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Can We Say No?: The Challenge of Rationing Health Care
Over the past four decades, the share of income devoted to health care nearly tripled. If policy is unchanged, this trend is likely to continue. Should Americans decide to rein in the growth of health care spending, they will be forced to consider whether to ration care for the well-insured, a prospect that is odious and unthinkable to many. This book argues that sensible health care rationing can not only save money but improve general welfare and public health. It reviews the experience with health care rationing in Great Britain. The choices the British have made point up the nature of the options Americans will face if they wish to keep public health care budgets from driving taxes ever higher and private health care spending from crowding out increases in other forms of worker compensation and consumption. This book explains why serious consideration of health care rationing is inescapable. It also provides the information policymakers and concerned citizens need to think clearly about these difficult issues and engage in an informed debate.
eBook
Making Fiscal Space Happen: Managing Fiscal Policy in a World of Scaled-Up Aid
Debt relief and the scaling up of aid to low-income countries should allow for greater fiscal space for expenditure programs to create long-term growth and lower poverty rates. But designing a suitable medium-term fiscal framework that fosters a sustainable delivery of better public services and infrastructure while maintaining a credible commitment to fiscal prudence confronts many challenges. This paper discusses what low-income countries can do to shape fiscal policy frameworks that are ambitious in trying to absorb additional aid while still ensuring longer-term sustainability for government expenditure programs and finances. It suggests what approaches can be used to manage the greater fiscal policy risks associated with a scaled-up aid environment, including coordination with monetary policy. The paper also discusses what institutional changes are needed if donors and countries are to facilitate the implementation of a higher level of aid-financed spending programs.
eBook
Public Expenditure in the Slovak Republic: Composition and Technical Efficiency (PDF Download)
Good practice suggests that budget allocations should reflect spending priorities and that spending should provide cost-effective delivery of public goods and services. This paper analyzes the composition of public expenditure in the Slovak Republic. It also assesses the relative efficiency of spending in education and health. The Slovak Republic spends more on social benefits and less on wages compared to the EU and OECD average. While it manages to translate the low expenditures into outcomes in an efficient manner in the education sector, this is not true for health. Moreover, the recent increases in expenditure levels have not improved outcomes, suggesting that significant budgetary savings could be achieved through increases in efficiency.
eBook
A Review of Capital Budgeting Practices
A key challenge in government budgeting is to define an appropriate balance between current and capital expenditures. Budgeting for government capital investment also remains not well-integrated into the formal budget preparation process in many countries. This paper aims to provide an overview of past and current budgeting practices for public investment. The study will also provide a comparison between the budget practices between low-income countries and developed countries and make a series of recommendations for how to ensure efficient integration of capital planning and budget management in low-income countries.
eBook