2009年-世界发展银行全球_Mitigating_the_Impact_of_the_Economic_Crisis_on_Public_Sector_Health_Spending_5页_757kb

Summary of Mitigating the Impact of the Economic Crisis on Public Sector Health Spending

Core Content

The document discusses the impact of the global financial crisis on public health spending in the Europe and Central Asia (ECA) region and proposes strategies to mitigate this effect. It emphasizes the importance of maintaining public health funding to protect access to care, especially for low-income groups, and highlights the need for targeted interventions and fiscal reforms.

Main Points

• Public Health Spending in ECA:
  Most ECA countries primarily finance their health sectors through public sources. In countries with low public health spending, the majority of health services are paid for by patients, increasing out-of-pocket costs and potentially limiting access for the poor.

• Economic Crisis Impact:
  The crisis is leading to reduced government revenues and increased unemployment, forcing many ECA countries to cut budgets, including health spending. This could result in a decline in public health investment, worsening health outcomes for vulnerable populations.

• Mitigation Strategies for Policy Makers:

  • Increase indirect taxes: Governments can raise excise taxes on alcohol, tobacco, fuel, and mobile phone services to generate additional revenue for health. Examples include Estonia, Romania, and Poland.
  • Use donor funding: Countries with limited fiscal capacity, such as Tajikistan and Kyrgyzstan, may need to rely on donor support to protect core health spending, especially for the poor.
  • Make fiscal transfers: Central governments should provide additional funds to poorer regions to ensure equitable health service delivery and prevent underfunding of local health facilities.

• Avoid Increasing Payroll Taxes:
  Raising payroll taxes for social health insurance is not advisable as it could harm labor markets and economic growth, especially in times of rising unemployment and declining wages.

• Short-Term Cost-Containment Measures:
  Governments are implementing measures such as postponing investments, reducing overhead costs, corporatizing hospitals, and cutting payments to providers. However, these measures are unlikely to significantly improve long-term financial sustainability.

• Rationalizing Hospital Overcapacity:
  Overcapacity in hospitals is a major cause of wasteful health spending. The crisis may provide an opportunity to restructure hospitals, reduce unnecessary beds, and improve productivity through financial incentives.

• Managing Pharmaceutical Costs:
  Cost-saving strategies include public tendering, purchasing generic drugs, reference pricing, and standardizing prescription protocols. These are especially important for countries that import pharmaceuticals and face currency devaluation risks.

• Improving Targeting Efficiency:
  Many ECA countries do not effectively target health subsidies to the poorest. Reforms such as means-testing and adjusting benefit periods (e.g., reducing maternity leave duration) are being considered to improve equity in health financing.

• Protecting Pro-Poor Health Programs:
  Governments should prioritize funding for health programs that serve low-income groups, such as immunization and maternal and child health services. Examples include Argentina and Thailand, which used subsidies to protect access during crises.

• World Bank's Role:
  The World Bank supports ECA countries through technical assistance and fiscal policy reforms, including reducing payroll taxes, increasing general budget funds for health, and improving governance to enhance the efficiency and equity of health systems.

Key Information

• Fiscal Challenges:
  The economic crisis is causing a decline in GDP growth, remittances, and government revenues, leading to reduced public health spending.

• Impact on Vulnerable Groups:
  Reductions in public health funding may disproportionately affect low-income populations, increasing out-of-pocket costs and limiting access to essential services.

• Long-Term Reforms:
  The crisis offers an opportunity to implement long-term reforms aimed at improving financial sustainability, equity, and efficiency in health systems.

• Donor Support:
  Donor funding is crucial for countries with limited fiscal capacity. However, access to donor support varies across ECA countries, and flexibility is needed to assist the poorest.

• Health System Governance:
  Strengthening governance and institutional capacity is essential to prevent leakage in public spending and ensure effective resource allocation in the health sector.

Conclusion

To effectively mitigate the impact of the economic crisis on public health spending, ECA policy makers should focus on increasing indirect taxes, using donor funding for vulnerable groups, and making fiscal transfers to poorer regions. While short-term cost-containment measures are necessary, they should be complemented with long-term reforms to improve the financial sustainability and equity of health systems. The World Bank plays a vital role in supporting these efforts through technical and fiscal assistance.