Did the Health Card Program Ensure Access to Medical Care for the Poor during Indonesia's Economic Crisis?

The Indonesian Social Safety Net health card program was implementedin response to the economic crisis that hit Indonesia in 1997,to preserve access to health care services for the poor. Healthcards were allocated to poor households, entitling them to subsidizedcare from public health care providers. The providers receivedbudgetary support to compensate for the extra demand. This articlefocuses on the effect of the program on primary outpatient healthcare use, disentangling the direct effect of allocating healthcards from the indirect effect of government transfers to healthcare facilities. For poor health card owners the program resultedin a net increase in use of outpatient care, while for nonpoorhealth card owners the program resulted mainly in a substitutionfrom private to public health care. The largest effect of theprogram seems to have come from a general increase in the supplyof public services resulting from the budgetary support to publicproviders. These benefits seem to have been captured mainlyby the nonpoor. As a result, most of the benefits of the healthcard program went to the nonpoor, even though distribution ofthe health cards was propoor. The results suggest that had theprogram, in addition to targeting the poor, established a closerlink between provision of services to the target groups andfunding, the overall results would have been more propoor.     

Crowding out or crowding in? Correlations of spending components within and across countries

Using data for a sample of advanced and developing countries, the paper studies variation in the transmission of shocks from public and private components of spending to the macro-economy and distinguishes between the effects of expansionary and contractionary shocks. The aim is to study the extent by which capacity and propagation channels would reinforce or mitigate the cyclical responses of macroeconomic variables to expansionary and contractionary shocks to private and public components of spending. Further, the evidence will spell out the extent of co-movement in the variables’ adjustments to the specific shock across the macro economy. The bulk of the time-series evidence indicates more pervasive effects on growth in connection to private consumption across advanced countries. In contrast, the growth effects of public consumption are more pervasive across developing countries. Across the two groups, the growth impact of public consumption is more pronounced, compared to that of public investment. Further, the inflationary effects are pronounced with respect to public and private spending shocks. In general, the limited statistically significant real time-series evidence attests to conflicting channels with respect to variables’ adjustments to one shock and inadequate co-movement in the transmission mechanism of various public and private spending shocks in many countries.     

What explains schooling differences across countries?

This paper provides a theory that explains the cross-country distribution of average years of schooling, as well as the so called human capital premium puzzle. In our theory, credit frictions as well as differences in access to public education, fertility and mortality turn out to be the key reasons why schooling differs across countries. Differences in growth rates and in wages are second order.     

PFIs involving multiple public partners: a case study from the Italian healthcare sector

The financial crisis experienced by many countries since 2008 has given new importance to private finance initiatives (PFIs) for providing public services. This paper analyses the relationships between multiple public and private sector actors participating in a PFI in the healthcare sector in order to better understand the motives and behaviour of public and private sector partners. High levels of trust and the active participation of a regulatory body were found to be significant factors in terms of creating a partnership that benefits all sides.     

Public Social Spending in Africa: Do the Poor Benefit?

Education and health care are basic services essential in anyeffort to combat poverty and are often subsidized with publicfunds to help achieve that purpose. This paper examines theeffectiveness of public social spending on education and healthcare in several African countries and finds that these programsfavor not the poor, but those who are better-off. It concludesthat this targeting problem cannot be solved simply by adjustingthe subsidy program. The constraints that prevent the poor fromtaking advantage of these services must also be addressed ifthe public subsidies are to be effective.      

Economic policy uncertainty and sovereign credit rating decisions: Panel quantile evidence for the Eurozone

We employ a panel quantile framework that quantifies the relative importance of quantitative and qualitative factors across the conditional distribution of sovereign credit ratings in the Eurozone area. We find that regulatory quality and competitiveness have a stronger impact for low rated countries whereas GDP per capita is a major driver of high rated countries. A reduction in the current account deficit leads to a rating or outlook upgrade for low rated countries. Economic policy uncertainty impacts negatively on credit ratings across the conditional distribution; however, the impact is stronger for the lower rated countries. In other words, the creditworthiness of low rated countries takes a much bigger ‘hit’ than that of high rated countries when European policy uncertainty is on the rise.     

How credible is a too-big-to-fail policy? International evidence from market discipline

This paper analyzes in an international sample of banks from 104 countries if the sensitivity of the cost of deposits to bank risk varies across banks depending on their systemic and absolute size. We analyze a period before the 2007 financial crisis and control for endogeneity of bank size, intervention policies in past banking crises, and soundness of countries’ public finances. Our results are consistent with the predominance of the too-big-to-fail hypothesis, although this effect is stronger in countries that did not impose losses on depositors in past banking crises and in countries with sounder public finances.     

