Higher Public Expenditure Research Articles

Perfil epidemiológico de infecciones respiratorias agudas en adultos hospitalizados.

Introducción: Las enfermedades respiratorias agudas constituyen una de las patologías de alta prevalencia en los pacientes hospitalizados en las áreas clínicas y conlleva un alto gasto público y social.
 Objetivo: Describir los aspectos epidemiológicos de las enfermedades respiratorias agudas en pacientes mayores de 18 años ingresados en el área clínica del Hospital General Ambato.
 Material y métodos: Estudio de tipo descriptivo, retorspectivo, basado en la revisión de historias clínicas de pacientes ingresados al Hospital General Ambato durante el periodo de enero 2017 a junio del 2017.
 Resultados: Las enfermedades respiratorias agudas representan el 16% de las hospitalizaciones, la Enfermedad Pulmonar Obstructiva Crónica exacerbada / sobreinfectada se presentó en el 43% de los pacientes seguida por la Neumonia asociada a la comunidad 23%, el género masculino represento el 54,3 %, la edad promedio fue de 73,3 años, el 27,2 % de los pacientes tubieron hábito tabáquico, el 87,5 % de los casos presentó algun tipo de comorbilidad asociada al diagnóstico de ingreso, la mortalidad alcanzo el 9%.
 Conclusiones: Las enfermedades respiratorias agudas representan el 16% de causas de hospitalización en las áreas clínicas, la EPOC exacerbada /sobreinfectada junto con la Neumonia comunitaria son las patologias más prevalentes en este grupo de pacientes

Salamanca 1994-2019: there is still a long way to Latin America

ABSTRACTThis article analyses the progresses and challenges in education in Latin America since the Salamanca World Conference on Special Needs Education. The main advances have been in the access to education of a greater number of students derived from a higher public expenditure. The challenges that still exist can be summed up through insufficient educational quality, especially with regard to the situation of teachers and the infrastructure of schools. It’s difficult to collect appropriate, rigorous and accurate data for special needs education. The article concludes by pointing out the importance of rebuilding three bridges to move faster in the inclusive process: first, a political bridge to agree on the improvement of the educational budget during the next decade; a social and cultural bridge that supports attitudes of citizens in favour of diversity and inclusion; and finally, an educational bridge with two fundamental pillars: education of infant and young children and training and professional development for teachers.

Pilot Study on the Cost of Some Oncohematology Diseases in Bulgaria.

The goal of the current study is to perform a pilot study of the cost of some oncohematology diseases in Bulgaria. This is a pilot broader burden of disease research. The official report of the National health insurance fund provided information about the total expenditures paid for medicines, ambulatory services, and hospitalizations in 2015 and 2016. To evaluate the costs from a patient perspective, an internet inquiry was organized with the support of the patient organization. The inquiry contained questions regarding the patients' demography, type of oncohematology disease, year of diagnosis, quality of life (EuroQol v5D), and additional out of pocket expenditures. Quality of Life data were statistically analyzed and Kruskal-Wallis analysis of variance was performed. From 2015 to 2016 the number of patients with oncohematological diseases decreased by approximately 3000 people. Less than 30% were hospitalized and the hospitalization cost decreased, but the cost for medicines increased by nearly 1.5 million Euros. Cost for medicines almost tripled the hospitalization cost. The reported mean quality of life was 0.749 (SD 0.203). There was positive correlation between QoL and current disease state (p = 0.008) and age (p = 0.025). 42% reported to have additional expenditures related to their oncohematology disease, 22% reported other expenditures (diet, change of everyday habits etc.) and 42% reported to have productivity loses due to loss of employment or change of work, 44% of the respondents reported additional payment for medicines for concomitant diseases. Thus, the total cost (public funds and patients) accounted for 37,708,764 Euro. Despite the high public expenditures, the indirect costs due to productivity loses are higher. Costs for medicines are higher than costs of inpatient treatment, but this tendency is observed in all European countries. The increases in the costs of medicines are compensated by reduced costs of hospitalization. Despite their higher costs, newer medicines are an effective and reasonable investment from a societal perspective. Currently the higher levels of copayment increase the burden on the patients.

