Philip Musgrove

Basic patterns in national health expenditure

Analysed in this paper are national health accounts estimates for 191 WHO Member States for 1997, using simple comparisons and linear regressions to describe spending on health and how it is financed. The data cover all sources - out-of-pocket spending, social insurance contributions, financing from government general revenues and voluntary and employment-related private insurance - classified according to their completeness and reliability. Total health spending rises from around 2-3% of gross domestic product (GDP) at low incomes (< 1000 US dollars per capita) to typically 8-9% at high incomes (> 7000 US dollars). Surprisingly, there is as much relative variation in the share for poor countries as for rich ones, and even more relative variation in amounts in US dollars. Poor countries and poor people that most need protection from financial catastrophe are the least protected by any form of prepayment or risk-sharing. At low incomes, out-of-pocket spending is high on average and varies from 20-80% of the total; at high incomes that share drops sharply and the variation narrows. Absolute out-of-pocket expenditure nonetheless increases with income. Public financing increases faster, and as a share of GDP, and converges at high incomes. Health takes an increasing share of total public expenditure as income rises, from 5-6% to around 10%. This is arguably the opposite of the relation between total health needs and need for public spending, for any given combination of services. Within public spending, there is no convergence in the type of finance - general revenue versus social insurance. Private insurance is usually insignificant except in some rich countries.

Cost-effective malaria control in Brazil. Cost-effectiveness of a Malaria Control Program in the Amazon Basin of Brazil, 1988-1996.

Malaria transmission was controlled elsewhere in Brazil by 1980, but in the Amazon Basin cases increased steadily until 1989, to almost half a million a year and the coefficient of mortality quadrupled in 1977-1988. The governments malaria control program almost collapsed financially in 1987-1989 and underwent a turbulent reorganization in 1991-1993. A World Bank project supported the program from late 1989 to mid-1996, and in 1992-1993, with help from the Pan American Health Organization, facilitated a change toward earlier and more aggressive case treatment and more concentrated vector control. The epidemic stopped expanding in 1990-1991 and reversed in 1992-1996. The total cost of the program from 1989 through mid-1996 was US

The oil price increase and the alleviation of poverty: Income distribution in Caracas, Venezuela, in 1966 and 1975

616 million: US

Indicators: how much complexity is desirable?

526 million for prevention and US

Educação e Saúde: mais diferentes do que parecidos

90 million for treatment. Compared to what would have happened in the absence of the program, nearly two million cases of malaria and 231,000 deaths were prevented; the lives saved were due almost equally to preventing infection and to case treatment. Converting the savings in lives and in morbidity into Disability-Adjusted Life Years yields almost nine million DALYs, 5.1 million from treatment and 3.9 million from prevention. Nearly all the gain came from controlling deaths and therefore from controlling falciparum. The overall cost-effectiveness was US

Educación y Salud: más diferentes que semejantes

2672 per life saved or US

Why education and health are more different than alike

69 per DALY, which is low compared to most previous estimates and compares favorably to many other disease control interventions. Contrary to much previous experience, case treatment appears more cost-effective than vector control, particularly where falciparum is prevalent and unfocussed insecticide spraying is relatively ineffective. Halting the epidemic by better targeted vector control and emphasizing treatment paid off in much reduced mortality from malaria and in significantly lower costs per life saved.

National health expenditures: a global analysis.

Abstract Two Caracas household budget surveys are used to compare household and individual income distributions. Real 1975 incomes are derived from income-specific price indexes. Minimum food budgets define destitution and poverty levels. During 1966–1975 mean real income rose substantially, especially among the rich. The fraction poor declined markedly, but mean income did not rise for those remaining poor. The poors share of income growth came entirely from reduction in the number of poor, and exceeded their 1966 income share. The poverty gap expanded with population growth but shrank in per capita terms and relative to total income.

Health insurance: the influence of the Beveridge Report

Paper prepared for Round-Table VI. Indicators: Methodological Aspects. V BrazilianEpidemiology Congress, Curitiba, PR, Brazil. March 23-27, 2002.The opinions expressed here are entirely the author’s, and do not necessarily represent theviews of the World Bank, its Executive Directors, or the countries they represent.

A critical review of ‘A critical review’: the methodology of the 1993 World Development Report, ‘Investing in Health’

Educacion y Salud – mejordicho, escolaridad y cuidados medicos – confrecuenciason tratados conjuntamente y considerados como partes del “Sector Social”. Escorrectodecir que hay similitudes importantes, pero son obliteradas por diferencias aun mas grandes y mas relevantes. Gran parte de las diferencias es intrinseca a lanaturalezadelconocimiento y delaprendizaje, por un lado, y a lasenfermedades y las formas de tratarlas, por elotro. Pero haytambien diferencias asociadas a las formas de organizacion y financiamiento de laeducacion y de los cuidados medicos. Tales diferenciasson criticas cuandohablamos de costos, gestiondelo cotidiano y de losesfuerzos de reforma de los sistemas. Tratar los dos sectores como si fueransemejantes revela unanalisispoco rigoroso que puedellevarnos a politicas equivocadas.