The Effects of a Fee-waiver Program on Health Care Utilization Among the Poor
The Effects of a Fee-waiver Program on Health Care Utilization Among the Poor

Author: Nazmul Chaudhury

Publisher: World Bank Publications

Published: 2003

Total Pages: 44

ISBN-13:

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This study examines the impact of a fee-waiver program for basic medical services on health care utilization in Armenia. Because of the reduction in public financing of health services and decentralization and increased privatization of health care provision, private out-of-pocket contributions are increasingly becoming a significant component of health costs in Armenia. To help poor families cope with this constraint, the Armenian government provided a free-of-charge basic package service to eligible individuals in vulnerable groups, such as the disabled and children from single parent households. Drawing on the 1996 and 1998-99 Armenia Integrated Survey of Living Standards (AISLS), which allows the identification of eligible individuals under this program, the authors estimate the impact of the fee-waiver program on utilization of health services, particularly among the poor. Across the two survey rounds utilization rates have indeed declined despite comparable levels of income, and this decline has occurred among both the poor and the rich, with average utilization falling by 12 percent between the two surveys. But families with four or more children, the largest beneficiary group under the "vulnerable population" program, have decreased their use of health care services in a disproportionate manner--21 percent reduction in use between the two survey rounds. This precipitous drop in health care use by this vulnerable group, despite being eligible for free medical services, suggests that the program was inadequate in stemming the decline in the use of health services. The authors further present evidence to suggest that the free-of-charge eligibility program acts more like an income transfer mechanism, particularly to disabled individuals. This paper--a joint product of Public Services, Development Research Group, and the Human Development Sector Unit, Europe and Central Asia Region--is part of a larger effort in the Bank to understand the impact of health sector reform on health care utilization and poverty.

Analyzing the Distributional Impact of Reforms, 2
Analyzing the Distributional Impact of Reforms, 2

Author: Aline Coudouel

Publisher: World Bank Publications

Published: 2005

Total Pages: 470

ISBN-13: 0821363492

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"The analysis of the distributional impact of policy reforms on the well-being or welfare of different stakeholder groups, particularly on th e poor and vulnerable, has an important role in the elaboration and implementation of poverty reduction strategies in developing countries. In recent years this type of work has been labeled as Poverty and Social Impact Analysis (PSIA) and is increasingly implemented to promote evidence-based policy choices and foster debate on policy reform options. While information is available on the general approach, techniques, and tools for distributional analysis, each sector displays a series of specific characteristics. These have implications for the analysis of distributional impacts, including the types of impacts and transmission channels that warrant particular attention, the tools and techniques most appropriate, the data source typically utilized, and the range of political economy factors most likely to affect the reform process. This volume provides an overview of the specific issues arising in the analysis of the distributional impacts of policy and institutional reforms in selected sectors. Each chapter offers guidance on the selection of tools and techniques most adapted to the reforms under scrutiny, and offers examples of applications of these approaches. This is a companion to the first volume, which offers guidance on trade, monetary and exchange rate policy, utility provision, agricultural markets, land policy, and education."

Short But Not Sweet
Short But Not Sweet

Author: Carolina Sánchez-Páramo

Publisher: World Bank Publications

Published: 2003

Total Pages: 52

ISBN-13:

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India spends 6 percent of its GDP on health-three times the amount spent by Indonesia and twice that of China-and spending on non-chronic morbidities is three times that of chronic illnesses. It is normally assumed that the high spending on non-chronic illnesses reflects the prevalence of morbidities with high case-fatality or case-disability ratios. But there is little data that can be used to separate out spending by type of illness. The authors address this issue with a unique dataset where 1,621 individuals in Delhi were observed for 16 weeks through detailed weekly interviews on morbidity and health-seeking behavior. The authors' findings are surprising and contrary to the normal view of health spending. They define a new class of illnesses as "short duration morbidities" if they are classified as non-chronic in the international classification of disease and are medically expected to last less than two weeks. The authors show that short duration morbidities are important in terms of prevalence, practitioner visits, and household health expenditure: Individuals report a short duration morbidity in one out of every five weeks. Moreover, one out of every three weeks reported with a short duration morbidity results in a doctor visit, and each week sick with such a morbidity increases health expenditure by 25 percent. Further, the absolute spending on short duration morbidities is similar across poor and rich income households. The authors discuss the implications of these findings in understanding household health behavior in an urban context, with special emphasis on the role of information in health-seeking behavior.

Informality Revisited
Informality Revisited

Author: William Francis Maloney

Publisher: World Bank Publications

Published: 2003

Total Pages: 32

ISBN-13:

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The author develops a view of the informal sector in developing countries primarily as an unregulated micro-entrepreneurial sector and not as a disadvantaged residual of segmented labor markets. Drawing on recent work from Latin America, he offers alternative explanations for many of the characteristics of the informal sector customarily regarded as evidence of its inferiority.