Differences in care use between men and women: The role of publicly financed and informal care at home

Although most recipients of long-term care are women, due to rising life expectancy among men, future users of care are increasingly likely to be men. There are indications that gender is an important factor in the way in which a country organizes its care, and that social policy can have diverging outcomes on the average health of men and women. Nevertheless, gender differences in the use of care are seldom considered. Research into possible explanations for these differences has focused mainly on differences between individual characteristics of men and women. In addition, this study examines the effect of public spending on professional home care and the average availability of informal care by over-50s on the actual use of care. Data from the Survey of Health, Ageing and Retirement 2004, 2007, and 2013 from eight European countries were used, in combination with OECD data on public spending on professional home care. A multinomial regression with fixed effects was estimated for the correlation between these macro characteristics and individual use of care for men and women separately. Findings show that higher public expenditure on home care is associated with less use of paid care, but also that this is particularly the case among men (“paid care” includes care paid for by the user himself or herself). More plentiful informal care is associated with lower use of paid care, in both men and women. One of the possible implications for future policy on long-term care is that men are relatively more likely to respond to changes in the availability of home care than women and that this responsiveness will become even more marked as the proportion of men using care rises.

Which are the Factors Influencing Innovation Performances? Evidence from Italian Cohesion Policy

Our paper aims at evaluating the role that the local administrations play on Italian regional innovation performance, by using a revised version of Regional Innovation Scoreboard. Carrying out a panel data analysis and a logistic regression, the analysis is based on a combined approach towards institutions, involving socio-political aspects, considered by the institutional quality index, and the capability of regional administrators of expending Structural and Cohesion Funds, by a quantitative index. Firstly, a panel data analysis helped us to highlight the role of institutions and which sectoral themes of EU investments affected the most regional innovative performances in the time span 2007-2015. Secondly, the logistic regression captures which investment is more likely to affect innovation performances within Italian Regions. The results underline that major effect on innovation performance derive from the combined effect of high quality institutions and efficient public expenditure.

Life expectancy effects of public and private health expenditures in OECD countries 1970–2012: Panel time series approach

Relationships between life expectancy at birth, public and private health expenditures are analysed with econometric panel time series methods for 34 OECD countries between the years 1970 and 2012. The countries are grouped in three clusters depending on size of public health expenditure as a share of GDP. This gives us the possibility to test whether private and public health expenditures have different impacts on life expectancy at different levels of public expenditure as a share of GDP. Panel unit root tests show that all series in clusters are not difference stationary. Co-integration is found for countries with high public expenditure as a share of GDP. The results, augmented with panel VAR models and impulse response analysis, stress the importance of the positive relationship between public health expenditures and life expectancy. Additional results based on private health expenditure as a share of GDP show also the importance of private expenditures for life expectancy, although these are, at the same time, also driven up by public health expenditures.

Does Fairness Matter for the Success of Fiscal Consolidation?

Does it matter for fiscal consolidation programs to be fair in order to be successful? This question has never been empirically addressed despite its profound importance especially since many developed countries have embarked on fiscal consolidation programs, which in many cases have led to sizeable increases in unemployment and poverty, and are met with public dissatisfaction. Using a data set for 29 OECD countries over the period 1971–2009, we argue that fairness matters, namely that improving the targeting of social transfers and their effectiveness in terms of poverty alleviation, higher public expenditure on training and active labor market programs and programs like social housing directed to the poor, even decreasing the VAT rate on necessities, improve the success probabilities of consolidation attempts. Introducing such concerns sheds new light on the prevailing view that the successful fiscal adjustments are those that rely on spending‐cuts rather than on tax increases. The results of this paper provide empirical evidence that ameliorating the effects of adjustment, by supporting the weaker parts of society, is crucial for the success of fiscal consolidations and argues that “fair fiscal adjustments” may provide the double dividend of enhancing the probability of success of the adjustment and of promoting social cohesion.

Does Fairness Matter for the Success of Fiscal Consolidation?

