- David Coady, Benedict Clements, and Sanjeev Gupta
- Published Date:
- May 2012
The Economics of Public Health Care Reform in Advanced and Emerging Economies
Benedict Clements, David Coady,
and Sanjeev Gupta
© 2012 International Monetary Fund
Cover design: IMF Multimedia Services Division
Cover illustration: Design Army
Typesetting: Maryland Composition, Inc.
The economics of public health care reform in advanced and emerging economies / editors, Benedict Clements, David Coady, and Sanjeev Gupta. - Washington, D.C. : International Monetary Fund, 2012.
Includes bibliographical references.
I. Health care reform. 2. Health care reform—Developed countries. 3. Health care reform—Developing countries. 4. Health care reform—Case studies. I. Clements, Benedict J. II. Coady, David. III. Gupta, Sanjeev. IV. International Monetary Fund.
Disclaimer: The views expressed in this book are those of the authors and should not be reported as or attributed to the International Monetary Fund, its Executive Board, or the governments of any of its members.
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- Carlo Cottorelli
- PART I TRENDS AND OUTLOOK FOR PUBLIC HEALTH SPENDING
- 1 The Challenge of Health Care Reform in Advanced and Emerging Economies
- Sanjeev Gupta, Benedict Clements, and David Coady
- 2 Public Health Care Spending: Past Trends
- David Coady and Kenichiro Kashiwase
- 3 New Projections of Public Health Spending, 2010-50
- Mauricio Soto, Baoping Shang, and David Coady
- PART II THE ROLE OF THE PRIVATE SECTOR IN HEALTH CARE FINANCING AND DELIVERY
- 4 The Future of Public and Private Health Care Insurance in Asia
- Ludwig Kanzler and Alexander Ng
- 5 Perspective on the Appropriate Role of the Private Sector in Meeting Health Care Needs
- Tsung-Mei Cheng and Uwe E. Reinhardt
- PART III CROSS-COUNTRY STUDIES
- 6 Containing Public Health Spending: Lessons from Experiences of Advanced Economies
- Justin Tyson, Kenichiro Kashiwase, Mauricio Soto, and Benedict Clements
- 7 Health Reform Lessons from Experiences of Emerging Economies
- Eva Jenkner, Baoping Shang, and Benedict Clements
- 8 Health Financing Systems in East Asia and the Pacific: Early Successes and Current Challenges
- John C. Langenbrunner and Ajay Tandon
- 9 Measuring the Health Effects of Health Care Reform
- Jonathan Skinner and Catherine Suarez
- PART IV COUNTRY CASE STUDIES: ADVANCED ECONOMIES
- 10 Public Health Expenditure Reforms in Canada, Finland, Italy, the Netherlands, Sweden, the United Kingdom, and the United States
- Justin Tyson and lzabela Karpowicz
- 11 Challenges in Reforming the Japanese Health Care System
- Masako li
- 12 Coverage Expansion and Cost Containment in the Republic of Korea
- Soonman Kwon
- 13 Containing Public Health Spending through Market-Based Health Reform in Germany
- Michael Stolpe
- 14 Taiwan Province of China’s Experience with Universal Health Care Coverage
- Tsung-Mei Cheng
- PART V COUNTRY CASE STUDIES: EMERGING ECONOMIES
- 15 Health Care Financing Reform in India’s Decentralized Health Care System
- M. Govinda Rao and Mita Choudhury
- 16 I Evidence-Based Health Financing Reform in Thailand
- Pongpisut Jongudomsuk, Supon Limwattananon, Phusit Prakongsai, Samrit Srithamrongsawat, Kumaree Pachanee, Adun Mohara, Walaiporn Patcharanarumol, and Viroj Tangcharoensathien
- 17 The Challenge of Health Care Reform in Estonia, Hungary, China, Chile, and Mexico
- Baoping Shang and Eva Jenkner
The mandate of the International Monetary Fund is primarily focused on macro-economic stabiliry. While recognizing that the issue of health care reform has much broader implications, in this volume we look at health care reform through the lens of our mandate, focusing primarily on macroeconomic stability and—of special importance to us in the IMF’s Fiscal Affairs Department—on fiscal stability.
