Espacio fiscal para la salud en Honduras / Fiscal space for health in Honduras

Objetivo. Analizar las fuentes de espacio fiscal para el sector salud enHonduras en un contexto de reforma del sector, con el compromiso de alcanzar una meta de gasto público en salud de 6% del producto interno bruto(PIB).Métodos.Se realizó un análisis de la condición básica y las fuentes de espacio fiscal en base a una revisión bibliográfica y datos secundarios. Se estimó el tamaño de las fuentes condatos oficiales, estadísticas internacionales estudios previos. De manera complementaria al estudio, serealizó un análisis de la factibilidad política y se aplicó una encuesta en línea a actores clave. Resultados. Las estimaciones de la condición básica de crecimiento económico muestran que es necesario identificar otras fuentes para poder genera rnuevos recursos. La recientere forma tributaria limita la factibilidad política degenera rnuevos impuestos, a excepción de los impuestos al pecado cuya recaudación se podría asignar exclusivamente a salud. La reforma de protección social abre el camino para explorar medidas que liberen recursos con mejoras en la eficiencia del sector. Una limitante en el caso del gasto1 Universidad del Pacífico de Perú, Lima, Perú. Enviar la correspondencia a Lorena Prieto Toledo, a.prietotoledo@up.edu.pe2 Organización Panamericana de la Salud, Washington DC, Estados Unidos de América.Manuscrito recibido el 1 de junio de 2017. Aceptado para publicación, tras revisión, el 22 de agosto de 2017. público proveniente de las eguridad social es el techo de la base contributiva, independiente de una aceleración en la formalización laboral. Conclusiones. Honduras puede avanzar en lograr la meta de un gasto público en salud de 6% del PIB que respalde los planes de reforma sectorial, pero sus opciones se ven limitadas por la reciente reforma tributaria. La reforma de protección social en salud debe considerar los recursos adicionales que tendrá disponibles para no poner en riesgo su implementación...(AU)

An assessment of fiscal space for health in Peru

[ABSTRACT]. Objective. To assess the fiscal space for health in Peru needed to attain the target of raising public spending in health to 6% of gross domestic product, as agreed by member countries of the Pan American Health Organization in 2014. Methods. The main sources of fiscal space were identified by means of a thorough literature review. Technical feasibility was determined from statistics and national and international surveys and by reviewing various documents and official reports. Political feasibility was ascertained by studying policy guidelines. Results. The sources showing the greatest technical and political feasibility are economic growth, a broadening of the personal income tax base, and an increase in tobacco-specific taxes. Decreasing informality in the job market and increasing contributory coverage are considered to be less politically feasible, but there is ample technical space for these measures. Conclusions. There is enough fiscal space to allow for an increase in public spending in health. Nevertheless, the 6% target will be reached only if the timeline is extended, tax revenues are increased, and informality in the job market is reduced.

Evaluación del espacio fiscal para la salud en Perú / An assessment of fiscal space for public health in Peru

Objetivo. Evaluar el espacio fiscal para la salud en Perú́ para alcanzar la meta de un gasto público en salud de 6% del producto interno bruto acordada por los Estados Miembros de la Organización Panamericana de la Salud en 2014. Métodos. Se han identificado las principales fuentes de espacio fiscal mediante una revisión bibliográfica profunda. Su factibilidad técnica se valoró a través de estadísticas y encuestas nacionales e internacionales y la revisión de documentos y reportes oficiales. Su factibilidad política se evaluó con el análisis de lineamientos de políticas. Resultados. Las fuentes con mayor factibilidad técnica y política son el crecimiento económico, el aumento de la base tributaria del impuesto al ingreso de las personas naturales y el aumento de la tributación específica sobre el tabaco. Con menos factibilidad política, pero con un amplio espacio técnico, se considera la reducción de la informalidad en el mercado de trabajo y el aumento de la cobertura contributiva. Conclusiones. Existe espacio fiscal para aumentar el gasto público en salud. No obstante, la meta de 6% solo se puede alcanzar con más plazo, mayor recaudación impositiva y menor informalidad en el mercado de trabajo.

