Publication:
Indonesia - Giving More Weight to Health : Assessing Fiscal Space for Health in Indonesia

Loading...
Thumbnail Image
Files in English
English PDF (2.32 MB)
1,191 downloads
English Text (162.44 KB)
90 downloads
Published
2009-01-30
ISSN
Date
2012-03-19
Author(s)
Editor(s)
Abstract
This report analyzes fiscal space issues related to government health spending in Indonesia. Fiscal space refers to the ability of a government to increase expenditures for a desired purpose. In all likelihood, and for a variety of reasons, Indonesia will need to boost health spending in the near future as it expands access to care through the expansion of Jamkesmas, the health insurance scheme for the poor and near poor. In addition, projections based on demographic and epidemiological changes in the country indicate there is likely to be a significant increase in the demand and need for health services and more sophisticated care. Despite a tripling of the public budget for health over the past five years, this increased need, combined with the fact that Indonesia remains a comparatively low spender on health, indicates that there will continue to be upward pressure on resources for the health sector in the near future. A number of different drivers of fiscal space for health in Indonesia are discussed in this paper. These include: (i) conducive macroeconomic conditions; (ii) reprioritization of health within the overall government budget; (iii) increasing health-specific foreign aid and grants; (iv) an increase in other health-specific resources; for example, through earmarked taxation or the introduction of premiums for mandatory health insurance; and (v) an increase in the efficiency of government health outlays. In addition to laying out the possibilities for Indonesia with regard to each of these options, relevant international experiences are also highlighted.
Link to Data Set
Citation
World Bank. 2009. Indonesia - Giving More Weight to Health : Assessing Fiscal Space for Health in Indonesia. © World Bank. http://hdl.handle.net/10986/3028 License: CC BY 3.0 IGO.
Digital Object Identifier
Associated URLs
Associated content
Report Series
Other publications in this report series
Journal
Journal Volume
Journal Issue

Related items

Showing items related by metadata.