THE PUBLIC SUBSIDIZATION OF EDUCATION AND HEALTH IN DEVELOPING COUNTRIES: A Review of Equity and Efficiency

The public sector in developing countries has traditionallyplayed an important role in the financing of educational andhealth services. This review finds, however, that the shareof public subsidies in these two sectors is not progressive,that is, proportionately higher for individuals in the lowersocioeconomic groups. This distribution persists despite explicitpolicies of universal free provision in many countries. Thearticle argues that the extent and pattern of public spendingcontribute to underinvestment and to a misallocation of scarceresources within the education and health sectors.      

Democracy, Public Expenditures, and the Poor: Understanding Political Incentives for Providing Public Services

The incentives of politicians to provide broad public goodsand reduce poverty vary across countries. Even in democracies,politicians often have incentives to divert resources to politicalrents and private transfers that benefit a few citizens at theexpense of many. These distortions can be traced to imperfectionsin political markets that are greater in some countries thanin others. This article reviews the theory and evidence on theimpact on political incentives of incomplete information forvoters, the lack of credibility of political promises, and socialpolarization. The analysis has implications for policy and forreforms to improve public goods provision and reduce poverty.      

What Do We Know about Capital Structure? Some Evidence from International Data

We investigate the determinants of capital structure choice by analyzing the financing decisions of public firms in the major industrialized countries. At an aggregate level, firm leverage is fairly similar across the G-7 countries. We find that factors identified by previous studies as correlated in the cross-section with firm leverage in the United States, are similarly correlated in other countries as well. However, a deeper examination of the U.S. and foreign evidence suggests that the theoretical underpinnings of the observed correlations are still largely unresolved.     

Multi‐Factor Effective Corporate Taxation,Firms’ Mark‐Ups and Tax Incidence: Evidence from OECD Countries

This paper provides novel evidence on the multi‐factor effective marginal tax rates (EMTRs) for a sample of 17 OECD countries and 11 manufacturing sectors. We use a single framework encompassing capital, labour and energy taxes. Our cross‐country/cross‐sector approach allows us to analyse the contributions of these input factors to the effective tax borne by firms, taking explicitly into account their degree of substitution, their tax incidence and the role of mark‐ups. We find that the labour tax plays a particularly important role in the overall level of the EMTR and that the presence of mark‐ups can significantly alter the levels of the multi‐factor EMTR, although without significantly altering the ranking of countries. We also find that the bulk of the variation in EMTRs is across countries, rather than across sectors (within countries).     

An international look at the lawsuit avoidance hypothesis of IPO underpricing

We examine the relationship between IPO underpricing and litigation risk in an international setting using a sample of 13,759 firms that went public across 40 countries between 1991 and 2011. While the majority of single-country studies do not find support for the lawsuit avoidance hypothesis, we find a significant positive relationship between litigation risk and underpricing in a cross-country framework. Contrary to all single-country legal liability studies outside the U.S. and consistent with the U.S. studies of Tiniç (1988) and Lowry and Shu (2002), our empirical results support the insurance effect of the lawsuit avoidance hypothesis in an international context. Our findings imply that the degree of litigation risk in a given country affects the level of underpricing for firms that go public in that country. We conclude that differences in legal risk factors can partially explain differences in underpricing across countries.     

Rent control: The citizen,the market,and the state

The paper is a positive and normative public choice analysis of rent control. The positive public choice section hypothesizes that differences in rent control regimes across countries emerge out of differences in the political power of tenants and landlords, out of differing attitudes to security of tenure and the fairness of gains from property ownership, and out of differing values regarding equality of opportunity versus equality of result. The normative public choice analysis evaluates rent control by asking whether rent control would be allowed under a unanimously approved constitution. It is argued control would not be allowed; not because the objectives of control are outside the sanctioned domain of government but because control is horizontally inequitable.     

Spanish healthcare public private partnerships: The ‘Alzira model’

Global infrastructure reports suggest that, in the wake of the fiscal crisis, healthcare PPPs are seen as a growing area as governments switch attention to social welfare projects. Spain is unique in having had a PPP hospital in operation for over a decade which is funded through a capitation fee. This paper takes a critical approach to evaluate this project, with our analysis showing that the original project could never have been viable and that the renegotiation of the contract has been costly to the government. Viewing the contract through a financialised lens we can see how this contract has been used to ‘make up’ a market for the private delivery of public healthcare in Spain. We also call into question the role of the Spanish savings banks in financing this type of project, which has now been replicated with further hospitals in Spain and Portugal, as well as in developing countries such as Lesotho.     

