Tajikistan : Review of Public Expenditures on Health

World Bank

Tajikistan : Review of Public Expenditures on Health

2014

World Bank

This policy note is part of the World Bank's Programmatic Public Expenditure Review (PER) work program for FY2012-2014. The PER consists of a series of fiscal policy notes, which aim at providing the Government of Tajikistan with recommendations to strengthen budgetary processes and analysis. This policy note, the second in the series, examines public expenditures on health in Tajikistan. After an introductory section, the note describes the institutional and administrative structure of the health sector. Section 3 presents health outcomes and health care utilization indicators. Section 4 describes health financing in Tajikistan and presents the main options to expand fiscal space for health. Section 5 reviews the health financing and organizational reforms implemented in Tajikistan. Section 6 provides the main conclusions: 1) despite progress, health sector outcomes are mixed in Tajikistan and utilization pattern of health services is characterized by significant inequalities; 2) public spending on health is relatively low and skewed towards hospitals rather than outpatient care; 3) the hospital sector is characterized by oversupply of beds, avoidable inpatient admissions, low occupancy rates, and excessive average length of stay; 4) an increase in public health expenditures since 2000 was largely driven by the expanding wage bill, while other expenditures had been compressed; 5) public health expenditures show a regressive incidence, with the distribution of inpatient care more pro-rich than outpatient care; 6) the large reliance on out-of-pocket produces a high incidence of catastrophic spending; 7) a number of health financing and organizational reforms have been initiated since 2000, but the scope and coverage is still limited; and 8) the overall prospect for increasing fiscal space for health in Tajikistan are positive, with rationalization of both the overall budget and the public health delivery system.

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accountability accounting capacity building central government child health cities diabetes disease control doctors economic growth exchange rate first aid gross domestic product health insurance health services hiv/aids hospitals household expenditure human resources human resources management hygiene immunization income income distribution infectious diseases living standards medical equipment medicines mortality nutrition patient patients physicians poverty reduction pregnancy public expenditure public health public sector quality assurance rehabilitation reproductive health resource allocation screening social services tuberculosis workers

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Washington, DC

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Financial protection; Health care utilization; Health administration; Budgetary funds; Primary health care; Primary care; General practitioners; Health budgets; Health care facilities; Health financing system; Expenditure tracking; Health expenditures; Health organization; Basic health services; Life expectancy; Health workers; Dispensaries; Public spending; Health care provision; Ministry of finance; Child health services; Access to services; Life expectancy at birth; Public expenditure on health; Public sector specialist; Capitation payments; Health conditions; Public health expenditures; National health; Infant mortality rates; Health project; Patient choice; Waste; Macroeconomic conditions; Access to health services; Income groups; Health delivery; Outpatient care; State budget; Negative value; Resource constraints; External financing; Capital investments; Hospital care; Health outcomes; Expenditures; Payment system; Health reforms; Budgetary resources; Infant mortality; Efficiency gains; Health systems in transition; Public health spending; Health affairs; Public health care; Universal access; Financial responsibility; Providers of health care; Medical services; Health financing; Income countries; Incentives for providers; Hospital spending; Medical supplies; Infant mortality rate; Health planning; Health care reform; Hospital beds; Health sector; Cost information; Provision of care; Antenatal care; Quality of services; Health care budget; Catastrophic health spending; Capitation; Health service; Total expenditure; Hospital sector; Cervical cancer; Health needs; Financial resources; Health centers; Health service utilization; Health care services; Incidence analysis; Transparency; Budgetary decisions; Private spending; Economic classification; Financial management; Programs; Administrative structure; Line-item budgets; Public service; Inpatient care; Public funds; Military personnel; Institutionalization; Information system; Hospital cost; Health indicators; Government budget; Provider payment; Capital assets; Sector policy; Ambulance; Social health insurance; Clinics; Allocation of funds; Government spending; Public resources; Informal payments; Health care networks; Budget planning; Expenditures on health; Fiscal transfers; Under-five mortality; Accountability for results; Health departments; Decision-making; Public service delivery; Health institutions; Allocation of resources; City administration; Health delivery system; Poverty impact; Health systems; Rehabilitation centers; Health system; Government revenue; Budget allocation; Patient satisfaction; National government; Entitlements; Ministry of defense; Health expenditures per capita; Nurses; Public expenditures; Health facilities; Catastrophic expenditures; Healthcare services; Government expenditure; Cash payment; Under five mortality; Finance ministry; Pocket payments; Health expenditure; Fee-for-service; Public expenditure review; Outpatient services; Benefit incidence analysis; Fiscal data; Health providers; Health policy; Health resources; State agencies; Budget transfers

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Tajikistan : Review of Public Expenditures on Health

2014

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