- Peter Heller, and William Hsiao
- Published Date:
- April 2007
© 2007 International Monetary Fund
Production: IMF Multimedia Services Division
Cover Design: Lai Oy Louie
Typesetting: Alicia Etchebarne-Bourdin
Cover Photo: ©Worldwide Rights/Northfoto
Hsiao, William C.
What macroeconomists should know about health care policy/William C. Hsiao and Peter S. Heller.—Washington, D.C. : International Monetary Fund, .
- p. cm.
Includes bibliographical references.
- 1. Medical economics. 2. Medical policy—Economic aspects. 3. Medical care—Economic aspects. I. Heller, Peter S. II. International Monetary Fund.
RA410 .H753 2007
Disclaimer: This publication should not be reported as representing the views or policies of the International Monetary Fund. The views expressed in this work are those of the authors and do not necessarily represent those of the IMF, its Executive Board, or its management.
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- 1. Introduction and Guide to the Primer
- 2. Why Is It Critical for Macroeconomists to Understand Health Issues?
- 3. Facts and Myths about Health Care and the Health Sector
- 4. Health Policy Challenges and Issues Confronting Nations
- 5. Conceptual Framework for Classifying Health Systems
- 6. Stages of Health System Development and Health System Performance
- 7. What Role Can Macroeconomists Play?
- 1. United States: Contingency Table of Health Care Expenditure, 2002
- 2. United States: Health Expenditure for Five Most Costly Conditions, 2002
- 3. Selected Countries: Projected Shares of Elderly People and the Support Ratio, 2000–50
- 4. Summary of Studies of the Macroeconomic Impact of HIV/AIDS in Africa
- 5. Progress on Millennium Development Goals in Fragile States Compared with Other Poor Countries, 2000
- 6. The Objectives of a Health System
- 7. Health Care Financing and Service Provision, by Stage of Economic Development
- 8. Economic Development Stage I: Three-Tier Health Care System
- 9. Selected Low- and Lower-Middle-Income Countries: Health Expenditure and Results by Model
- 10. Low- and Lower-Middle-Income Countries: Comparison of Health Care System Performance
- 11. Input and Output Indicators of a Best-Performing Low-Income Country: Sri Lanka
- 12. Input and Output Indicators of a Median-Performing Low-Income Country: Belize
- 13. Upper-Middle-Income Countries: Health Care Expenditure and Results by Model
- 14. Upper-Middle-Income Countries: Comparison of Performance by Model
- 15. Input and Output Indicators of Two Best-Performing Upper-Middle-Income Countries
- 16. Input and Output Indicators of a Median-Performing Upper-Middle-Income Country: Colombia
- 17. High-Income Countries: Health Expenditure and Results by Model
- 18. Comparison of Performance: Advanced Economies
- 19. Input and Output Indicators of “Best”-Performing Country among Advanced Economies: Canada
- 20. Selected Transition Countries: Social Insurance Arrangements
- 21. Middle-Income Transition Economies: A Summary of Common Health Sector Problems, Reform Measures, and Consequences
- 1. A Road Map for Reading the Primer
- 2. Channels through Which Health May Influence Macroeconomic and Microeconomic Variables
- 3. United States: Average Health Care Expenditure by Age Group, 1999
- 4. Selected Countries: Total Health Care Expenditure, 1960–2003
- 5. United States: Concentration of Health Care Expenditure over Time
- 6. Means, Intermediate Ends, and Final Ends of a Health System
- 7. Selected Countries: Comparison of Actual National Health Expenditure and Government Statistics on Health Expenditure
- 8. Government Revenue as a Fraction of GDP, by Average per Capita Income Level
- 9. Selected Transition Countries: Government Revenue
- 10. Selected Transition Countries: Number of Physicians
- 11. Selected Transition Countries: Number of Hospital Beds
Commission on Macroeconomics and Health (WHO)
Diagnostic related group
Gross domestic product
Gross national income
Human immunodeficiency virus/acquired immune deficiency syndrome
International financial institution
International Monetary Fund
Low Income Countries Under Stress
Millennium Development Goals
Medical savings account
National Health Account
Organization for Economic Cooperation and Development
Purchasing power parity
Severe acute respiratory syndrome
World Health Organization
Economic policymakers often measure their success solely by their country’s economic growth. As a result, they devote most of their time and efforts to thinking about macroeconomic policy issues, overlooking the way in which macroeconomic policy is influenced by and influences the social sectors—education, health, and income security. Over the past decades, structural adjustment policies have had a profound impact on the social sectors and on social development in low-income countries. And in many industrial countries, policymakers are increasingly aware that developments in the health and pension areas will create fiscal pressures that have implications for the macroeconomic policy framework.
Although incorporating health concerns into macroeconomic policy (and vice versa) requires an understanding of health economics, macroeconomics and health economics are two distinct fields. Seldom does a specialist in one field have more than a modest understanding of the other. More important, macroeconomists and economic policymakers frequently assume that social sector policies should follow the free market strategy that has worked so well in fostering economic growth. This leads them to simply apply efficient market theory in devising policies related to the social sectors, thus ignoring the ways in which various market failures make such an approach undesirable.
This primer is a step toward bridging the divide between macroeconomic policy and health policy. It aims to acquaint macroeconomists with some fundamental facts about the economics of health care and the major health issues confronting countries. It provides a perspective for examining a country’s health care system by suggesting some broad parameters that macroeconomists can use to evaluate a country’s health policy and the performance of its health system.
This Special Issues paper has been made possible by the generous contributions of many people. The authors benefited greatly from discussions with Sanjeev Gupta of the IMF, and in particular from his insights into macroeconomic policy and social development. Other IMF economists offered insightful comments on the earlier version of this primer, including Juan Pablo Cordoba, Luis Cubeddu, Philip Gerson, Robert Gillingham, Thomas Richardson, Markus Haacker, and George Tsibouris. Philip Musgrove also provided valuable comments. Alexander Preker, George Schieber, and Kei Kawabata of the World Bank helped the authors focus on the major issues facing low-income and middle-income countries and contributed to the paper’s substance and empirical evidence. Finally, Yessica Alvarado provided superb secretarial skills in putting this paper to bed.