Policy Options for Meeting the Millenium Development Goals in Brazil
Policy Options for Meeting the Millenium Development Goals in Brazil

Author: Francisco H. G Ferreira

Publisher: World Bank Publications

Published: 2003

Total Pages: 44

ISBN-13:

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Ferreira and Leite investigate whether micro-simulation techniques can shed light on the types of policies that should be adopted by countries wishing to meet their Millennium Development Goals. They compare two families of micro-simulations. The first family of micro-simulations decomposes required poverty changes into a change in the mean and a reduction in inequality. Although it highlights the importance of inequality reduction, it appears to be too general to be of much use for policymaking. The second family of micro-simulations is based on a richer model of behavior in the labor markets. It points to the importance of combining different policy options, such as educational expansion and targeted conditional redistribution schemes, to ensure that the poorest people in society are successfully reached. But the absence of market equilibria in these statistical models, as well as the strong stability assumptions which are implicit in their use, argue for extreme caution in their interpretation. This paper--a product of the Poverty Team, Development Research Group--is part of a larger effort in the group to understand pro-poor policies.

The Future of the Public's Health in the 21st Century
The Future of the Public's Health in the 21st Century

Author: Institute of Medicine

Publisher: National Academies Press

Published: 2003-02-01

Total Pages: 536

ISBN-13: 0309133181

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The anthrax incidents following the 9/11 terrorist attacks put the spotlight on the nation's public health agencies, placing it under an unprecedented scrutiny that added new dimensions to the complex issues considered in this report. The Future of the Public's Health in the 21st Century reaffirms the vision of Healthy People 2010, and outlines a systems approach to assuring the nation's health in practice, research, and policy. This approach focuses on joining the unique resources and perspectives of diverse sectors and entities and challenges these groups to work in a concerted, strategic way to promote and protect the public's health. Focusing on diverse partnerships as the framework for public health, the book discusses: The need for a shift from an individual to a population-based approach in practice, research, policy, and community engagement. The status of the governmental public health infrastructure and what needs to be improved, including its interface with the health care delivery system. The roles nongovernment actors, such as academia, business, local communities and the media can play in creating a healthy nation. Providing an accessible analysis, this book will be important to public health policy-makers and practitioners, business and community leaders, health advocates, educators and journalists.

For Protection and Promotion
For Protection and Promotion

Author: Margaret Grosh

Publisher: World Bank Publications

Published: 2008-08-25

Total Pages: 614

ISBN-13: 0821375822

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Safety nets are noncontributory transfer programs targeted to the poor or vulnerable. They play important roles in social policy. Safety nets redistribute income, thereby immediately reducing poverty and inequality; they enable households to invest in the human capital of their children and in the livelihoods of their earners; they help households manage risk, both ex ante and ex post; and they allow governments to implement macroeconomic or sectoral reforms that support efficiency and growth. To be effective, safety nets must not only be well intended, but also well designed and well implemented. A good safety net system and its programs are tailored to country circumstances, adequate in their coverage and generosity, equitable, cost-effective, incentive compatible, and sustainable. Good safety nets are also dynamic and change over time as the economy changes or as management problems are solved and new standards are set. Drawing on a wealth of research, policy, and operational documents from both academia and the World Bank s work in over 100 countries, For Protection and Promotion provides pragmatic and informed guidance on how to design and implement safety nets, including useful information on how to define eligibility and select beneficiaries, set and pay benefits, and monitor and evaluate programs and systems. The book synthesizes the literature to date and enriches it with new examples on various program options cash transfers (conditional and unconditional), in-kind transfers, price subsidies, fee waivers, and public works. It concludes with a comprehensive diagnostic for fitting safety net systems and programs to specific circumstances.

High consumption Volatility
High consumption Volatility

Author: Philippe Auffret

Publisher: World Bank Publications

Published: 2003

Total Pages: 40

ISBN-13:

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A history of repeated external and domestic shocks has made economic insecurity a major concern across the Caribbean region. Of particular concern to all households, especially the poorest segments of the population, is the exposure to shocks that are generated by catastrophic events or natural disasters. The author shows that despite high consumption growth, the Caribbean region suffers from a high volatility of consumption that decreases household welfare. After presenting some empirical evidence that consumption volatility is higher in the Caribbean region than in the rest of the world, he makes some empirically testable inferences that help explain consumption volatility. The author develops a conceptual framework for analyzing the effects of catastrophic events on household and aggregate welfare. According to this framework, the volatility of consumption comes from production shocks that are transformed into consumption shocks mostly because of underdeveloped or ineffective risk-management mechanisms. Auffret conducts an empirical analysis of the impact of catastrophic events on 16 countries (6 from the Caribbean region and 10 from Latin America) from 1970-99 and shows that catastrophic events lead to: 1) A substantial decline in the growth of output. 2) A substantial decline in the growth of investment. 3) A more moderate decline in consumption growth (most of the decline is in private consumption, while public consumption declines moderately. 4) A worsening of the current account of the balance of payments.