Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA.
J Health Econ. 2012 Jan;31(1):147-57. doi: 10.1016/j.jhealeco.2011.09.003. Epub 2011 Oct 5.
We examine the marginal effects of decentralized public health spending by incorporating estimates of behavioural responses to changes in health spending in benefit incidence analysis. The analysis is based on a panel dataset of 207 Indonesian districts over the period from 2001 to 2004. We show that district public health spending is largely driven by central government transfers, with an elasticity of around 0.9. We find a positive effect of public health spending on utilization of outpatient care in the public sector for the poorest two quartiles. We find no evidence that public expenditures crowd out utilization of private services or household health spending. Our analysis suggests that increased public health spending improves targeting to the poor, as behavioural changes in public health care utilization are pro-poor. Nonetheless, most of the benefits of the additional spending accrued to existing users of services, as initial utilization shares outweigh the behavioural responses.
我们通过在受益归属分析中纳入对卫生支出变化的行为反应的估计，考察了分散的公共卫生支出的边际效应。该分析基于 2001 年至 2004 年期间的 207 个印度尼西亚区的面板数据集。我们表明，区公共卫生支出主要由中央政府转移支付驱动，弹性约为 0.9。我们发现，公共卫生支出对最贫困的两个四分位数的公共部门门诊服务利用率有正向影响。我们没有发现公共支出挤出私人服务或家庭卫生支出利用的证据。我们的分析表明，增加公共卫生支出改善了对穷人的针对性，因为公共卫生保健利用方面的行为变化有利于穷人。尽管如此，由于初始利用份额超过了行为反应，大部分额外支出的收益都流向了现有服务使用者。
