Health Care Spending

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PIDE Working Papers 2007:32

Health Care Services and Government Spending in Pakistan

Muhammad Akram
International Institute of Islamic Economics International Islamic University, Islamabad


Faheem Jehangir Khan
Pakistan Institute of Development Economics, Islamabad



All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means—electronic, mechanical, photocopying, recording or otherwise—without prior permission of the author(s) and or the Pakistan Institute of Development Economics, P. O. Box 1091, Islamabad 44000.

© Pakistan Institute of Development Economics, 2007.

Pakistan Institute of Development Economics Islamabad, Pakistan E-mail: Website: Fax: +92-51-9210886 Designed, composed, and finished at the Publications Division, PIDE.

CONTENTS Page Abstract 1. Introduction and Background 2. Literature Review 3. Policies Emphasising Health Care Services in Pakistan 3.1. Health Millennium Development Goals (2015) 3.2. Medium Term Development Framework (2005–10) 3.3. Poverty Reduction Strategy Papers 3.4. National Health Policy (Health Sector Reform) 4. Public Health Care Service Delivery in Pakistan 4.1. Access to Health Care Services 4.2. Public Sector Spending on Health Care Services 5. Research Focus Methodology Data Sources 6. Results and Discussion 7. Conclusion and Policy Implications Conclusion Policy Implications References List of Tables Table 1. Health Related Indicators (Regional Comparison) Table 2. National Medical and Health Establishments Table 3. Registered Medical and Paramedical Personnel 5 8 12 v 1 2 4 5 7 9 9 10 11 13 16 16 17 18 22 22 23 24

4 Page Table 4. Health Consultations in Past Two Weeks by Type of Health Provider Consulted Table 5. Distribution of Health Expenditure by Sub-sectors Table 6. Distribution of Government Health Expenditure by Sector and Quintile List of Figures Figure 1. Child Health Care Status and MDGs Figure 2. Maternal Health Care Status and Targets Figure 3. Total Public Sector Expenditure on Health Figure 4. Share in Total Public Sector Health Expenditure Figure 5. Public Expenditure on Health as % of GDP 11 11 14 14 15 13 15 19

ABSTRACT The study has been carried out to measure the incidence of government spending on health in Pakistan at provincial, both rural and urban level; using the primary data of the Pakistan Social Standard Living Measures Survey (PSLM), 2004-05, and by employing the three-step Benefit Incidence Approach (BIA) methodology. The paper reviews the national policies emphasising health services as well as the trend in access to and public sector spending on health care facilities in Pakistan. The study explores the inequalities in resource distribution and service provision against the government health expenditures. The rural areas of Pakistan are the more disadvantaged in the provision of the health care facilities. The expenditures in health sectors are overall regressive in rural Pakistan as well as at provincial and regional levels. Mother and Child subhead is regressive in Punjab and General Hospitals and Clinics are regressive in all provinces. Only the Preventive Measures and health facilities sub-sector is progressive in Pakistan. Public health expenditures are pro-rich in Pakistan. JEL classification: H51, H53, I11, I18, I38, O18 Keywords: Health, Expenditure, Public Policy, Gini, Concentration Coefficient, Mother and Child, Preventive Measures, Hospital and Clinics

1. INTRODUCTION AND BACKGROUND Health plays the key role in determining the human capital. Better health improves the efficiency and the productivity of the labour force, ultimately contributes the economic growth and leads to human welfare. To attain better, more skilful, efficient and productive human capital resources, governments subsidise the health care...
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