Assessing Fiscal Space for Health in Nepal
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World Bank Group, Washington, DC
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Nepal has seen impressive improvements
in health outcomes and has done well both in its rate of
progress and relative to its income level. Infant mortality
has been declining over the past five decades to 38.6 per
1,000 live births in 2009. Similarly, maternal mortality has
decreased to 380 per 100,000 live births in 2008. Life
expectancy has been steadily increasing to 67 years in 2009.
The rate of progress is better than those witnessed by
neighboring countries. But challenges remain in addressing
inequality, high and increasing out of pocket payments.
Geographic and income-related inequalities in population
health outcomes remain large and are increasing. For
example, not only is the decline in infant mortality not
uniform, some regions have seen an increase. The policy
response to these challenges has been to expand free care
services and pilot protection mechanism against the
financial risk of ill health. There is growing demand to
expand the package as well as the coverage of existing free
essential health care to all Nepalese; to introduce new
programs such as health insurance, and other similar
initiatives This note identifies efficiency gains as the
main potential source of additional fiscal space. The
analysis presented herein indicates that improvement in
health system efficiency i.e., getting more value for money
is by far the most plausible option for realizing additional
fiscal space for health in Nepal. As the note demonstrates,
the prospects for additional resources for health from all
other possible sources from conducive macroeconomic
conditions, re-prioritization of health, external resources,
and other health-sector specific sources is limited in
Nepal. On the other hand, there are many indications of
systemic inefficiencies in the health system of the country
and the challenge would be to focus on identifying and
implementing appropriate interventions to improve the
situation and reduce waste. The note highlights some
specific areas, such as those related to provider payments,
drug procurement mechanisms, and hospital and district grant
allocations whereby significant improvements in obtaining
better value for money can be realized.
Palabras clave
LIVING STANDARDS, HEALTH CARE PROVIDERS, INFANT MORTALITY RATES, WASTE, FORECASTS, EMPLOYMENT, FEMALE EDUCATION, RISKS, HEALTH INSURANCE SYSTEM, FINANCING, INFORMAL SECTOR, INCOME, UNDER-FIVE MORTALITY, FEE FOR SERVICE, HEALTH EXPENDITURES, PUBLIC SECTOR, DOCTORS, HEALTH ECONOMICS, NEEDS ASSESSMENT, SHARE OF HEALTH SPENDING, PRIMARY CARE, COST-EFFECTIVENESS, HEALTH SYSTEM EFFICIENCY, MONITORING, HEALTH INSURANCE, HEALTH CARE, FINANCIAL PROTECTION, PROVISION OF HEALTH SERVICES, FISCAL POLICY, INCENTIVES, NATIONAL HEALTH INSURANCE, HEALTH, ECONOMIC POLICY, BUDGETARY RESOURCES, HEALTH WORKERS, POCKET PAYMENTS, ENVIRONMENTAL HEALTH, BASIC HEALTH CARE, HEALTH FACILITIES, PUBLIC HEALTH, LIFE EXPECTANCY, HEALTH RESOURCES, HOSPITALIZATION, ADULT MORTALITY, HEALTH SECTOR, CAPITATION, CHOICE, PUBLIC EXPENDITURE ON HEALTH, PROTECTION MECHANISMS, PRIVATE HOSPITALS, HEALTH STATUS, COSTS, IMMUNIZATION, DEMAND FOR HEALTH SERVICES, HEALTH INDICATORS, HEALTH SYSTEMS, FIXED COSTS, PUBLIC HOSPITALS, HEALTH CENTERS, HEALTH SYSTEM PERFORMANCE, EXTERNALITIES, SOCIAL INSURANCE, NURSES, HEALTH CARE SERVICES, DEBT, ALLOCATIVE EFFICIENCY, HEALTH SHARE, MEDICAL CARE, ESSENTIAL HEALTH CARE, TUBERCULOSIS, HEALTH ORGANIZATION, HEALTH-SECTOR, MORTALITY, HEALTH PROMOTION, HEALTH SPENDING SHARE, HEALTH SPENDING, SOCIAL HEALTH INSURANCE SCHEMES, MEDICAL EDUCATION, EQUITY, INFANT MORTALITY, WORKERS, SOCIAL HEALTH INSURANCE, HEALTH INSURANCE SCHEMES, PUBLIC HEALTH CONCERNS, PUBLIC EXPENDITURE, CROWDING, CARE, HEALTH CARE POLICY, HEALTH POLICY, BUDGETS, DEMAND, HEALTH OUTCOMES, INSURANCE CONTRIBUTIONS, HOSPITAL REVENUES, ADULT MORTALITY RATE, FAMILY PLANNING, MEDICAL SUPPLIES, MEDICAL EQUIPMENT, EXPENDITURES, INCOME COUNTRIES, HEALTH CARE FINANCING, FINANCIAL BARRIERS, TEACHING HOSPITALS, PRIVATE SECTOR, MEASUREMENT, NUTRITION, BEDS, HEALTH POSTS, HEALTH CARE PROVIDER, INSURANCE SYSTEM, PRICE OF HEALTH CARE, INTERNET, NATIONAL HEALTH, INSURANCE, HEALTH RESULTS, HEALTH SYSTEM, INSURANCE PREMIUMS, COMMUNICABLE DISEASES, LOW INCOME, ESSENTIAL DRUGS, CHILDREN, DISEASE CONTROL, RISK, HUMAN RESOURCES, DEMAND FOR HEALTH, POVERTY, HEALTH INSURANCE CONTRIBUTIONS, HEALTH EXPENDITURE, ILLNESS, INCIDENCE, PRIVATE SPENDING, POPULATION, HOSPITAL BEDS, HEALTH- SECTOR, FINANCIAL RISK, STRATEGY, PRIVATE FINANCING, FEES, HEALTH FINANCING, PUBLIC SPENDING, HOSPITALS, HEALTH SERVICE, INFANT MORTALITY RATE, HEALTH SERVICES, IMPLEMENTATION, HEALTH STRATEGY, PROVIDER PAYMENT, HUMAN DEVELOPMENT