Effect of regulated user fee on quality of healthcare for the poor and the non-poor

User fee for healthcare continues to be used in many countries despite the extensive documentation on the impoverishing effect on households. The literature has also analyzed the effect of user fee on the quality of care for both rich and poor. The purpose of this study is to find the factors affecting the physician’s behavior, under a user fee payment mechanism with an exemption program for the poor, when choosing treatment for poor and non-poor patients. The factors examined were treatment effort input, the fine, cost of investigation, costliness of government, severity of illness for the non-poor and for the poor, and the proportion of non-poor patients. The results showed that regulated user fee cannot be effectively implemented without government investigation or monitoring of the health provider’s treatment choice. The possibility of investigation provides incentive for the provider to choose the proper treatment quality when the poor are likely to be high risk than the non-poor. An important result is that regulated user fee can deteriorate the quality of care received by the rich, through excessive treatment, especially in developing economies where there is a small proportion of the rich. Improvement in innovative technologies that reduce the cost of investigation, government revenue collection, and treatment effort input is likely to improve the quality of care provided to patients regardless of income status.     

The Role of Central Government in Tax Competition Between Heterogenous Regions

This paper analyzes the role of central government in a Nash tax competition between two heterogenous regions, which differ in their endowments of two production factors. Regional governments use a source-based unit tax on mobile capital to finance their public service expenditures. The central government employs excise subsidies and lump-sum taxes to induce the two regions to efficient resource allocations. We answer to the question that whether the central government can induce an efficient equilibrium, and investigate the effects of endowments difference on the optimum subsidy rates. We find that there exists a unique tax rate under which the efficiency is achieved. We identify the set of endowment allocations for which the subsidy rate to one region is higher (or lower) than the subsidy rate to the rival. The large poor region receives a higher subsidy than the small rich region, but the subsidy to the small poor region may be higher or lower than that to the large rich region. [H2]     

Resource abundance and regional development in China1

Over the past several decades, China has made tremendous progress in market integration and infrastructure development. Demand for natural resources has increased from the booming coastal economies, causing the terms of trade to favour the resource sector, which is predominantly based in the interior regions of the country. However, the gap in economic development level between the coastal and inland regions has widened significantly. In this paper, using a panel dataset at the provincial level, we show that Chinese provinces with abundant resources perform worse than their resource‐poor counterparts in terms of per capita consumption growth. This trend that resource‐poor areas are better off than resource‐rich areas is particularly prominent in rural areas. Because of the institutional arrangements regarding property rights of natural resources, most gains from the resource boom have been captured either by the government‐ or state‐owned enterprises. Thus, the windfall of natural resources has more to do with government consumption than household consumption. Moreover, in resource‐rich areas, greater revenues accrued from natural resources bid up the price of non‐tradable goods and hurt the competitiveness of the local economy.     

Can regional policy in a federation improve economic efficiency?

In the European Union and in many federal and non-federal countries, the central government pays subsidies to poor regions. These subsidies are often seen as a redistributive measure which comes at the cost of an efficiency loss. This paper develops an economic rationale for regional policy based on economic efficiency. We consider a model of a federation consisting of a rich and a poor region. The economy is characterized by imperfect competition in goods markets and unemployment. Firms initially produce in the rich region but may relocate their production to the poor region. We show that a subsidy on investment in the poor region unambiguously increases welfare if labour markets are competitive. If there is unemployment in both regions, the case for regional subsidies is weaker.     

The quality of government

We investigate empirically the determinants of the quality ofgovernments in a large cross-section of countries. We assessgovernment performance using measures of government intervention,public sector efficiency, public good provision, size of government,and political freedom. We find that countries that are poor,close to the equator, ethnolinguistically heterogeneous, useFrench or socialist laws, or have high proportions of Catholicsof Muslims exhibit inferior government performance. We alsofind that the larger governments tend to be the better performingones. The importance of (reasonably) exogenous historical factorsin explaining the variation in government performance acrosscountries sheds light on the economic, political, and culturaltheories of institutions.     

The transfer of production from rich to poor countries

A model with two countries, three factors, and a continuum of goods is used to explain why manufacturing production is being transferred from more to less developed countries over time. The three factors are labor, capital, and infrastructure, where labor and infrastructure are immobile internationally but capital is perfectly mobile through direct investment. Production of a good shifts from the rich to the poor country when lower poor country costs attract direct investment from the rich country. This direct investment is assumed to carry with it the necessary technological and marketing know-how. It is shown that only by adding to its stocks of immobile factors of production will one country lower its relative costs and thus expand the range of goods it produces domestically at the expense of the other country. It is also shown that given optimal investment behavior the stock of infrastructure in the poor country will grow faster than in the rich country. Taking endowments of labor as given, it follows that production must be transferred continuously over time. This process ends because there is enough relative change in the two countries' infrastructure-labor endowment ratios to allow factor-price equalization and incomplete specialization in production.     