Summary Does it matter for fiscal consolidation programs to be fair in order to be successful? This question has never been empirically addressed despite its profound importance especially since many developed countries have embarked on fiscal consolidation programs, which in many cases have led to sizeable increases in unemployment and poverty, and are met with public dissatisfaction. Using a data set for 29 OECD countries over the period 1971–2009, we argue that fairness matters, namely that improving the targeting of social transfers and their effectiveness in terms of poverty alleviation, higher public expenditure on training and active labor market programs and programs like social housing directed to the poor, even decreasing the VAT rate on necessities, improve the success probabilities of consolidation attempts. Introducing such concerns sheds new light on the prevailing view that the successful fiscal adjustments are those that rely on spending-cuts rather than on tax increases. The results of this paper provide empirical evidence that ameliorating the effects of adjustment, by supporting the weaker parts of society, is crucial for the success of fiscal consolidations and argues that “fair fiscal adjustments” may provide the double dividend of enhancing the probability of success of the adjustment and of promoting social cohesion.

Health Expenditures and Inequality: A Political Economy Perspective

We consider an overlapping generations model with heterogeneous agents where a person’s probability of survival into old age is determined by a variable elasticity of substitution health production function in which public and private expenditures are the inputs. Analytical and numerical results reveal that higher aggregate substitutability, as measured by the elasticity of substitution between private and public expenditures, leads to higher long run wealth levels and lower inequality. In the political equilibrium, higher aggregate substitutability is associated with higher public expenditure on health. We conclude that policies aimed at increasing the degree of substitutability between private and public health expenditures could yield better long run outcomes.

An initial investigation into the impact of tourism on local budgets: A comparative analysis of Spanish municipalities

The Spanish Federation of Municipalities has, particularly since 2008, been vocal about a “chronic deficit” situation caused by high public expenditures in tourist areas. Within this context, new strategies to increase revenues have been proposed, including the introduction of tourist taxes. This paper contributes to this debate by determining if tourism activity actually has a negative impact on local finances in Spain. To that end, a comparative analysis of budget structures between tourism-intensive and non-tourism-intensive municipalities is undertaken using data from more than 3200 local corporations for the years 2001–2010. The determinants of expenditures, revenues and deficit per capita are identified using a linear regression. The results indicate a direct relationship between tourism intensity and local deficits only in the smallest and largest municipalities, while a beneficial effect is actually seen in the remainder of the sample. In view of this evidence, we recommend revising the existing regulations to allow for municipalities below 20,000 residents to be officially recognized as “tourist municipalities” so that they can benefit from that status. In addition, the option of introducing new tourist taxes should be more restricted in scope and depend upon further evidence of possible cost inefficiency in the affected municipalities.

Making explosive cocktails: Recipes and costs of 20 Argentine crises from 1865 to 2004

The objective of this paper is twofold. Firstly, we investigate what were the “recipes” of the 20 Argentine currency crises from 1865 to 2004 using regression tree analysis, which is a non-parametric data classification technique. Secondly, we evaluate the costs of Argentina's crises in terms of output losses and recovery time.We obtained three “recipes” that constitute an early warning system. The most costly and frequent mix has two “ingredients”: high Public Expenditures (% of GDP) and Current Account Deficit (% of GDP). The less frequent and less costly mix consists of moderate Public Expenditures, Real Exchange Rate Overvaluation, and high International Interest Rates. Finally, the mix with intermediate costs and medium frequency is made up of five ingredients: moderate Public Expenditures, Real Exchange Rate Overvaluation, moderate International Interest Rates, strong decline in Bank Deposits, and high ratio of Monetary Aggregate M2 to International Reserves.

Затратность экономики России. Динамические модели развития

The following national income dynamics models are considered: Keynes model
 and modified Keynes model, which takes into account expenditure factor of
 the Russian economy. It is shown, that high public expenditures and low
 cost-effectiveness of economy can move the economy towards the degradation
 stage (bifurcation point of the differential equation solution), that can cause
 the need for significant external borrowings. Major causes of high costs in
 the Russian economy are indicated. The key economic strategy provisions
 that can enable the Russian economy to make transition to the sustainable
 development path are considered.

Does Fairness Matter for the Success of Fiscal Consolidation?