  • Publication
    Assessing Public Expenditure on Health from a Fiscal Space Perspective
    (World Bank, Washington, DC, 2010-02) Tandon, Ajay; Cashin, Cheryl
    This document delineates a simple conceptual framework for assessing fiscal space for health and provides an illustrative roadmap for guiding such assessments. The roadmap draws on lessons learned from analyses of seven fiscal space case studies conducted over the past two years in Cambodia, India, Indonesia, Rwanda, Tonga, Uganda, and Ukraine. The document also includes a summary of the fiscal space assessments from these seven case studies. Any assessment of fiscal space typically entails an examination of whether and how a government could feasibly increase its expenditure in the short-to-medium term, and do so in a way that is consistent with a country's macroeconomic fundamentals. Although fiscal space generally refers to overall government expenditure, for a variety of reasons there has been growing demand for a framework for analyzing fiscal space specifically for the health sector. This document outlines ways in which generalized fiscal space assessments could be adapted to take a more health-sector specific perspective: what is the impact of broader macroeconomic factors on government expenditures for health? Are there sector-specific considerations that might expand the set of possible options for generating fiscal space for health? Are there country-specific examples of innovative strategies that have been successful in increasing fiscal space for health?
  • Publication
    Liberia Public Expenditure Review : Options for Fiscal Space Enlargement
    (Washington, DC, 2013-05) World Bank
    Liberia's post-conflict reconstruction and rehabilitation has been successful. Peace, stability and security gradually returned and provided an enabling environment for the rebuilding of this war-torn country. Over the next five years (2013-2017), the Bank will focus on building infrastructure (energy and transport), increasing youth employment opportunities, strengthening human development and sustaining peace and security. This note considers how to increase Liberia s fiscal space by examining four options: 1) improving the efficiency of public expenditure, 2) increasing external grants, 3) increasing domestic revenue, and 4) increasing borrowing (domestic and/or external). While any increase in fiscal space gained from the first two options will not impose a burden in terms of debt or tax on the economy, the latter two will impose such burdens. In its examination of public expenditure by economic classification, this note finds that fiscal space in Liberia can be created by further improving the technical efficiency of current expenditure (wages and salaries, goods and services and transfers to state owned enterprises). However, the size of the fiscal space gained from these measures is difficult to pinpoint.
  • Publication
    Assessing Fiscal Space for Health in Nepal
    (World Bank Group, Washington, DC, 2015-04) Belay, Tekabe; Tandon, Ajay
    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.
  • Publication
    Analyzing Fiscal Space Options for Health in Zimbabwe
    (World Bank, Washington, DC, 2017-02) World Bank
    The fiscal space analysis for the health sector in Zimbabwe is timely and the need for such analysis has been strongly expressed by the government and its development partners. This imperative is Justified on multiple grounds. As the country is hit by an economic crisis resulting in lower revenues and cuts in expenditures, Understanding the consequences and assessing coping strategies for the health sector is critical. As the Country engages in The implementation of its new health sector strategy which sets ambitious targets in terms of Health outcomes towards Universal Health Coverage, it Is also critical to explore ways to increase resources for the sector, Even in A constrained macro-fiscal environment. The fiscal space analysis also highlights the major sources of inefficiencies to identify areas for improvement to increase the value for money in the sector. Overall, the fiscal space analysis aims to generate evidence to inform MOFED and MOHCC on short-term and medium-term options to generate resources for the health sector. It will provide evidence for government partner consultations on short-term options and choices in light of declining public financing for health and a difficult economic growth outlook.
  • Publication
    Public Spending in Russia for Health Care : Issues and Options
    (Washington, DC, 2008-08) World Bank
    This report examines three critically important areas to inform discussions on the appropriate level of health care spending in the Russian Federation: (i) the efficiency of spending on health care services; (ii) distributional impacts of spending on health care services; and (iii) the key factors that will influence the growth in health care spending over the next 20 years. There are few data showing how spending in health care in the Russian Federation translates into better health outcomes such as improved mortality, improved morbidity, increased economic output and productivity, improvements in the number of life years gained, or more sophisticated composite measures such as Quality Adjusted Life Years (QALYs). There is also limited data on outputs of hospitals and other healthcare providers which allow controlling for case mix, socioeconomic status, supply-side variables, and quality of care. Therefore, it is difficult to assess the efficiency or distributional impacts of health interventions. While the analysis draws on primary data specifically collected for the study, the absence of detailed output and outcome data necessarily limits the scope of the study and its findings.

