Public Budget Research Articles

Designing a Roadmap for Health Technology Assessment Implementation in Algeria.

Background The scarcity of resources restricts healthcare financing decisions, affecting the population's health. Health technology assessment (HTA) balances restricted budgets with the best possible health outcomes. We aim to characterize the current status of HTA in Algeria and describe the future directions for HTA implementation according to the priorities set by local stakeholders. Methods Stakeholders from the public and private sectors responded to a policy survey about the current and preferred future status of HTA implementation in Algeria. The survey was administered during an online workshop and used a widely accepted international scorecard covering eight domains: capacity building, HTA financing, process and organizational structure, scope of HTA implementation, decision criteria, standardization of methodology, use of local data, and international collaboration. After that, one-on-one interviews with another local expert were conducted to validate and modify the draft recommendations. The interviewees were representatives from government agencies, hospitals, and pharmaceutical companies. Results Thirty-one experts filled out the HTA scorecard survey; most of them were from the public sector (74%). They highlighted that project-based HTA workshops or short courses were the most common form of HTA education in Algeria and recommended the establishment of postgraduate HTA training programs in the future to build sustainable capacities. They reported a lack of funding for HTA research and critical appraisal and recommended an increased public budget for HTA and the introduction of submission fees by manufacturers. There was consensus about the need for local HTA evidence generation in the future. Most of the experts advocated an explicit soft decision threshold. The interviewees further recommended using multi-criteria decision analysis in the short term. The application of quality indicators was believed to improve the reliability of the HTA process. Conclusion The results of our policy research delineate the gap between the current and preferred future status of HTA in Algeria based on insights from multiple stakeholders. The need to improve the educational HTA programs in Algeria, use local data in policy decisions, and increase funding for HTA were the most advocated recommendations.

The incidence and prevalence of ankylosing spondylitis in Thailand using ministry of public health database

Ankylosing spondylitis (AS), an inflammatory condition affecting axial and peripheral joints, exhibits varying prevalence worldwide. This study sought to ascertain AS incidence and prevalence in Thailand from 2017 to 2020. Utilizing national databases, individuals aged 18 and above with primary AS diagnoses (ICD-10 code M45) were identified. AS prevalence and incidence were calculated with 95% confidence intervals. The total number of AS patients was 13,292 patients in 2017. The prevalence of AS was 20.4 per 100,000 populations (95% CI 20.0–20.7) in 2017. The number of new AS cases, identified during 2018–2020, was 6784, 6805, and 6791 patients, respectively. The incidences of AS in 2018, 2019, and 2020 were comparable with the incidence of 10.4 (95% CI 10.1–10.6) per 100,000-person-years. The peak age at diagnosis was 50–59 years of age between 2018 and 2020. The number of female patients was 57.8%, 57.0%, and 57.6%, in 2018, 2019, and 2020, respectively. In conclusion, AS was relatively rare among Thais and comparable between males and females. The prevalence and incidence of AS in Thailand were identified by the Thailand Database Ministry of Public Health. The epidemiological profile of AS in Thailand might help to plan better care, workforce needs, and public health budgets.

Predicting pharmaceutical prices. Advances based on purchase-level data and machine learning

BackgroundIncreased costs in the health sector have put considerable strain on the public budgets allocated to pharmaceutical purchases. Faced with such pressures amplified by financial crises and pandemics, national purchasing authorities are presented with a puzzle: how to procure pharmaceuticals of the highest quality for the lowest price. The literature explored a range of impactful factors using data on producer and reference prices, but largely foregone the use of data on individual purchases by diverse public buyers.MethodsLeveraging the availability of open data in public procurement from official government portals, the article examines the relationship between unit prices and a host of predictors that account for policies that can be amended nationally or locally. The study uses traditional linear regression (OLS) and a machine learning model, random forest, to identify the best models for predicting pharmaceutical unit prices. To explore the association between a wide variety of predictors and unit prices, the study relies on more than 200,000 purchases in more than 800 standardized pharmaceutical product categories from 10 countries and territories.ResultsThe results show significant price variation of standardized products between and within countries. Although both models present substantial potential for predicting unit prices, the random forest model, which can incorporate non-linear relationships, leads to higher explained variance (R2 = 0.85) and lower prediction error (RMSE = 0.81).ConclusionsThe results demonstrate the potential of i) tapping into large quantities of purchase-level data in the health care sector and ii) using machine learning models for explaining and predicting pharmaceutical prices. The explanatory models identify data-driven policy interventions for decision-makers seeking to improve value for money.