Does it matter for the success of fiscal consolidation programmes that they are fair? This question has never been empirically addressed despite its profound importance especially since many developed countries have embarked on fiscal consolidation programmes, which in many cases have led to sizeable increases in unemployment and poverty, and are met with public dissatisfaction. Using a data set for 29 OECD countries over the period 1971-2009, we argue that fairness matters, namely that improving the targeting of social transfers and their effectiveness in terms of poverty alleviation, higher public expenditure on training and active labor market policies and programmes like social housing directed to the poor, even decreasing the VAT rate on necessities, improve the success probabilities of consolidation attempts. Introducing such concerns sheds new light on the prevailing view that the successful fiscal are those that rely on spending-cuts rather than on tax increases. The results of this paper provide empirical evidence that ameliorating the effects of adjustment, by supporting the weaker parts of society, is crucial for the success of fiscal consolidations and argues that fair fiscal adjustments may provide the double dividend of enhancing the probability of success of the adjustment and of promoting social cohesion.

POLITICIANS AT WORK: THE PRIVATE RETURNS AND SOCIAL COSTS OF POLITICAL CONNECTIONS

We quantify the private returns and social costs of political connections exploiting a unique longitudinal dataset that combines matched employer–employee data for a representative sample of Italian firms with administrative archives on the universe of individuals appointed in local governments over the period 1985–1997. According to our results, the revenue premium granted by political connections amounts to 5.7% on average, it is obtained through changes in domestic sales but not in exports, and it is not related to improvements in firm productivity. The connection premium is positive for upstream producers for the public administration only, and larger (up to 22%) in areas characterized by high public expenditure and high levels of corruption. These findings suggest that the gains in market power derive from public demand shifts towards politically connected firms. We estimate that such shifts reduce the provision of public goods by approximately 20%. (JEL: D21, D73, H72, J31).

Variations in preventive care utilisation in Europe.

Prevention has been identified as an effective strategy to lead healthy, active and independent lives in old age. Developing effective prevention programs requires understanding the influence of both individual and health system level factors on utilisation of specific services. This study examines the variations in utilisation of preventive services by the population aged 50 and over in 14 European countries, pooling data from the two waves of Survey of Health Ageing and Retirement in Europe and the British Household Panel Survey. The models used allow for the impact of individual level demand-side characteristics and supply-side health systems features to be separately identified. The analysis shows significant variations in preventive care utilisation both within and across European countries. In all countries, controlling for individual health status and country-level systemic differences, higher educated and higher income groups use more preventive services. At the health system level, high public health expenditures and high GP density is associated with a high level of preventive care use, but specialist density does not appear to have any effect. Moreover, payment schemes for GPs and specialists appear to significantly affect the incentives to provide preventive health care. In systems where doctors are paid by fee-for-service the utilisation of all health services, including cancer screening, are higher.

The Funding and Efficiency of Higher Education in Croatia and Slovenia: A Non-Parametric Comparison with EU and OECD Countries

The paper applies a non-parametric approach, i.e. data envelopment analysis (DEA), to assess the relative technical efficiency of higher education across countries, with a particular focus on Croatia and Slovenia. When estimating the efficiency frontier we focus on measures of quantities outputs/outcomes. The results show that the relatively high public expenditure per student in Croatia should have resulted in a better performance regarding the outputs/outcomes, i.e. a higher rate of higher education school enrollment, a greater rate of labor force with a higher education and a lower rate of the unemployed who have a tertiary education. On the other hand, regardless of the input-output/outcome mix, the higher education system in Slovenia is shown to have a much higher level of efficiency compared to both Croatia and many other comparable EU and OECD countries.