Government size and economic growth in an endogenous growth model with rent‐seeking

We explore the relationship between government size and economic growth in an endogenous growth model with human capital and an unproductive capital which facilitates rent‐seeking. With exogenous as well as endogenous time discounting, we find a non‐monotonic relationship between the size of government and economic growth. We find that with very high (low) discounting, there is a unique low (high) growth equilibrium, regardless of the size of government. For the intermediate range of discounting, there are multiple equilibria and the growth outcome depends on the size of government. With endogenous time discounting, the growth outcome is path dependent and depends on the level of inherited human capital. However, there is only one stable growth regime and the economy endogenously switches to it. When the institutional constraints on rent‐seeking are not extremely high, the stable regime is the one in which there is a high‐growth equilibrium for a smaller size of the government and for larger size, both the high‐growth and the low‐growth equilibrium coexist. When the institutional constraints on rent‐seeking are extremely high, there exists only a unique high‐growth equilibrium irrespective of the size of government. Furthermore, economies with bigger size of the government and/or with poor quality institutions will take longer to endogenously switch to this stable growth regime.     

Changes in income distribution over time in a one-sector neoclassical setting

This paper, which is aimed at explaining the endogeneous changes in the income distribution as an economy grows, extends Darity's model and applies it to the Gini decomposition equation developed by Fei, Ranis and Kuo. It defines two types of families, the rich and the poor, both being allowed to own labor and capital but the former being assumed to own more capital and have a higher savings rate than the latter. Total supply is produced according to a neoclassical production function. Consumption demand is determined by the pattern of income distribution, and the excess of total supply over consumption is available for investment, which is an addition to the physical capital stock as well as an increase in the wealth of the rich and poor families. Over time, both families become more wealthy as the economy grows according to enlarged production capacities, meanwhile the wage rate rises and the return to capital falls as capital deepening proceeds. These, along with the distribution of factor ownership between the poor and the rich family, determines the pattern of income distribution. It is then found that: (a) as the economy grows from an initial low-level per capita income towards a long-run steady-state equilibrium, the changes in income distribution over time may follow a variety of patterns, depending mainly on the magnitude of the elasticity of substitution and the situation of the initial position; and (b) only if (i) the initial distribution of the ownership of capital is comparable to or slightly more concentrated in the hands of the rich family than its long-run steady level, and (ii) the elasticity is less than one, will the changes in income distribution over time be consistent with the Kuznets inverted-U pattern.     

Government Ponzi games and the sustainability of public deficits under uncertainty

This paper reconsiders the conditions under which a government may engage in debt roll-over schemes by financing interest payments through the issue of new debt. Output growth rates in excess of interest rates on government debt have traditionally been considered grounds for sustaining such schemes. A government may avoid debt repayment, or even run a primary deficit forever, and yet maintain a bounded debt-to-income ratio. Recent research has pointed at the stronger constraints placed on government behaviour by uncertain output growth. We show that this is not the case when an alternative criterion for solvency is used, namely that the debt-to-income ratio converges almost surely in the long run. In this case, the government is solvent when the asymptotic growth rate of the economy exceeds the asymptotic interest rate on debt, a natural extension of a familiar criterion in a deterministic environment.Convergence to the long-run outcome may, however, be a slow process. For realistic parameter values, long-run-stable fiscal plans may resemble unsustainable plans over long horizons. This circumstance may explain the observed poor performance of debt ratios as indicators of fiscal sustainability.     

MEASURING THE LIFETIME REDISTRIBUTION ACHIEVED BY DUTCH TAXATION, CASH TRANSFER AND NON-CASH BENEFITS PROGRAMS

This paper assesses how the Dutch system of taxation, cash transfers and non-cash benefits redistributes between the rich and the poor. The approach in this paper deviates from the usual approach by incorporating the full life cycle in the measurements, rather than only the annual effects. Moreover, the coverage is larger than is usually the case: the paper takes account of both direct and indirect taxes and direct and indirect benefits. In order to obtain the measurements on redistribution, we use the level of educational attainment to classify the population. We therefore measure, in terms of present values, the average net benefit from government policies for an average representative person of each level of education. The results indicate a sizable redistribution from the rich to the poor and a significant reduction of welfare inequality. The net effect on welfare inequality is, however, substantially smaller than when measured on an annual basis.     

Is power more evenly balanced in poor households?

The structure of intra-household allocation is crucial to know whether a transfer from a rich household to a poor one translates into a transfer from a rich individual to a poor one. If rich households are more unequal than poor ones, then a progressive transfer among households reduces intra-household inequality, hence inequality among individuals. More specifically, two conditions have to be satisfied for extending Generalized Lorenz judgments from household level to individual one. The fraction of the couple's expenditures devoted to goods jointly consumed should decrease at the margin with the couple's income as well as the part of private expenditure devoted to the disadvantaged individual. This double concavity condition is non-parametrically tested on the French Household Expenditure Survey (2000). It is not rejected by the data and supports the view that power is more evenly distributed in poor households.     

让公共预算中的政府问责制运转起来——对印度公民预算组织的考察

在贫富差距极度悬殊、种族和教派冲突频繁发生、政府效率低下的环境中,印度的公民预算组织积极投:身社会变革,促进公共参与和政府创新.他们创造出"公民报告卡"、"预算分析"、"预算跟踪"等公民参与预算的方法,以强化内在于公共预算中的政府问责制.他们的思想、观点以及一些具体做法对我国的公共预算制度创新具有一定的借鉴意义.     

