Public expenditure allocation and incidence under health care market liberalization: a Tanzanian casestudy

Mackintosh, Maureen and Kida, Tausi Mbaga (2005). Public expenditure allocation and incidence under health care market liberalization: a Tanzanian casestudy. In: Mackintosh, Maureen and Koivusalo, Meri eds. Commercialization of Health Care: Global and Local Dynamics and Policy Responses. Social Policy in a Development Context Series. Basingstoke, UK: Palgrave Macmillan, pp. 267–283.

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Abstract

Potential conflicts between health care commercialisation (promoted through health sector reform policies) and poverty-focused public expenditure policies are widely remarked upon by African policy analysts yet are insufficiently researched. This chapter addresses that gap in the international health policy debate. It contributes evidence of commercialisation of health care at all income levels in Tanzania, and then examines the allocation and incidence of public expenditure on health. Since all income groups use private as well as public care, and since people’s capacity to benefit from public subsidy to health care in this commercialised system depends upon ability to pay the fees and other associated costs of publicly subsidised care, people face a barrier to accessing the subsidy. We conclude that policies that encourage commercialisation should be evaluated carefully for conflicts with policies that attempt to improve the extent to which the poorest benefit from public expenditure on health.

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