Analysis of Public Budgets with a Gender Perspective in Higher Education

Analysis of Public Budgets with a Gender Perspective in Higher Education

Green Parties and the Quest for Biodiversity: The Political Economy of Fiscal Commitments in OECD Economies

This study focuses on green parties in government and analyzes the political economy of public spending for biodiversity and landscape protection, comparing it with other environmental and non-environmental spending categories. Using panel data covering 26 OECD economies during the sample period from 1995 to 2021, we employ an error-correction approach that effectively accounts for both the presence of stochastic trends in the data and the structure of public budgets. Our findings highlight significant differences in the political economy of biodiversity and landscape protection spending compared with other environmental expenditures. Firstly, while governments under the participation of green parties generally allocate more funds to other environmental issues, the same does not hold true for biodiversity. Secondly, growth rates of other environmental expenditures increase considerably during election periods, whereas expenditures dedicated to biodiversity and landscape protection tend to shrink. Thirdly, environmental expenditures are more procyclical in comparison with public spending for non-environmental purposes, where, however, under green parties in government the cyclicality of biodiversity and landscape protection expenditure is mitigated during periods of fiscal adjustments. These results underscore the importance of establishing enhanced and counter-cyclical funding mechanisms, bolstered by support from supranational organizations, to ensure continuous and effective preservation of biodiversity.

Impact of Public Debt Refinancing Techniques on Managing Public Budgeting in Iraq: An Analytical Study

The use of public debt by the state as a primary financial instrument is an essential strategy for directing economic activity, ensuring economic stability, and fostering economic growth. Despite this, as the levels of public debt continue to climb, governments are increasingly resorting to debt refinancing methods that are focused on either replacing or rescheduling current debt or converting to a new kind of creditor via investment and securitization investment vehicles to relieve the burden of their debt. Utilization of these instruments is essential for effective management of the overall budget. The discovery that debt scheduling and the debt sustainability index impact the accomplishment of fiscal surpluses and maximizing public revenues informed the study's results in Iraq, which inspired the conclusion that debt refinancing methods and general budget advice are connected. In order to reduce public debt with the possibility of eliminating it, to take advantage of the time it gives to initiate a strategy for investing in projects that contribute to increasing public revenues through which that debt can be repaid, to achieve sustainable economic growth, and to reduce the budgetary deficit, the author of the study recommended that the mechanism of scheduling public debt in its entirety and not just a part of its structure be implemented. Implementing the technique of scheduling public debt in its totality rather than simply a portion of its structure may help achieve these aims. .

Does fiscal decentralization improve people's access to health and education services in Cameroon?

AbstractWe study the effects of fiscal decentralization on people's access to health and education services in Cameroon. It is generally believed that fiscal decentralization is an essential way to improve people's access to social services such as education and health. After reviewing the literature, we employed the Driscoll and Kraay estimate in a sample of 45 rural and urban municipalities for the period 2010–2020 to find our results. The results show that fiscal decentralization has a positive effect on the number of classrooms per pupil and the number of desks per pupil. At the same time, it negatively affects public hospitals per capita and the state of public hospitals. To improve people's access to education and health services in Cameroon, it is necessary to encourage the transfer of powers to municipalities. There is a need to control the actions of local officials to avoid mismanagement of resources that will not benefit the population. Also, the responsibility for selecting communal projects financed via the public investment budget within the framework of decentralization should be exclusively that of municipal executives, and not that of the central government.

