Peter S. Heller

A model of the demand for medical and health services in Peninsular Malaysia

This paper provides an empirical analysis of the determinants of the demand for medical services in Peninsular Malaysia. After elaborating a theoretical model of household demand for medical care in Section II an econometric model is specified and estimated in Sections III, IV, and V. The results indicate that total medical demand, as measured by the absolute volume of outpatient and inpatient consumption, is highly inelastic to the cash price and to the cost in time of utilization. Total medical demand is also inelastic with respect to income. Yet consumers are clearly responsive to the relative prices of alternative sources of medical care. Consumers are also sensitive to the way in which the time of utilization is spent, with high travel and treatment time causing reduced demand for services.

Malnutrition, Child Morbidity and the Family Decision Process

A microeconomic model of the process by which infants and preschoolers are subject to malnourishment, diarrhea and other illnesses in developing countries is given. The model is econometrically based of a cross-section time-series for 1200 children from Candelaria, Colombia. Four primary issues are addressed: economic constraints and intra-family resource allocation decisions impacting on a childs nutritional and health status; the interrelationship between malnutrition, diarrhea, and other diseases; specific policy interventions (maternal-child health education, food supplementation and the encouragement of breast feeding) impacting on health and nutritional status; and the need to distinguish between the effect of different policy variables on a childs height and weight during infancy and preschool age. The observations were taken over a 7 year period during the Promotora maternal-child health program in Colombia.

'Pity the Finance Minister': Issues in Managing a Substantial Scaling Up of Aid Flows

Substantially scaling up of aid flows will require development partners to address many issues, including the impact of higher aid flows on: the competitiveness of aid recipients; the management of fiscal and monetary policy; the delivery of public services; behavioral incentives; and the rate of growth of the economy. Other issues will include the appropriate sequencing of aid-financed investments; balancing alternative expenditure priorities; the implications for fiscal and budget sustainability; and exit strategies from donor funding. Donors will need to ensure greater long-term predictability and reduced short-term volatility of aid. The international financial institutions can play a critical role in helping countries address these scaling-up issues.

Rethinking Public Pension Reform Initiatives

This paper argues that there are significant risks, limitations, and complications associated with reliance upon mandatory DC, fully funded schemes as the dominant public pension pillar. Policies to limit risks may result in the government being reinjected into playing an important financial role in the provision of social insurance. For many countries, the principal source of old age support should thus derive from a well-formulated, public DB pillar, with a significant amount of prefunding. A DC/FF pillar can play a useful supplemental role in a multi-pillar system for the accumulation of pension savings.

Aging and Social Expenditure in the Major Industrial Countries, 1980-2025

Most of the seven major industrial countries are now experiencing significant changes in their demographic structure. A persistent pattern of declining fertility and improving life expectancy has created major segments of the population that are already relatively aged or will become so in the near future. This paper examines the impact of prospective demographic trends on the level and structure of social expenditure by the governments of the seven major industrial countries (the Group of Seven) through the year 2025.

What Should Macroeconomists Know About Health Care Policy

This primer aims to provide IMF macroeconomists with the essential information they need to address issues concerning health sector policy, particularly when they have significant macroeconomic implications. Such issues can also affect equity and growth and are fundamental to any strategy of poverty reduction. The primer highlights the appropriate roles for the state and market in health care financing and provision. It also suggests situations in which macroeconomists should engage health sector specialists in policy formulation exercises. Finally, it reviews the different health policy issues that confront countries at alternative stages of economic development and the range of appropriate policy options.

Social Sector Reform in Transition Countries

During the transition process, many existing social sector institutions and policies were significantly eroded and their underlying character changed. As a result, they often do not redistribute to the poorest, nor generally serve the role of facilitating economic change. Social sector reforms have therefore become necessary for reasons of social welfare as well as economic growth. The analysis of eleven transition countries - comprising some of the most advanced as well as some of the poorest transition economies - shows that almost all countries have started to undertake reforms; however, their individual efforts vary. Reform does not only stand for cutting back, but also requires in some cases a building up and in others a redesign of social safety nets; it needs to address insurance issues, budgetary transfer programs, the performance of the health and education sector, as well as the labor market regime and the approach to tax administration.

Is Asia Prepared for an Aging Population

Population aging is a global phenomenon that influences not only the industrialized countries of Asia and the West, but also many middle- and low- income countries that have experienced rapid fertility decline and achieved long life expectancies. This book explores how workers and consumers are responding to population aging and examines how economic growth, generational equity, trade and international capital flows are influenced by population aging.

Making Fiscal Space Happen: Managing Fiscal Policy in a World of Scaled-Up Aid

Debt relief and the scaling up of aid to low-income countries should allow for greater fiscal space for expenditure programs to create long-term growth and lower poverty rates. But designing a suitable medium-term fiscal framework that fosters a sustainable delivery of better public services and infrastructure while maintaining a credible commitment to fiscal prudence confronts many challenges. This paper discusses what low-income countries can do to shape fiscal policy frameworks that are ambitious in trying to absorb additional aid while still ensuring longer-term sustainability for government expenditure programs and finances. It suggests what approaches can be used to manage the greater fiscal policy risks associated with a scaled-up aid environment, including coordination with monetary policy. The paper also discusses what institutional changes are needed if donors and countries are to facilitate the implementation of a higher level of aid-financed spending programs.

The fiscal impact of privatization, with some examples from Arab countries

Abstract This paper reviews current thinking on the fiscal impact of privatization against the background of developments and prospects for privatization in Arab countries. It argues that the fiscal impact is likely to be slight in the absence of fundamental structural reforms by Arab countries to secure gains in allocative efficiency by the privatized enterprises. By itself, privatization may simply lead to a change in the governments asset portfolio. In the case of loss- making enterprises, the government may need to pay the private entrepreneur to take on the enterprise, particularly when the sources of inefficiency reflect government policy decisions that are not likely to be modified; alternatively, liquidation of the assets of unprofitable enterprises may be the appropriate policy.