1. Public Expenditures in Health

2. Main Principles Establish Market Failures Identify beneficiaries of expenditures Balance potential benefits with ability to deliver services

3. Health - Market Failures Public goods (pest control, sanitation, health education) Externalities (infectious disease control) Information advantage of doctors Insurance

4. Health - equity concerns Inequities in health status Inequities in benefits of services

5. The poor are sicker than other people: Mortality by “wealth”- Brazil, 1996

6. Incidence of disease by “wealth” India 1992-3

7. Female 45Q15 by cause of death by income group, China 1987

8. Health - Problems of Implementation Management challenge –Personnel placement –Quality of services Conscientious providers Maintenance of facilities Political Influence

9. Health: Complementarity/ conflict between goals Public goods - strong complementarity Primary health care - modest efficiency effects (varies), potentially high equity effects, difficult management Hospitals - high efficiency, high potential but low actual equity effects, easier management(?)

10. In Brazil: the poor have worse sanitation facilities... % with no sanitation facilities

11. …they have less access to safe water...

12. …and this costs the lives of their children Mortality rate

13. Health: Complementarity/ conflict between goals Public goods - strong complementarity Primary health care - modest efficiency effects (varies), potentially high equity effects, difficult management Hospitals - high efficiency, high potential but low actual equity effects, easier management(?)

14. Determinants of infant mortality

15. Philippines: Effect of public medical care Poor areaNot-so-poor area

16. Substitution between public and private providers

17. Distribution of health care subsidies, Indonesia

18. Health: Complementarity/ conflict between goals Public goods - strong complementarity Primary health care - modest efficiency effects (varies), potentially high equity effects, difficult management Hospitals - high efficiency, high potential but low actual equity effects, easier management(?)

19. Value of insurance as a % of expected cost

20. Priorities in health policy