Study Relationship of Under Bid Price, Contract Termination, and Risk of Regional Loss

According to the Audit Reports of BPK Representative in West Sumatera Province with title “LHP on Compliance Audit of Regional Expenditures of West Sumatera Province for Fiscal Year of 2021”, and “LHP on Financial Statements Audit of West Sumatera Province for Fiscal Year of 2021” as well as the auction data from Electronic Procurement Portal (LPSE), it is known that there were 293 construction packages with tender procurement in West Sumatera Province during Fiscal Year of 2021. Of those 293 packages, there were 81 packages has caused public budget losses and potential budget losses with total amount of Rp1.935.987.094,02, lacks of revenue with total amount of Rp9.660.218.603,31, and there were 8 packages experienced contract termination. Of those 8 packages with contract termination, 5 packages were known to be under bid price or using bid price that was too low (less than 80% of the HPS Value). Termination of the contract has resulted in the work not being utilized for the community in a timely manner, the risk of quality degression of the abandoned work until the work is resumed, and the risk of public budget losses. This research was conducted by seeing and analyzing the bid price that is too low (under bid price) which has potential impact on contract termination and the risk of public budget losses as well as the relationship between bid price fixing issues and the causes of contract termination. This needs to be done so that the contract termination can be avoided and the results of construction works can be completed and utilized immediately. This study aims to find a causal relationship between under bid price issues and contract terminations and the risk of public budget losses through the causes that influence the occurrence of contract termination, starting from the determination of HPS and under bid price, the selection process, the preparation and the implementation of the works according to timeline. From this study, it can be concluded that under bid price has a lot of influences and is a trigger for contract termination which resulted in the risk of public budget losses. There needs to be a calculation of the real bid price by considering overhead expenses, potential increases in material and wage prices, other expenses, and unexpected expenses. In addition, the parties involved in the construction works should make a risk map in order to mitigate problems which occur during the contract implementation period. This research takes the study of water resources building construction projects. Thus, further research is still needed on the occurrence of contract termination in road and bridge construction projects.

THE POLITICAL FUNCTION OF PUBLIC FINANCE. THE POLAND EXAMPLE

The article concerns the function of public finance. The authors attempt to provide an answer as to whether, in addition to the classic functions of public finance – the allocative, redistributive and stabilizing functions – one can arrive at a claim that public finance also plays a political function. These reflections are based on the course of 2023 parliamentary elections in Poland and the analysis of election programs presented by the individual political parties. Extracted from the programs were all the promises which could impact the redistribution of public goods and services and would involve their public funding, as well as those which could impact the tax revenues of the state. The analysis leads to the conclusions that the scope of public spending and the degree of fiscalism were one of the main factors encouraging the voters to vote for a particular political party. Since election promises have a major impact on the election results and they can be turned into legal regulations impacting public budgets, the claim concerning the political function of public finance is justified.

AN INVESTIGATION ON IMPACT OF TRADE OPENNESS & BUDGET DEFICIT ON PAKISTAN'S PUBLIC DEBT: ARDL APPROACH TO COINTEGRATION

In this empirical research, the purpose was to investigate the impact of trade openness and budget deficits on public debt in Pakistan. In this regard, data was examined spanning from 1975 to 2020. To map both long-run and short -run interactions, we used the autoregressive distributed lag (ARDL) method of co-integration along with ECM approaches. The results show that variables such as public debt, budget deficit, trade openness, and inflation have long- and short-term co-integration. Also, trade openness’s coefficient’s negative sign with value of -0.759 confirms negative relationship between public debt, trade openness and shows that a 1% upsurge in trade openness will bring a 75.9% decrease in public debt’s growth in Pakistan. While budget deficit and inflation both possess a positive sign of coefficients and a positive link with public debt, the coefficient of budget deficit is 0.498, which depicts that a 1% escalation in budget deficit will lead to a rise in public debt of 49.8 percent. In conclusion, Pakistan's national debt is rising due to budget deficit & inflation, but it is falling due to trade openness. To reduce budget deficit, government should balance domestic & external debt so as to sustain desired position. So, it is suggested the government actively trade internationally to minimize the public debt.

