| Abstract: | This article addresses the problem of how to determine the optimalallocation of public expenditure in the health sector. The firstpart poses the question: How should the set of services providedin the public health care system and the fees charged for thembe chosen to maximize the health status of the population witha fixed budget? First, the findings show that policy reformshould take into account the response of the private sector.Substituting for a reasonably well-functioning private sectoris not as valuable as providing services the private sectorcannot. Second, the assumptions needed to justify the cost-effectivenessof medical interventions as a criterion for setting prioritiesare so restrictive as to make this method usable in few, ifany, circumstances. Third, prices for any one service shouldbe set to balance the conflicting goals of encouraging its useand of conserving the budget for more effective services. The second part broadens the objective of policy to cover thestandard welfare economics concerns of utility and market failure,that latter being extensive in the health sector. It reexamineswelfare maximization rules to show that only the market failurecomponents of shadow prices are needed to calculate the welfaregains from public investments. |