Does Medicare benefit the poor?

Measuring the progressivity of age-targeted government programs is difficult because no single data set measures income and benefit use throughout life. Previous research, using zip code as a proxy for lifetime income, has found that Medicare benefits flow primarily to the most economically advantaged groups, and that the financial returns to Medicare are often higher for the rich than the poor. However, our analysis produces the starkly opposed result that Medicare is an extraordinarily progressive public program, in dollar terms or welfare terms. These new results owe themselves to our measurement of socioeconomic status as an individual's education, rather than the geographically aggregated measures of income used by previous research. We argue that individual education has important practical and conceptual advantages over geographically aggregated measures of income. Our results suggest the crucial importance of accurate poverty measurement in evaluating the progressivity of complex government programs like Medicare or Social Security.     

Democracy and growth

Growth and democracy (subjective indexes of political freedom) are analyzed for a panel of about 100 countries from 1960 to 1990. The favorable effects on growth include maintenance of the rule of law, free markets, small government consumption, and high human capital. Once these kinds of variables and the initial level of real per capita GDP are held constant, the overall effect of democracy on growth is weakly negative. There is a suggestion of a nonlinear relationship in which more democracy enhances growth at low levels of political freedom but depresses growth when a moderate level of freedom has already been attained. Improvements in the standard of living—measured by GDP, health status, and education—substantially raise the probability that political freedoms will grow. These results allow for predictions about which countries will become more or less democratic over time.     

Explaining educational attainment across countries and over time

Consider the following facts. In 1950, the richest countries attained an average of 8 years of schooling whereas the poorest countries 1.3 years, a large 6-fold difference. By 2005, the difference in schooling declined to 2-fold because schooling increased faster in poor than in rich countries. What explains educational attainment differences across countries and their evolution over time? We consider an otherwise standard model of schooling featuring non-homothetic preferences and a labor supply margin to assess the quantitative contribution of productivity and life expectancy in explaining educational attainment. A calibrated version of the model accounts for 90 percent of the difference in schooling levels in 1950 between rich and poor countries and 71 percent of the faster increase in schooling over time in poor relative to rich countries. These results suggest an alternative view of the determinants of low education in developing countries that is based on low productivity.     

Schooling,wages and profits: Negative pecuniary externalities from schooling and their consequences for schooling investments

This paper tests the hypothesis that the schooling of the poor reduces profits for landowners, and that such negative pecuniary externalities in turn adversely affect schooling investments made by local governments. A theoretical model of occupational choice in the presence of credit and labor market constraints, combined with existing political economy models of the delivery of local public goods delivers such a result. This hypothesis is tested using household data from India. The empirical analysis shows that profits are reduced by the schooling of the poor and that this is primarily because of the effect of schooling on wages. It also shows that the negative effect of wages on profits reduces government provided schooling inputs.     

Distribution and development in a model of misgovernance

This paper presents an analysis of bureaucratic corruption, income inequality and economic development. The analysis is based on a dynamic general equilibrium model in which bureaucrats are appointed by the government to implement a redistributive programme of taxes and subsidies designed to benefit the poor. Corruption is reflected in bribery and tax evasion as bureaucrats conspire with the rich in providing false information to the government. In accordance with empirical evidence, the model predicts a positive relationship between corruption and inequality, and a negative relationship between corruption and development.     

A note on economic freedom and political ideology

Within the field of public economics, there is the perception that Republicans are associated with ‘small government’ and Democrats with ‘big government’. We test this notion by examining whether economic freedom is affected when a single party is in control of the state legislature. We find no link between party control and our main economic freedom indicator, but we do find a positive link between Republican control and the taxation component of economic freedom, suggesting a Republican legislature leads to lower taxation.     

The Lifetime Distributional Impact of Government Health Outlays

This article examines the lifetime redistributive impact of government health outlays and finds that such outlays redistribute income from the lifetime rich to the lifetime poor and from men to women.     

The eye of the beholder. Reconsidering the notions of pro‐poor growth and progressivity,with an application to Vietnam

Both policymakers and economists have tried to find criteria to assess whether economic growth is pro‐poor. In this paper we reconsider the inequality‐oriented approach originally proposed by Jenkins and Van Kerm. They look at the changes in the whole income distribution, and decompose the change in income inequality, measured by the Gini coefficient, into a progressivity and a reranking component. They define a pro‐poor (or progressive) change as one where the changes in income are more to the benefit of those who are initially poor than to the benefit of those who are initially rich. We challenge this assumption, and maintain that also the point of view of the finally poor and the finally rich should be taken into account when evaluating whether growth is pro‐poor. We suggest a new decomposition method, based on an inequality index of the generalized entropy family, which allows the change in income inequality to be decomposed exactly into a forward‐looking and a backward‐looking progressivity component. Our empirical illustration, using data from household surveys in Vietnam, shows that economic growth in Vietnam has been pro‐poor from a forward‐looking perspective, but not from a backward‐looking perspective.