Climate Change, Human Rights, and Private Capital: The Obligation of States to Close the Climate Investment Gap

Abstract Climate change affects humanity in many ways, such as rising sea levels, water shortages, agricultural droughts, and the displacement of people. Thus, climate change threatens the enjoyment of human rights. States must therefore put in place effective mitigation and adaptation measures to combat climate change. But since no public budget can finance those transformation efforts, combatting climate change requires large sums of private capital. However, the international community has identified a multi-trillion dollar ‘climate investment gap’. Against this backdrop, the present contribution argues that international human rights obligations call on states to urgently redirect private investment flows into climate mitigation and adaptation measures. The existence of such an obligation and its impact on concrete policy decisions is then illustrated by three practical examples: the announced withdrawal of European states from the Energy Charter Treaty, Austria’s windfall tax on energy profits, and the US Inflation Reduction Act.

Perceived legitimacy of agricultural support schemes: An investigation using factorial survey experiments

Abstract Agricultural support payments are a significant position in public budgets, and the legitimacy of such payments is subject to continuing debate. The legitimacy rests on the social acceptance of citizens for support payments to farmers, which is the focus of this study. Social acceptance is investigated using evaluations of farm and farmer descriptions in a factorial survey experiment. The results reveal higher acceptance of payments for farms demonstrating enhanced animal welfare, biodiversity, and a lower carbon footprint. The acceptance of support payments is negatively associated with payment amount, but payments to farmers who are financially struggling are more accepted than payments to profitable farmers; indicating respondent preferences that align with the need justice principle. Study findings can be used to inform priorities for legitimate policies of agricultural support schemes, to identify areas of consensus or disagreement regarding social acceptance of support, and to facilitate effective communication on agricultural support policy.

Descriptive Study of Government Expenditure & Poverty Reduction in South Halmahera, Indonesia (Maqashid Sharia Approach)

AbstractGovernment intervention plays an important role in reducing poverty in South Halmahera as an antithesis to when market mechanisms fail to distribute wealth. From the Islamic public finance perspective, the ulil-amri (the government) plays a central role in managing public budget and is subject to the sharia value system. This research descriptively explores how the SH government manages its expenditure side for poverty alleviation and tries to conceptualize direct spending using the 2019 APBD(The Regional Revenue and Expenditure Budget) sample with the maqashid sharia approach. The results show that government spending brings benefits to the poor, but unfortunately an increase in spending does not always reduce poverty. During the COVID-19 pandemic, budget refocusing was quite successful in reducing poverty. Meanwhile, the expenditure allocation according to the maqashid sharia indicator has reached 69% of the total direct expenditure, although the expenditure allocation for religious protection received the smallest portion, 0.42%. Keywords:Poverty, Government Expenditure, Budget Refocusing, Maqashid Sharia

Health technology assessment for sexual reproductive health and rights benefits package design in sub-Saharan Africa: A scoping review of evidence-informed deliberative processes

Background Health technology assessment uses a multidisciplinary approach to support health benefits package design towards universal health coverage. The evidence-informed deliberative process framework has been used alongside Health technology assessment to enhance stakeholder participation and deliberations in health benefits package design. Applying the evidence-informed deliberative framework for Health assessment could support the morally diverse sexual reproductive health and rights (SRHR) benefits package design process. However, evidence on participation and deliberations for stakeholders in health technology assessment for SRHR benefits package design has not been curated in sub-Saharan Africa. This study synthesises literature to fill this gap. Methods This scoping review applies the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews, and deductive analysis following the evidence-informed deliberative processes framework. The search strategy uses the Guttmacher–Lancet Commission-proposed comprehensive definition of SRHR and the World Health Organisation’s universal health coverage compendium of SRHR interventions to generate search terms. Six databases and biographical hand searches were used to identify studies in Sub-Saharan Africa from 1994. Results A total of 14 studies met the inclusion criteria. Evidence for yearly public budgets and explicit SRHR health technology assessment processes was not found. In 12 of the studies reviewed, new advisory committees were set up specifically for health technology assessment for SRHR priority-setting and benefits package design. In all decision-making processes reviewed, the committee member roles, participation and deliberations processes, and stakeholder veto powers were not clearly defined. Patients, the public, and producers of health technology were often excluded in the health technology assessment for the SRHR benefits package design. Most health technology assessment processes identified at least one decision-making criterion but failed to use this in their selection and appraisal stages for SRHR benefits design. The identification, selection, and scoping stages in health technology assessment for SRHR were non-existent in most studies. In 11 of the 14 processes of the included studies, stakeholders were dissatisfied with the health policy recommendation from the appraisal process in health technology assessment. Perceived benefits for evidence-informed deliberative processes included increased stakeholder engagement and fairness in decision-making. Conclusion To support the integration of diverse social values in health technology assessment for fairer SRHR benefits package design, evidence from this review suggests the need to institutionalise health technology assessment, establish prioritisation decision criteria, involve all relevant stakeholders, and standardise the process and assessment methodological approaches.

