2.5 government health spending has increased moderately since the

2.5 Trends of Public Health Care Expenditure

In a study
conducted by Goldsbrought et al. (2007) on low income
countries with IMF program taken indicate that health spending in relation to GDP
rose quite rapidly through the early-1990s but then dropped in the mid-1990s.
It began to rise again, moderately, in the late 1990s a period that coincided
with the increased prevalence of debt relief, but only regained its previous
peaks, of around 2 1/2 per cent of GDP in 2000-2001 and has not risen much
above these levels subsequently.

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Trends
in the share of total government spending allocated to health show a similar
pattern a strong trend increased through the early 1990s that was partly
reversed in the mid-1990s. Viewed in this longer-term context, the increasing
share of total spending going to health since the late 1990s has only managed
to restore previous peaks (Goldsbrought, et al. 2007). The
authors found that government health spending has increased moderately since
the late 1990s through they lamented that the increment is only sufficient to
reverse an earlier decline that took place in the mid-1990s. They also found
that there were no major differences between recent trends in health spending
as a share of GDP or as a share of total government spending in the groups of
programme and non-programme countries outside of Africa.

A recent
study by Rashidul’alam et al (2015) investigates the trend
of determinants of health care expenditure in Bangladesh the study uses annual
time series data for the period 1995 to 2010. The authors employed simple
regression analysis and t-test to compare between public and private healthcare
expenditure they found that public health care expenditure as a share of GDP
was stabilized from 1995 but private health care expenditure was increasing
from the early 1997s.

In
Sub-Saharan Africa total government spending increased more in the group of
programme countries, but the difference are not large, especially in light of
the size of external resources directed towards the health sector. Finally,
they found that estimates of the impact of IMF – supported programmes on health
spending were complicated by a number of econometric difficulties but available
estimates suggest little overall impact; at least programmes may be associated
with a small and relatively short-lived increase in health spending but in
practice it is not possible to distinguish between the effects of the IMF
programme and other factors such as HIPC debt relief.

On
fiscal targets, the authors found that there has been some shift towards more
expansionary fiscal programs but even in the latest (2003-2006) period most
programs targeted relatively small increase in the deficit that tapered off by
the end of the 3-year period. The same pattern occurred in projection of
grants, a moderate increase in the first year of the programme which disappears
by the third year. Whether this represents sufficient fiscal flexibility
depends on judgments regarding likely financing prospects as well as the uses
and effect of additional government expenditure. These questions can only be answer
taking into account the circumstance in each country.

Shenggen and Anuja (2007) examined public
spending in developing countries; trends determination, and impact; the study
revealed that over the past two decades total government expenditures, in 44
developing countries considered in the study experienced overall growth. During
the 1980s, expenditures increased from $993 billion in 1980 to $1,595 billion
in 1990s with an annual growth rate of 4.8 percent. In the 1990s governments
increased their spending power by 5.6 percent per year. By 2000, total
government expenditure increased to $2,748 billion. They further reached
$3,347.6 billion in 202. Therefore, there is accelerated growth in government
expenditure in developing countries.

However,
amongst developing countries, regional variation from these averages were quite
market. Across all regions, Asia experienced the most rapid growth, while
Africa and Latin America increased at a much slower pace. In fact, most of the increases
in total government expenditure come from Asia, accounting for 67 percent of
total expenditures in 2002, up from 50 percent 1980. This is due to the fact
that the most Asian countries experienced rapid growth in per capita GDP. With
exception of Sri Lanka and Myanmar, all countries in the region at least
doubled their total expenditures from the period 1980-2002. Republic of Korea
and Bangladesh had the most rapid growth over 1980-2002, followed by India and
Thailand.

For
African countries, expenditures grew at 3.8 percent over 1980-2002. Growth was
much slower in the 1980s at 2.92 percent per annum. In fact, there was a brief
contraction after 1982 and it was not until 1986 that total government
expenditure recollected to 1982 levels, when many African countries implemented
macroeconomic structural adjustments.

Elijah and Shoria (2009) assessed
capital flows in the health care sector in Zimbabwe; Trends and implications
for health system; using a literature review, an initial mapping and review of
capital flows in the Zimbabwe health sector, drawing on both quantitative and
quantitative secondary evidence from 1995-2005. The study revealed that, the
period 1980-1990 saw rapid expansion of public sector health facilities as the
Zimbabwe government implemented the post-independence government implemented
the post-independence planning for Equity in Health policy, with health sector
expansion linked to their development programs (Sanders, 1990).
By 2000, 456 health centers, 612 rural hospitals 25 district hospitals and a
provincial hospital in each of the country’s provinces had been built or
upgraded, resulting in 85 per cent of the population willing within 8 km of a
health facility.

In a
paper by UNICEF (2003), on fiscal space and public Expenditure on
the social sectors indicated that the general trend was one of rising domestic
revenue accompanies by increased aid (concentrated particularly in the
countries receiving debt relief) and by restraint in expenditure to restore
fiscal stability.