Health care reform has key implications for fiscal stability. Public spending on health care has been a key driver of aggregate increases in public spending over the past 40 years. As discussed in this book, spending is projected to continue rising as a share of GDP unless reforms are undertaken to help break these trends. The projected increases in public health spending will take place at a time when most countries need to undertake large fiscal adjustments to help bring public debt ratios down to more prudent levels. In this light, public health care spending is indeed an important macro-fiscal issue. Moderating the growth of age-related spending, including on health, will have to be a major element of the fiscal consolidation strategy in the advanced economies over the coming years. For many emerging economies, the outlook for health spending is better, and immediate pressures are expected to be more benign. But it will by no means be easy for emerging economies to expand access to and improve the quality of health care services in light of the limited fiscal space to increase public health spending.
Despite the fiscal importance of health care reform, there has been relatively little systematic work on the macro-fiscal implications of reforms in advanced economies and emerging markets. Recent work by the Fiscal Affairs Department has tried to fill that void, both by projecting future health care spending if current policies were to be maintained and by estimating the potential fiscal impact of various reform options to contain health spending growth. This book draws on a recent study on the macro-fiscal implications of health care reforms presented to the IMF Executive Board in January 2011 and on papers prepared by outside experts for conferences at the IMF Regional Offices for Europe and Asia and the Pacific in June 2011 and October 2011, respectively.
An important objective of the IMF’s analytical work in this area—and of our continued dialogue with health experts—is to improve our understanding of how feasible it would be to slow down the projected growth of health spending. This, in turn, has an important bearing on the composition of fiscal consolidation strategies going forward, since insufficient scope for containing health spending increases would shift the burden of expenditure cuts to other areas or require revenues to increase.
Health care reform is a difficult policy issue. It involves complex trade-offs between policy goals, such as ensuring access to high-quality health care and keeping public spending at fiscally affordable levels. Preferences regarding the role of the state in the provision and financing of health care services also vary significantly across countries. Many of these issues go beyond the scope of our work in this area. However, with a combination of cross-country analyses and case studies—and not least based on the stimulating debate within and outside the IMF on these issues—this book identifies potential policy responses to contain public health spending pressures in an efficient and equitable manner. Of course, much remains for us to learn, and the IMF will continue to stay abreast of new developments and insights in this complex area of policy.
Fiscal Affairs Department
International Monetary Fund
We first would like to thank the contributing authors. Without their hard work and dedication, this book would not have been possible. The book has also benefited from the comments of staff in the IMF’s Fiscal Affairs Department, staff in other IMF departments, and seminar participants from the European Commission, the World Bank, and the Organization for Economic Cooperation and Development. Many of the chapters in this volume were presented as papers at IMF health conferences in Paris in June 2011 and Tokyo in October 2011. We would like to thank conference participants for their valuable comments.
We are grateful to Joanne Blake and Michael Harrup of the IMF’s External Relations Department for managing the production of the book. We are thankful to Pierre Jean Albert, Jeffrey Pichocki, and Mileva Radisavljevic, staff in the Fiscal Affairs Department’s Expenditure Policy Division, for their support throughout the entire process. We are also grateful to Baoping Shang—who worked with us from the beginning when the book project was conceived—for his written contributions and efforts to ensure that all steps in the production process were followed in a timely manner.
Arzneimittelmarktneuordnungsgesetz (law regulating reimbursement for drugs) (Germany)
Association of Southeast Asian Nations
Bureau of National Health Insurance (Taiwan Province of China)
compound annual growth rate
cyclically adjusted primary balance
consumer-directed Health care
Children’s Health Insurance Program (United States)
Civil Servant Medical Benefit Scheme (Thailand)
data envelopment analysis
disease management program
East Asia and the Pacific
excess cost growth
free disposable hull
Second-Generation National Health Insurance (Taiwan Province of China)
Gemeinsamer Bundesausschuss (Federal Joint Committee) (Germany)
gross state domestic product (India)
Health Insurance Fund (Hungary)
Health Insurance System Research Office (Thailand)
Health Intervention and Technology Assessment Program (Thailand)
Health maintenance organization
Health savings account
Health Systems Research Institute (Thailand)
International Health Policy Program (Thailand)
Institut fur Qualität und Wirtschaftlichkeit im Gesundheitswesen (Institute for Quality and Efficiency in Health Care) (Germany)
National Health Account (Thailand)
National Health insurance
National Health Insurance (Japan, Taiwan Province of China)
National Health Insurance Corporation (Republic of Korea)
National Health Service (U.K.)
National Rural Health Mission (India)
Organization for Economic Cooperation and Development
ordinary least squares
out of pocket
Popular Health Insurance (Mexico)
purchasing power parity
Rashtriya Swastya Bima Yojana (health insurance scheme for those below the poverty line) (India)
statutory health insurance
social health insurance (Thailand)
universal health coverage
World Health Organization