Budgeting System and Economic Development Outcomes

Although public budgeting is considered one of governments’ most crucial policy statements for economic development outcomes, scholarly works that explain the linkages between the two are scant. Drawing on the budgeting system for theoretical context, this article examines the perception of local administrators on the effects of three budgeting practices—planning, budgeting, and evaluation —on economic development outcomes. It utilizes survey data from the ICMA’s 2014 Economic Development Survey and U.S. Census Bureau and logistic regressions to examine the determinants of four economic development outcomes—tax base, job creation, quality of life, and environmental sustainability. The results show that planning impacts sustainability, budgeting influences tax base, environmental sustainability, and job creation. Lastly, evaluation has consequences for the quality of life, tax base, and job creation. The study emphasizes how differing perceptions of budgetary practices shape economic development outcomes, highlighting the necessity of a system approach. It identifies critical leverage points within the budgeting system, where targeted actions can significantly influence multiple economic development outcomes. The study contributes to the Government Finance Officers Association’s (GFOA) Best Practices for economic development.

Why is child protection in many African countries perennially underfunded? - A political economy perspective

BackgroundAt a time when many children suffer from various kinds of abuse, child protection is chronically under-funded in government budgets. Whether a government decides to increase or cut spending on health, education, child protection and other issues boils down to political choice, which is influenced by social, economic, and political realities within which decisions on resource mobilization and allocation are made. ObjectivesExplore how political economy dynamics influence decisions on public spending on child protection in Africa. Participantsand Setting: 192 key informants selected through stratified and purposive sampling including government officials, academics, and civil society organizations from Botswana, Kenya, South Sudan, and Zimbabwe. The country selection reflects the different levels of fragility. MethodsUsing a multi-disciplinary conceptual framework, the study entailed document review, participant observation and in-depth interviews guided by an-open ended interview guide. The study applied a qualitative analysis methodology to identify common trends and themes. ResultsThe under-prioritization of child protection in budgeting is a consequence of a mosaic of political economy dynamics including prevailing socio-cultural and legal constructions of childhood, fiscal politics throughout the budget cycle, how the state is structured, and power exercised to drive national development. ConclusionsInstead of viewing under prioritization of child protection in government budgets as a purely technical problem, child-focused organizations should do some soul-searching and be intentional in seeking to understand and to navigate the politics and economics of public budgeting which influence decisions, if they are to trigger positive changes in government spending on child protection.

OUTSOURCING IN HEALTHCARE, CHANGES IN SUS MANAGEMENT AND WORK RELATIONS IN A NEOLIBERAL BRAZIL

Labor relations have been adapting to new legislation and the market profile over the years, a way that broadens a debate in the health sector, correlating changes in the management of the Unified Health System (SUS) and the arrival of the provision of services, by the cooperative entities, with a contractual configuration,which reinforces the labor issue and expresses the scenario of neoliberalism in Brazil. The present research aims to raise the discussions present in the cited parts, having the versions, such as unions, associations and workers’representatives,which present a critical position and point to the precariousness of labor relations, fearing the lack of inspection of resources transferred in the current model, while public managers and service providers say they are able to meet the demands and contracts signed with municipalities and states, so that health outsourcing takes place in our country. Legislation in constant adaptation seeking to guide the quality assistance to the health user seeking a political and social balance. For this, a bibliographic review was carried out on the proposed themes, with the main and most recent articles found. In this way, it is considered that in a country that descends from slavery and exploitation of cheap labor, the problem is not that social spending fits in the public budget, but that universal rights fit in the psyche of the elites, who are indignant with basic rights offered the working class.