Users also downloaded

Showing related downloaded files

  • Publication
    Digital Africa
    (Washington, DC: World Bank, 2023-03-13) Begazo, Tania; Dutz, Mark Andrew; Blimpo, Moussa
    All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.
  • Publication
    Digital Progress and Trends Report 2023
    (Washington, DC: World Bank, 2024-03-05) World Bank
    Digitalization is the transformational opportunity of our time. The digital sector has become a powerhouse of innovation, economic growth, and job creation. Value added in the IT services sector grew at 8 percent annually during 2000–22, nearly twice as fast as the global economy. Employment growth in IT services reached 7 percent annually, six times higher than total employment growth. The diffusion and adoption of digital technologies are just as critical as their invention. Digital uptake has accelerated since the COVID-19 pandemic, with 1.5 billion new internet users added from 2018 to 2022. The share of firms investing in digital solutions around the world has more than doubled from 2020 to 2022. Low-income countries, vulnerable populations, and small firms, however, have been falling behind, while transformative digital innovations such as artificial intelligence (AI) have been accelerating in higher-income countries. Although more than 90 percent of the population in high-income countries was online in 2022, only one in four people in low-income countries used the internet, and the speed of their connection was typically only a small fraction of that in wealthier countries. As businesses in technologically advanced countries integrate generative AI into their products and services, less than half of the businesses in many low- and middle-income countries have an internet connection. The growing digital divide is exacerbating the poverty and productivity gaps between richer and poorer economies. The Digital Progress and Trends Report series will track global digitalization progress and highlight policy trends, debates, and implications for low- and middle-income countries. The series adds to the global efforts to study the progress and trends of digitalization in two main ways: · By compiling, curating, and analyzing data from diverse sources to present a comprehensive picture of digitalization in low- and middle-income countries, including in-depth analyses on understudied topics. · By developing insights on policy opportunities, challenges, and debates and reflecting the perspectives of various stakeholders and the World Bank’s operational experiences. This report, the first in the series, aims to inform evidence-based policy making and motivate action among internal and external audiences and stakeholders. The report will bring global attention to high-performing countries that have valuable experience to share as well as to areas where efforts will need to be redoubled.
  • Publication
    Food Insecurity and Conflict
    (World Bank, Washington, DC, 2010-08-02) Brinkman, Henk-Jan; Hendrix, Cullen S.
    This paper provides a synthetic overview of the link between food insecurity and conflict, addressing both traditional (civil and interstate war) and emerging (regime stability, violent rioting and communal conflict) threats to security and political stability. In addition, it addresses the various attempts by national governments, intergovernmental organizations, and civil society to address food insecurity and, in particular, the link with conflict. It begins with a discussion of the various effects of food insecurity for several types of conflict, and discusses the interactions among political, social, and demographic factors that may exacerbate these effects. It then discusses the capabilities of states, international markets, intergovernmental organizations, and nongovernmental organizations (NGOs) to break the link between food security and conflict by focusing on mechanisms that can shield both food consumers and producers from short-term price instability. Finally, it discusses projected trends in both food insecurity and conflict and concludes with some brief comments on policies that can build resilience in light of projections of higher and volatile food prices and a changing climate.
  • Publication
    Business Ready 2024
    (Washington, DC: World Bank, 2024-10-03) World Bank
    Business Ready (B-READY) is a new World Bank Group corporate flagship report that evaluates the business and investment climate worldwide. It replaces and improves upon the Doing Business project. B-READY provides a comprehensive data set and description of the factors that strengthen the private sector, not only by advancing the interests of individual firms but also by elevating the interests of workers, consumers, potential new enterprises, and the natural environment. This 2024 report introduces a new analytical framework that benchmarks economies based on three pillars: Regulatory Framework, Public Services, and Operational Efficiency. The analysis centers on 10 topics essential for private sector development that correspond to various stages of the life cycle of a firm. The report also offers insights into three cross-cutting themes that are relevant for modern economies: digital adoption, environmental sustainability, and gender. B-READY draws on a robust data collection process that includes specially tailored expert questionnaires and firm-level surveys. The 2024 report, which covers 50 economies, serves as the first in a series that will expand in geographical coverage and refine its methodology over time, supporting reform advocacy, policy guidance, and further analysis and research.
  • Publication
    Pharmaceuticals in Latin America and the Caribbean
    (World Bank, Washington, DC, 2022-01-03) Vargas, Veronica; Rama, Martin; Singh, Rucheta
    Pharmaceutical products have contributed to longer life expectancy and better quality of life in Latin America and the Caribbean. However, they often account for a significant share of household expenditures, especially among the poor and those facing catastrophic health shocks. And they are not always accessible, as dramatically exposed by the Covid-19 pandemic. This mixed record can be linked to the workings of the pharmaceutical sector, an issue that has not received much attention in policy discussions. This paper identifies the sector’s key domestic and foreign players, and analyzes its local output, international trade, and price levels. It also documents government policies, including intellectual property rights, regulatory oversight, and public procurement. An important contribution of the paper is to show the significant scientific capacity of the region, especially in relation to biological products - including vaccines - whose intrinsic heterogeneity challenges intellectual property rights protection. Based on this diagnosis, the paper flags three sets of issues for policy makers to consider. Relatively uncontroversial measures include strengthening regulatory authorities, promoting the use of generics, and upgrading public procurement. Other areas, such as supporting R and D and regulating prices, involve tradeoffs. Finally, there are strategic choices to be made, with some countries in the region favoring stringent intellectual property rights, while others support national champions or rely on state entrepreneurship.