Читать книгу The Political Economy of the BRICS Countries - Группа авторов - Страница 79

How do the countries compare in terms of how much is spent on health? Figure 3 gives the total per capita expenditure, which includes both public and private finances.

Per capita health expenditure in 2014 was the highest ($947) in Brazil (see Figure 3), 13 times that of India at $75. However, the per capita GDP of Brazil was only five times that of India. Brazil has historically been the bigger and the most consistent health spender among BRICS. Between 1995 and 2005, the highest increase (20 times) in per capita health spending, however, happened in China followed very distantly by South Africa (eight times). Viewed in conjunction with Figure 1, it can be stated that except Russia, the share of private OOP expenditure had an increasingly marginal contribution to this increase in total expenditure over time. In other words, much of this increase in per capita total health expenditure in China has been on account of increased government spending on health.

While not measured as an indicator of UHC, government health finances remain a critical component of UHC, whether spent on expanding its own services to provide access or to expand a social health insurance program, primary care, or pre-payment systems. Higher GDP going into the health of a country has been seen as an important indicator of political commitment (Gottret and Schieber, 2006; Stuckler et al., 2010).

Table 4 presents the performance of BRICS nations in some of the key indicators related to public financing of health — total health expenditure in GDP, general government health expenditure in GDP, general government health expenditure in total health expenditure, and general government health expenditure in general government total expenditure.

Table 4:Public financing of health in BRICS.

Notes: THE: Total Health Expenditure, GGHE: General Government Health Expenditure, GGE: General Government Expenditure.

Source: Global Health Expenditure Database, World Health Organization.

The first aggregate gives the proportion of GDP spent on health and is inclusive of private health expenditure as well. South Africa and Brazil spend more than 8% of their GDP on health. While Brazil, China, India, and Russia have incrementally enhanced their health share of GDP over the 20 years, South Africa has been steadily spending around 8 percent during the same period. India spends less than 5% of its GDP on health and displays one of the lowest percentage point increase between 1995 and 2014.

How much do governments spend on health out of total income? For this, the second aggregate — general government health expenditure as a share of GDP — is useful, and it shows that South Africa spends the most with Brazil, Russia, and China following closely. India’s government spending on health is very low, around 1% of GDP. Governments of all the other BRICS nations spend more than double the amount as share of their respective GDP’s. The highest increase in the share of public expenditure on health between 1995 and 2014 happened in China, followed closely by Brazil. The lowest increase in this share was evident in the case of India, while in case of Russia the share actually declined.

This pattern is sharper when one looks at how much of the health spending is from government sources, the third column. All the countries, with the exception of India, spend almost half or more of their total health spending from government sources. Except Russia, all the nations increased their share of public finance in total health spending during the 20-year period. This is significant since in the nineties, close to three-fourths of health spending in Russia came from the government, way above the other BRICS nations. The biggest turnaround in this indicator appears to have happened for China, which saw a significant decline in the share of public spending in total health spending between 1995 and 2005, but thereafter increased by 17 percentage points between 2005 and 2014. Currently, China has the highest share of public spending in total health spending among BRICS, at 56%.

Finally, the last column shows how health is prioritized by Governments facing competing claims on its resources; general government health spending as a percentage of total government spending is highest in South Africa. This is followed by China and Russia and Brazil. Here again, India ranks low as it spends just 5% of its total government expenditure on health. However, for China and Brazil the share has declined from their 1995 levels.

Overall, the three indicators above indicate that China and Brazil have done consistently the best in terms of moving towards UHC, especially if one considers the changes in terms of public spending on health in the recent past. Russia and South Africa are also not doing too badly and often have interchanging places in the rankings among these five countries. However, the gap between the performance of these countries and that of India is often quite stark when we look at the body of evidence presented.