Globalisation squeezes the public sector—is it so obvious?

It is widely perceived that globalization squeezes public sector activities by making taxation more costly. This is attributed to increased factor mobility and to a more elastic labour demand due to improved scope for relocation of production, and thus employment across countries. We argue that this consensus view overlooks that gains from trade unambiguously work to lower the marginal costs of public funds. Moreover, we argue that a more elastic labour demand may actually reduce the marginal costs of labour income taxation and that globalization may actually reduce the labour demand elasticity.     

The Politics of Accountability: Institutionalising Internal Auditing in Israel

Israel's attempt at strengthening public sector internal audit is found to have limited success, conforming with experiences of other countries. The adopted internal audit policy had little more than symbolic value, being devoid of stipulations to affect significant change. This is confirmed by implementation data that reveal low scores for most organizations across dimensions of structure, process and outcome. Politics of accountability and policy change models help to explain the causes of ineffectual internal audit legislation and of weak implementation. Findings suggest that top–down approaches to strengthening public sector internal audit are misplaced.     

What we spend and what we get: Public and private provision of crime prevention and criminal justice

In this paper, we consider a number of issues regarding crime prevention and criminal justice. We begin by considering how crime is measured and present both general and specific evidence on the level of crime in a variety of countries. Crime is pervasive and varies substantially across countries. We outline the arguments for some public role in crime prevention, enforcement, prosecution, defence, adjudication and punishment. We consider the relative roles of the public and private sectors in crime control and criminal justice. We discuss various measures for the effectiveness of the criminal justice system. We conclude by suggesting some potential areas for research.     

Centralisation versus Decentralisation of Public Policies: Does the Heterogeneity of Individual Preferences Matter?*

This paper explores the role of the heterogeneity of fiscal preferences in the assignment of policy tasks to different levels of government (decentralisation versus centralisation). With reference to a sample of European countries, a median‐voter mechanism of collective decision is assumed to work at both a national and a supranational level. Using data from a large international survey (the International Social Survey Programme, ISSP), a series of econometric models are estimated in order to make individual attitudes representative of different categories of public expenditure and of different countries. The dominance of decentralisation over centralisation or vice versa is determined on the basis of the utility loss that each individual suffers in connection with the distance between his or her own most preferred level of public expenditure and that chosen by the national/supranational median voter. The main finding is that, differently from the predictions of Oates's decentralisation theorem, the assignment of responsibilities at the supranational level (centralisation) for a number of public expenditure programmes (healthcare, education, unemployment benefits) dominates (or is close to dominating) decentralisation, even in the absence of economies of scale and interregional spillovers. However, when the possibility of interjurisdictional mobility is explicitly considered, in line with the predictions of Tiebout's model, decentralisation dominance becomes more and more substantial and also prevails in the sectors where, under the nonmobility assumption, the assignment of responsibilities at the supranational level is efficient.     

Public perceptions of food-related risks: a cross-national investigation of individual and contextual influences

Public concerns about food risks have grown in recent decades in response to many food-related scandals. Despite some evidence that risk concerns vary across societies and risk domains, these variations remain understudied. To address this gap, this paper conducts a multi-level analysis of public concerns about biological and chemical/technical food risks in 26 European countries. Findings confirm previous work on individual predictors of risk concern and suggest that several contextual factors contribute to cross-national variations: aggregate perceptions of risks as unnatural, retail concentration in the food sector, and media coverage. The effect of institutional trust on risk concerns varies substantially across nations. Findings also reveal important differences in public concerns about biological versus chemical/technical food risks, supporting the view that food risk perception is multi-dimensional and complex.     

Weak Links in the Chain: A Diagnosis of Health Policy in Poor Countries

Recent empirical and theoretical literature sheds light on thedisappointing experience with implementation of primary healthcare programs in developing countries. This article focuseson the evidence showing two weak links in the chain betweengovernment spending for services to improve health and actualimprovements in health status. First, institutional capacityis a vital ingredient in providing effective services. Whenthis capacity is inadequate, health spending, even on the rightservices, may lead to little actual provision of services. Second,the net effect of government health services depends on theseverity of market failures—the more severe the marketfailures, the greater the potential for government servicesto have an impact. Evidence suggests that market failures arethe least severe for relatively inexpensive curative services,which often absorb the bulk of primary health care budgets.A companion paper, available from the authors (seep. 219), offersa perspective on how government funds can best be used to improvehealth and well-being in developing countries. It gives an alternativeview of appropriate public health policy, one that focuses onmitigating the characteristic market failures of the sectorand tailoring public health activities to the government's abilityto deliver various services.