Public Spending in
Available online as PDF file [33p.] at:
“….This report examines three critically important areas to inform discussions on the appropriate level of health care spending in the
· The efficiency of spending on health care services. What is the relationship between inputs and outputs in the
· Distributional impacts of spending on health care services. How are resources distributed across the regions and how are resources allocated by income. What can be done to minimize the disparities across the regions and by income?
· The key factors that will influence the growth in health care spending over the next 20 years. How can the
This analysis draws on routinely collected regional and federal data and as discussed below is limited in scope by the relative absence of routinely or specifically collected data on the outcomes and outputs of the health care systems in
Table of Contents
I. The Efficiency of Spending on Health Care Services
1.1 Poor health outcomes in the
1.3 Life expectancy differences within the
1.4 The social and economic cost of NCDI in the
1.5 Low Levels of Health Care Expenditure in the
1.6 Health care expenditures in the
1.7 Health Spending and Outcomes
II. The Distributional Impact of Spending on Health Care Services
2.1 Health Care Spending by Regions of the
2.2 Distribution of health care spending by income deciles by region
2.3 Outcomes by Region
2.4 Distribution of Spending By Type of Health Service
2.5 Household Payments for Medical Drugs.
2.6 Uses of Medical Services by Income Group
III. Factors that will influence the growth in health spending over the next 20 years and considerations for guiding the allocation of additional resources
3.1 What are the main drivers of health and long-term care expenditures globally?
3.2. Increasing Level of Funding for Health in the
3.3. Where should additional public resources come from?
3.4. How to allocate additional financial resources for health care?
3.5 The process for developing standards
IV. The Imperative of Policy, Structural and Institutional Reforms to Achieve Better Health
4.1 Key Areas for Action
4.2 Is health system reform possible in the
V. The way forward
This report was prepared in June/July 2008 by Patricio Marquez, Lead Health Specialist, Europe and Central Asia Region (ECA), The World Bank, with contributions of Edward Frid, Russian Consultant, The World Bank, Rifat Atun, Imperial College of London, Kalipso Chalkidou, UK’s National Institute for Health and Clinical Excellence (NICE), and Sevil Kamalovna Salakhutdinova, Health Officer, Moscow Office, The World Bank. The report also incorporates advice and suggestions that were provided by Gerard Anderson, Johns Hopkins University Bloomberg School of Public Health; and Sergey Shishkin, Igor Sheiman and Nadezhda Lebedeva, leading Russian Health Economists. The report is part of the Long Term Fiscal Study that is being conducted by the World Bank for the Russian Ministry of Finance under the leadership of Zeljko Bogetic, Lead Economist and Country Sector Coordinator, Russia Country Management Unit, The World Bank.
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