2.5 Trends of Public Health Care Expenditure In a studyconducted by Goldsbrought et al.
(2007) on low incomecountries with IMF program taken indicate that health spending in relation to GDProse quite rapidly through the early-1990s but then dropped in the mid-1990s.It began to rise again, moderately, in the late 1990s a period that coincidedwith the increased prevalence of debt relief, but only regained its previouspeaks, of around 2 1/2 per cent of GDP in 2000-2001 and has not risen muchabove these levels subsequently.Trendsin the share of total government spending allocated to health show a similarpattern a strong trend increased through the early 1990s that was partlyreversed in the mid-1990s. Viewed in this longer-term context, the increasingshare of total spending going to health since the late 1990s has only managedto restore previous peaks (Goldsbrought, et al.
2007). Theauthors found that government health spending has increased moderately sincethe late 1990s through they lamented that the increment is only sufficient toreverse an earlier decline that took place in the mid-1990s. They also foundthat there were no major differences between recent trends in health spendingas a share of GDP or as a share of total government spending in the groups ofprogramme and non-programme countries outside of Africa.A recentstudy by Rashidul’alam et al (2015) investigates the trendof determinants of health care expenditure in Bangladesh the study uses annualtime series data for the period 1995 to 2010. The authors employed simpleregression analysis and t-test to compare between public and private healthcareexpenditure they found that public health care expenditure as a share of GDPwas stabilized from 1995 but private health care expenditure was increasingfrom the early 1997s.
InSub-Saharan Africa total government spending increased more in the group ofprogramme countries, but the difference are not large, especially in light ofthe size of external resources directed towards the health sector. Finally,they found that estimates of the impact of IMF – supported programmes on healthspending were complicated by a number of econometric difficulties but availableestimates suggest little overall impact; at least programmes may be associatedwith a small and relatively short-lived increase in health spending but inpractice it is not possible to distinguish between the effects of the IMFprogramme and other factors such as HIPC debt relief.Onfiscal targets, the authors found that there has been some shift towards moreexpansionary fiscal programs but even in the latest (2003-2006) period mostprograms targeted relatively small increase in the deficit that tapered off bythe end of the 3-year period.
The same pattern occurred in projection ofgrants, a moderate increase in the first year of the programme which disappearsby the third year. Whether this represents sufficient fiscal flexibilitydepends on judgments regarding likely financing prospects as well as the usesand effect of additional government expenditure. These questions can only be answertaking into account the circumstance in each country.
Shenggen and Anuja (2007) examined publicspending in developing countries; trends determination, and impact; the studyrevealed that over the past two decades total government expenditures, in 44developing countries considered in the study experienced overall growth. Duringthe 1980s, expenditures increased from $993 billion in 1980 to $1,595 billionin 1990s with an annual growth rate of 4.8 percent. In the 1990s governmentsincreased their spending power by 5.6 percent per year. By 2000, totalgovernment expenditure increased to $2,748 billion.
They further reached$3,347.6 billion in 202. Therefore, there is accelerated growth in governmentexpenditure in developing countries.However,amongst developing countries, regional variation from these averages were quitemarket. Across all regions, Asia experienced the most rapid growth, whileAfrica and Latin America increased at a much slower pace.
In fact, most of the increasesin total government expenditure come from Asia, accounting for 67 percent oftotal expenditures in 2002, up from 50 percent 1980. This is due to the factthat the most Asian countries experienced rapid growth in per capita GDP. Withexception of Sri Lanka and Myanmar, all countries in the region at leastdoubled their total expenditures from the period 1980-2002. Republic of Koreaand Bangladesh had the most rapid growth over 1980-2002, followed by India andThailand.
ForAfrican countries, expenditures grew at 3.8 percent over 1980-2002. Growth wasmuch slower in the 1980s at 2.92 percent per annum.
In fact, there was a briefcontraction after 1982 and it was not until 1986 that total governmentexpenditure recollected to 1982 levels, when many African countries implementedmacroeconomic structural adjustments.Elijah and Shoria (2009) assessedcapital flows in the health care sector in Zimbabwe; Trends and implicationsfor health system; using a literature review, an initial mapping and review ofcapital flows in the Zimbabwe health sector, drawing on both quantitative andquantitative secondary evidence from 1995-2005. The study revealed that, theperiod 1980-1990 saw rapid expansion of public sector health facilities as theZimbabwe government implemented the post-independence government implementedthe post-independence planning for Equity in Health policy, with health sectorexpansion linked to their development programs (Sanders, 1990).By 2000, 456 health centers, 612 rural hospitals 25 district hospitals and aprovincial hospital in each of the country’s provinces had been built orupgraded, resulting in 85 per cent of the population willing within 8 km of ahealth facility.In apaper by UNICEF (2003), on fiscal space and public Expenditure onthe social sectors indicated that the general trend was one of rising domesticrevenue accompanies by increased aid (concentrated particularly in thecountries receiving debt relief) and by restraint in expenditure to restorefiscal stability.