Does the gender dissimilarity of female mayors with their political government team affect municipalities’ budgets? Evidence from Spain

ABSTRACT Recent research has considered whether the growing presence of women in political institutions has affected public budgets. This study takes a different gender perspective. The aim is to assess how gender dissimilarity between female mayors and their government teams can affect municipal budgetary policies. We use data from Spanish municipalities with more than 20,000 inhabitants in the period from 2004 to 2018, a dynamic regression model and take into account the possible moderating effect of ideology. Our main findings are that gender dissimilarity of female mayors increased current social spending and reduced nonsocial spending in line with female gender preferences, while it decreased tax revenues. However, when we analyze only the years of economic growth, we observe that the gender dissimilarity of female mayors increased tax revenue in accordance with their gender preferences. We also see that the interaction between right-wing ideology and the dissimilarity of female mayors substantially and significantly accentuated the decrease in nonsocial spending. We confirm our findings in different population segments.

Exploratory analysis on payment mechanisms to Community Mental Health Centers in Chile using mixed grounded theory.

Research on psychiatric deinstitutionalization has neglected that reforms in this field are nested in a health system that has undergone financial reforms. This subordination could introduce incentives that are misaligned with new mental health policies. According to Chile's National Mental Health Plan, this would be the case in the Community Mental Health Centers (CMHC). The goal is to understand how the CMHCpayment mechanism is a potential incentive for community mental health. A mixed quantitative-qualitative convergent study using grounded theory. We collected administrative production data between 2010 and 2020. Following the payment mechanism theory, we interviewed 25 payers, providers, and user experts. We integrated the results through selective coding. This article presents the relevant results of mixed selective integration. Seven payment mechanisms implemented heterogeneously in the country's CMHC are recognized. They respond to three schemes subject to rate limits and prospective public budget. They differ in the payment unit. They are associated with implementing the community mental health model negatively affecting users, the services provided, the human resources available, and the governance adopted. Governance, management, and payment unit conditions favoring the community mental health model are identified. A disjointed set of heterogeneously implemented payment schemes negatively affects the community mental health model. Formulating an explicit financing policy for mental health that is complementary to existing policies is necessary and possible.

"The relationship between the public budget deficit and public debt in Egypt for the period from 2011-2020"

ان نجاح الدول يقاس بمدى استقرارها الاقتصادي، لذلك تم إيلاء اهتمام كبير من قبل الباحثين بعجز الموازنة العامة لعلاقته المباشرة بالوضع الاقتصادي للدولة، ويعد عجز الموازنة احد أهم المشكلات التي يعاني منها الاقتصاد المصري، وهو اختلالاً هيكلياً لا يرتبط بالدورة التجارية، ويبين تفوق بنود الأنفاق الحكومي على الايرادات العامة، وقد سعت الحكومة المصرية إلى مواجهة عجز موازناتها العامة والعمل على الحد منه عن طريق برنامج للإصلاح الإقتصادي، متبعة سياسة انكماشية تعمل على زيادة الإيرادات وترشيد النفقات العامة، وبالرغم من ذلك لا زالت تمثل تحدياً كبيراً للحكومة المصرية، إذ أن نسبة (8.0%) هو ما يمثله العجز الكلي للسنة المالية (2019-2020)، تشكل ما يزيد عن ضعفي النسبة المسموح بها وفقاً لإتفاقية الاتحاد الأوروبي (ماسترخت) التي حددت نسبة (3%) كمؤشر للحجم المقبول لعجز الموازنة العامة، وبما أن أغلب دول العالم تلجأ إلى الدين العام من أجل تغطية العجز في موازناتها العامة، فقد كان العجز المزمن في الموازنة العامة هو من أهم اسباب الافراط في الاقتراض الداخلي والخارجي، والذي تنامى بشكل كبير، فضلاً عن تفاقم اعباء خدمات الدين.