respectively. Identification of efficient and inefficient provinces can serve as guide in determining which provinces are in need of closer examination by the Department of Health. DEA also provides an estimation potential input and outcome targets which can serve as a guide for policy makers in setting-up program targets. Although this should not be treated as actual targets, still it can serve as a guide in setting up the ballpark figure. More importantly, DEA identifies peers which are based on units having similar production sets. By knowing which provinces are similar, comparisons can be done at a more meaningful level.

Elsewhere we have also assessed performance against inputs and health outcomes, where Armenia does reasonably well vis-àvis health outcomes relative to public and private spending levels but tends to have more physical inputs than other comparable income countries.Out-of-pocket expenditure as share of CHE, GDP = gross domestic product.

Ample presence of infrastructure has been identified as one of the key drivers of economic growth. Having experienced sluggish growth compared to its ASEAN neighbors, among the reforms introduced by the Philippines is deregulation of its key infrastructure sectors, particularly the energy sector. Despite the deregulation, however, energy prices remain to be one of the highest in the region. To be able to benefit from the restructuring, critical aspects of electricity regulation need to be examined critically particularly the appropriateness of the current method of pricing in the deregulated environment. This paper attempts to answer the question of whether the current pricing methodology, the Rate-of-Return (ROR) regulation, gives incentive for regulated firms to overcapitalize. According to the Averch-Johnson (A-J) Model, ROR regulation induces firms to have an inefficiency high capital/labor ratio because as more capital is used, the firm is allowed to earn higher absolute profit. By observing the input prices and the marginal products of a regulated firm in the generation sub-sector, the A-J hypothesis was tested. Since marginal products are not directly observable, it is approximated by estimating the firm’s production function using capital, labor and fuel as three major inputs. The results confirm the existence of overcapitalization in all generation plants in the sample by approximately twenty to thirty percent. The results are consistent with previous studies done in the USA. The empirical results obtained are consistent with the hypothesis that the rate of return regulation induces firms to overcapitalize. 1 An earlier draft of this paper was presented at the Third East West Center International Graduate Student Conference, Hawaii, February 2004. This paper is a part of the author’s master’s thesis at Hitotsubashi University, titled “Essays on Electricity Regulation in the Philippines.” The author acknowledges the help of her supervisor, Prof. Shigeki Kunieda. Thanks are also due to Mr. Hua Changchun for his valuable comments and contribution as well as to the moderators and participants of the International Conference.

The stochastic frontier model with heterogeneous technical efficiency explained by exoge-nous variables is augmented with a spatial-temporal component, a generalization relaxing the panel independence assumption in a panel data. The estimation procedure takes advantage of additivity in the model, computational advantages over maximum likelihood estimation of parameters is exhibited. The spatial-temporal component can improve estimates of technical efficiency in a production frontier that is usually biased downwards. We present a test to veri-fy model assumptions that facilitates estimation of parameters.

The stochastic frontier model with heterogeneous technical efficiency explained by exoge-nous variables is augmented with a spatial-temporal component, a generalization relaxing the panel independence assumption in a panel data. The estimation procedure takes advantage of additivity in the model, computational advantages over maximum likelihood estimation of parameters is exhibited. The spatial-temporal component can improve estimates of technical efficiency in a production frontier that is usually biased downwards. We present a test to veri-fy model assumptions that facilitates estimation of parameters.