Objective. To assess the fiscal space for public health in Peru so as to attain the goal of raising health spending to 6% of gross domestic product, as agreed upon by member countries of the Pan American Health Organization in 2014. Methods. The main sources of fiscal space were identified by means of a thorough literature review. Technical feasibility was determined from statistics and national and international surveys and by reviewing various documents and official reports. Political feasibility was ascertained by studying policy guidelines. Results. The sources showing the greatest technical and political feasibility are economic growth, a broadening of the personal income tax base, and an increase in tobacco- specific taxes. Decreasing informality in the job market and increasing contributory coverage are considered to be less politically feasible, but there is ample technical space for these measures. Conclusions. There is enough fiscal space to allow for an increase in public health spending. Nevertheless, the 6% target will be reached only if the timeline is extended, tax revenues are increased, and informality in the job market is reduced.

Mortality outcomes in hospitals with public, private not-for-profit and private for-profit ownership in Chile 2001-2010.

UNLABELLED: Public, private not-for-profit (PNFP) and private for-profit (PFP) hospitals may have different behaviour and performance in different indicators such as health outcomes, cost-efficiency and quality. Chile has a mixed healthcare system both in financing and service delivery. The public National Health Fund (Fondo Nacional de Salud) covers 76% of the population-poorer and with higher health risks-whereas private health insurers cover 16% of the population-richer and with lower health risks. The aim of the study was to analyse the in-patient mortality outcomes by hospital ownership in Chile. METHODS: We use hospital discharge data in Chile for the period 2001-10 with a total of 16,205,314 discharges in 20 public, 6 PNFP and 15 PFP hospitals. We analyse in-patient mortality considering all diagnoses and a subsample considering only myocardial infarction and stroke diagnoses. Using a probit regression, we estimate how hospital ownership explains in-patient mortality controlling for other confounding variables like health and socioeconomic status, and hospital characteristics. RESULTS: The discharge condition was reported as death in 3.5% of the public hospitals' discharges, 1.3% in PNFP and 0.7% in PFP. PNFP and PFP hospitals show a lower risk of in-hospital mortality for all diagnoses, myocardial infarction and stroke in comparison with public hospitals. DISCUSSION: The question about which type of hospital ownership performs better in Chile remains open. Policy decisions regarding health service provision requires more evidence explaining differences by ownership. Better controls for health risk and hospital characteristics are suggested to address these differences in hospital performance.

[Out-of-pocket health spending: the case of Chile, 1997 and 2007]. / El gasto de bolsillo en salud: el caso de Chile, 1997 y 2007.

OBJECTIVE: Determine the impact, characteristics, and changes in out-of-pocket health spending of households in Chile in 1997 and 2007. METHODS: A descriptive econometric study was conducted based on household surveys with cross-sectional information on spending in two years-1997 and 2007-for Greater Santiago. The evolution of indicators of per capita household spending by quintile was reviewed. The method proposed by the World Health Organization was used for econometric analysis of the determinants of out-of-pocket spending and catastrophic spending. The Gini indices were also calculated to analyze equity. RESULTS: Out-of-pocket health spending in the households of Greater Santiago increased significantly (39.5% per capita). The ratio of health spending in quintile 5 compared to quintile 1 decreased, but the increase in spending was less in quintile 5. In 2007, out-of-pocket spending was still determined by the presence of risk groups: under 5 years and, although to a lesser extent, over 65 years of age. Catastrophic spending decreased slightly and the presence of older adults continues to increase this risk. The presence of women of childbearing age tends to minimize out-of-pocket spending. CONCLUSIONS: Out-of-pocket health spending in the households is high and has increased. It continues to have a significant influence on inequality. The effects of out-of-pocket spending containment programs such as AUGE are evident, but new financial protection policies that address the problem are needed.