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International Monetary Fund. Western Hemisphere Dept.
Natural disasters and climate change are existential threats to Grenada, with annual losses from these events estimated at 1.7 percent of GDP. Grenada has proactively pursued resilience-building, with its Climate Change Policy and National Adaptation Plan providing detailed roadmaps for policymakers. However, the challenges are increasing, including from slow-moving effects owing to the rising sea level, even as implementation capacity and resource constraints remain significant impediments. The COVID-19 pandemic has amplified those challenges by increasing risks and tightening Grenada’s fiscal space.
International Monetary Fund. Western Hemisphere Dept.
Dominica is among the countries most vulnerable to natural disasters and climate change. During 1997-2017, it was the country with highest GDP losses to climate-related natural disasters and ranked in the top 10 percent among 182 countries for climate-related fatalities. Following a huge devastation, owing to back-to-back major storms in 2015 and 2017, Dominica announced its intention to become the first disaster resilient nation. In 2019, it was agreed with the government that the Fund, in consultation and collaboration with other development partners, would provide support for preparing a Disaster Resilience Strategy (DRS), a comprehensive plan including policies, cost, and financing to build resilience against natural disasters.
Ms. Li Lin and Mr. Mico Mrkaic
Healthcare in the United States is the most expensive in the world, with real per capita spending growth averaging 4 percent since 1980. This paper examines the role of market power of U.S. healthcare providers and pharmaceutical companies. It finds that markups (the ability to charge prices above marginal costs) for publicly listed firms in the U.S. healthcare sector have almost doubled since the early 1980s and that they explain up to a quarter of average annual real per capita healthcare spending growth. The paper also finds evidence that the Affordable Care Act and Medicaid expansion were successful in raising coverage and expanding care, but may have had the undesirable side-effect of leading to labor cost increases: Hourly wages for healthcare practitioners are estimated to have increased by 2 to 3 percent more in Medicaid expansion states over a five-year period, which could be an indication that the supply of medical services is relatively inelastic, even over a long time horizon, to the boost to demand created by the Medicaid expansion. These findings suggest that promoting more competition in healthcare markets and reducing barriers to entry can help contain healthcare costs.
Mr. Jose L. Torres
Over the last two decades, the Peruvian government has made great efforts to improve access to health care by significantly augmenting the coverage of the non-contributory public health care system Seguro Integral de Salud (SIS). This expansion has a positive impact on welfare and public health indicators, as it limits the risk of catastrophic health-related costs for previously uninsured individuals and allows for the appropriate treatment of illnesses. However, it also entails some unintended consequences for informality, tax revenues, and GDP, since a few formal agents are paying for a service that the majority of (informal) agents receive for free. In this paper, we use a general equilibrium model calibrated for Peru to simulate the expansion of SIS to quantify the unintended effects. We find that overall welfare increases, but informality rises by 2.7 percent, while tax revenues and output decrease by roughly 0.1 percent. Given the extent of the expansion in eligibility, the economic relevance of these results seems negligible. However, this occurs because the expansion of coverage was mostly funded by reducing the spending per-insured person. In fact, we find larger costs if public spending is increased to improve the quality of service given universal coverage.