世界发展银行-From-Double-Shock-to-Double-Recovery---Implications-and-Options-for-Health-Financing-in-the-Time-of-COVID-19_66页_2mb

Summary of From Double Shock to Double Recovery - Implications and Options for Health Financing in the Time of COVID-19

Core Content

The document From Double Shock to Double Recovery - Implications and Options for Health Financing in the Time of COVID-19 examines the dual impact of the pandemic on health and economic systems, and explores policy options to ensure sustainable health financing and recovery. It is authored by a group of experts including Christoph Kurowski, David B. Evans, and others, and published by the World Bank's Health, Nutrition, and Population (HNP) Global Practice.

Main Points

The Double Shock of the Pandemic

• The COVID-19 pandemic has caused a double shock—a significant health crisis and an economic crisis.
• As of March 1, 2021, over 2.5 million lives had been lost globally.
• The economic impact was severe, with global GDP per capita expected to take until 2023 to return to pre-pandemic levels.
• Poverty rates are projected to increase, with up to 163 million people possibly falling into extreme poverty by the end of 2021, reversing 20 years of progress.

Government Health Spending Trends

• Governments increased health spending in 2020 to address the pandemic, but projected declines in 2021 and 2022 due to reduced revenue and debt servicing capacity.
• The IMF forecasts that government per capita health spending will fall across all income groups in 2021 and 2022.
• Four scenarios are outlined to project future health spending trends:
  • Scenario 1: Procyclical spending—health spending follows GDP trends, declining during recessions.
  • Scenario 2: Status quo—health spending share remains constant, leading to a delayed recovery.
  • Scenario 3: Pro-health spending—health spending continues to grow at pre-pandemic rates.
  • Scenario 4: High-ambition spending—health spending increases and compensates for reduced out-of-pocket (OOP) payments.

Household Out-of-Pocket (OOP) Spending

• OOP spending is expected to decline as incomes fall.
• In low- and middle-income countries, OOP remains a major source of health financing despite its deterrent effect on service utilization.
• The elasticity of OOP spending to GDP per capita is slightly less than 0.9, indicating a strong link between economic conditions and health spending.

External Financing for Health

• External financing is uncertain, with IMF projections suggesting a decline in per capita grants to LICs and LMICs.
• The ACT-A initiative has boosted R&D for vaccines and pandemic tools, but its impact on long-term health system strengthening is unclear.
• The World Bank has allocated $18 billion in emergency financing to support vaccine rollouts and health system strengthening.
• The Global Financing Facility (GFF) provides grants tied to IDA and IBRD financing, and will require renewed donor commitments in 2021.

Policy Options for Health Financing

1. Increasing Government Funding for Health

• Governments must increase the share of health spending in their budgets to maintain or improve health financing.
• Tax reforms and pro-health taxes (e.g., on tobacco, alcohol, sugar-sweetened beverages, and carbon) can help generate revenue and improve population health.
• Social health insurance (SHI) schemes can be stabilized through reserves, lower reserve requirements, and adjustments to contribution rates and ceilings.

2. Expanding Fiscal Space

• The health sector can contribute to fiscal space through tax reforms, spending reviews, and performance-based budgeting.
• These strategies help align spending with national goals and improve efficiency.
• Contingency funds, in-year flexibility, and supplementary budgets can enhance budget agility.

3. Improving Equity and Efficiency in Health Spending

• Prioritization of expenditures is crucial to ensure that equity and efficiency are improved.
• Emergency measures should be reviewed and adjusted to reflect new realities.
• The document highlights the trade-offs in health financing, such as cutting vs. protecting certain programs, and the need for transparency and accountability in spending decisions.

Key Information

• The pandemic has disrupted essential non-COVID-19 health services, threatening progress toward UHC.
• Health financing must support both pandemic response and long-term recovery.
• Debt relief can be a temporary solution, but careful management is needed to avoid crowding out regular health budgets.
• Coordination between health and finance ministries is essential for effective health financing.
• Sub-national governments play a significant role in health service delivery and primary care, requiring inter-governmental transfers and predictable funding.

Conclusion

The document emphasizes the need for bold fiscal decisions, coordinated efforts, and equity-focused policies to ensure a double recovery from the health and economic shocks of the pandemic. It outlines policy options that can help sustain health spending, improve efficiency, and support UHC in the long term.