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  • Reprioritizing government spending on health: pushing an elephant up the stairs? / Ajay Tandon;Lisa Fleisher;Rong Li;Wei Aun Yap
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Reprioritizing government spending on health: pushing an elephant up the stairs? / Ajay Tandon;Lisa Fleisher;Rong Li;Wei Aun Yap

Tác giả : Ajay Tandon;Lisa Fleisher;Rong Li;Wei Aun Yap

Nhà xuất bản : World Health Organization. Regional Office for South-East Asia

Năm xuất bản : 2014

Chủ đề : 1. fiscal space. 2. government health expenditure. 3. political economy. 4. prioritization. 5. universal health coverage. 6. Journal / periodical articles.

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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 prioritizedby governments. World Health Organization (WHO) data estimate that, in 2011,health’s share of aggregate government expenditure averaged 12% in the 170countries for which data were available. However, country differences werestriking: ranging from a low of 1% in Myanmar to a high of 28% in Costa Rica.Some of the observed differences in health’s share of government spending acrosscountries are unsurprisingly related to differences in national income. However,significant variations exist in health’s share of government spending even aftercontrolling for national income. This paper provides a global overview of health’sshare of government spending and summarizes some of the key theoretical andempirical perspectives on allocation of public resources to health vis-à-vis othersectors from the perspective of reprioritization, one of the modalities for realizingfiscal space for health. The paper argues that theory and cross-country empiricalanalyses do not provide clear-cut explanations for the observed variations ingovernment prioritization of health. Standard economic theory arguments that areoften used to justify public financing for health are equally applicable to manyother sectors including defence, education and infrastructure. To date, empiricalwork on prioritization has been sparse: available cross-country econometricanalyses suggest that factors such as democratization, lower levels of corruption,ethnolinguistic homogeneity and more women in public office are correlated withhigher shares of public spending on health; however, these findings are not robustand are sensitive to model specification. Evidence from case studies suggests thatcountry-specific political economy considerations are key, and that results-focusedreform efforts – in particular efforts to explicitly expand the breadth and depth ofhealth coverage as opposed to efforts focused only on government budgetarybenchmarking targets – are more likely to result in sustained and politically feasibleprioritization of health from a fiscal space perspective
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https://iris.who.int/handle/10665/329750