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.
Mr. David Coady, Mr. Benedict J. Clements, and Mr. Sanjeev Gupta
Using cross-country analysis and case studies, this book provides new insights and potential policy responses for the key fiscal policy challenges that both advanced and emerging economies will be facing.
This technical note analyzes the health care spending issues in advanced economies. Both public and total health spending have increased substantially in advanced countries. Total health spending increased by more than 6 percentage points of GDP in the Organization for Economic Cooperation and Development countries between 1970 and 2007. This note examines the recent trends in health care spending in advanced countries. It discusses the main challenges for advanced countries over the medium term. Policy options for containing health care costs are also described.
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.
Mr. Nicolas R Blancher, François Haas, Mr. John Kiff, Ms. Oksana Khadarina, Mr. Paul S. Mills, Parmeshwar Ramlogan, Mr. William Lee, Ms. Yoon Sook Kim, Todd Groome, and Mr. Shinobu Nakagawa
The paper discusses the limits to market-based risk transfer in the financial system and the implications for the management of systemic long-term financial risks. Financial instruments or markets to transfer and better manage these risks across institutions and sectors are, as yet, either nascent or nonexistent. As such, the paper investigates why these markets remain "incomplete." It also explores a range of options by which policymakers may encourage the development of these markets as part of governments' role as a risk manager.
This Selected Issues paper examines Germany’s growth record in 1992–2001 and analyzes how future performance might be enhanced. The paper focuses on the longer-term strains on the public finances. It reviews Germany’s external competitiveness, which deteriorated substantially in the wake of unification, and concludes that, by the beginning of the current decade, competitiveness had been largely restored. The paper also examines the recent slowdown in credit, which has gone beyond what might be expected on cyclical grounds.
This Selected Issues paper highlights that over the past decade, the Netherlands has undergone a remarkable fiscal adjustment, with the deficit, the tax burden, and the expenditure-to-GDP ratio falling significantly. The switch from a deficit-target-based to an expenditure-target-based fiscal framework in 1994 and commitments to two successive four-year fiscal plans have played an important role. The current multiyear framework expires in 2002, and the Study Group on the Budgetary Margin has produced recommendations for the coming government period.
The IMF Working Papers series is designed to make IMF staff research available to a wide audience. Almost 300 Working Papers are released each year, covering a wide range of theoretical and analytical topics, including balance of payments, monetary and fiscal issues, global liquidity, and national and international economic developments.
Health policy has been for some time high on the agenda of many countries--and where it has not, it should be. Since no ideal model of health services has ever been devised 9 one may look for favorable elements in the health sector of a given country and examine their applicability to other countries. This paper analyzes Israel’s health sector in this context.
High and rapidly rising health care costs in the United States and growing ranks of uninsured persons have brought health care reform to the top of the U.S. Administration’s policy agenda. This paper describes the health care financing system in the United States, highlights what are viewed as its most serious shortcomings, and explores possible reasons for high and rising medical care costs. After brief descriptions of alternative reform proposals, the paper discusses universal coverage under managed competition and its ability to deal with the equity and efficiency problems in the U.S. health care system.