Health equity in Lebanon: a microeconomic analysis

BackgroundThe health sector in Lebanon suffers from high levels of spending and is acknowledged to be a source of fiscal waste. Lebanon initiated a series of health sector reforms which aim at containing the fiscal waste caused by high and inefficient public health expenditures. Yet these reforms do not address the issues of health equity in use and coverage of healthcare services, which appear to be acute. This paper takes a closer look at the micro-level inequities in the use of healthcare, in access, in ability to pay, and in some health outcomes.MethodsWe use data from the 2004/2005 Multi Purpose Survey of Households in Lebanon to conduct health equity analysis, including equity in need, access and outcomes. We briefly describe the data and explain some of its limitations. We examine, in turn, and using standardization techniques, the equity in health care utilization, the impact of catastrophic health payments on household wellbeing, the effect of health payment on household impoverishment, the equity implications of existing health financing methods, and health characteristics by geographical region.ResultsWe find that the incidence of disability decreases steadily across expenditure quintiles, whereas the incidence of chronic disease shows the opposite pattern, which may be an indication of better diagnostics for higher quintiles. The presence of any health-related expenditure is regressive while the magnitude of out-of-pocket expenditures on health is progressive. Spending on health is found to be "normal" and income-elastic. Catastrophic health payments are likelier among disadvantaged groups (in terms of income, geography and gender). However, the cash amounts of catastrophic payments are progressive. Poverty is associated with lower insurance coverage for both private and public insurance. While the insured seem to spend an average of almost LL93,000 ($62) on health a year in excess of the uninsured, they devote a smaller proportion of their expenditures to health.ConclusionsThe lowest quintiles of expenditures per adult have less of an ability to pay out-of-pocket for healthcare, and yet incur healthcare expenditures more often than the wealthy. They have lower rates of insurance coverage, causing them to spend a larger proportion of their expenditures on health, and further confirming our results on the vulnerability of the bottom quintiles.

‘Sharing the Proceeds of Growth’: Conservative Economic Policy under David Cameron

Upon becoming Conservative leader, David Cameron, and his Shadow Chancellor, George Osborne, initially sought to compete with Labour by pledging increased expenditure on education and the NHS, and thereby insisting that tax cuts would have to wait. Rather than cutting taxation overall, the emphasis was on restructuring and simplifying Britain's tax system, and shifting the burden towards the better off, mainly thorough promoting environmental taxes. However, the economic collapse at the end of 2008 has prompted the Conservatives to modify this new economic stance, by insisting that they will no longer match Labour's planned increases in public expenditure, but, instead, will increase it at a lower rate. This is intended to reduce the need to increase government borrowing during the recession, and thereby ensure that when the economy recovers, the proceeds of economic growth can be shared between higher public expenditure and lower taxation, rather than being spent on repaying government debt for many years ahead.

Human development, public expenditure and economic growth: a system dynamics approach

PurposeIt is now widely recognized that human development (HD) and economic growth (EG) are intertwined in two‐way feedback processes either leading to an upward spiral of development or a poverty trap. This concept is used to overcome one of the limitations of a previous study by Qureshi which assumes exogenous gross domestic product (GDP). With endogenous GDP formulation, the impact of public expenditure on HD and EG in Pakistan is examined.Design/methodology/approachSystem dynamics approach is used to model, identify and help manage the development path of HD and EG in Pakistan given alternative policies for public expenditure on HD and EG. For this purpose the model endogenously determines path of population cohorts, and education, health and economic indicators.FindingsThe simulation results suggest that the current level of public expenditure on HD is extremely low and any further decrease will have irreversible negative impact on HD and economic indicators, even if the resources so saved are effectively invested in EG. Further, higher public expenditure on EG may neither result into better HD indicators nor economic indicators. On the contrary, higher public expenditure on HD not only improves HD indicators but also supplements EG. The results of this study conform to the results of earlier research and challenge the very basis of fiscal policy in Pakistan which has continually ignored HD over decades.Research limitations/implicationsThe model boundary excludes possible causal links of public expenditure, HD and income distribution. Identification and inclusion of these causalities may improve understanding of perpetuating asymmetric income distribution in Pakistan its role in HD and EG trade‐off.Practical implicationsThis paper suggests reorientation of fiscal policy in Pakistan and to anchor it to HD by allocating more public funds.Originality/valueThe unique characteristic of this model is explicit modelling of population cohorts in a two‐way feedback relationship with economic development considering the delays and non‐linearities involved in this process.

Politicians at Work: The Private Returns and Social Costs of Political Connections

We quantify the private returns and social costs of political connections exploiting a unique longitudinal dataset that combines matched employer-employee data for a representative sample of Italian firms with administrative archives on the universe of individuals appointed in local governments over the period 1985-97. According to our results, the revenue premium granted by political connections amounts to 5% on average, it is obtained through changes in domestic sales but not in exports, and it is not related to improvements in firm productivity. The connection premium is positive for upstream producers for the public administration only, and larger (up to 25%) in areas characterized by high public expenditure and high levels of corruption. These findings suggest that the gains in market power derive from public demand shifts towards politically connected firms. We estimate such shifts reduce the provision of public goods by approximately 20%.