| Abstract: |
1. Rationale/Objective Evaluation of healthcare reforms has been an integral
part of healthcare system studies. In Uganda the effectiveness of the
healthcare reforms that were systematically undertaken since 1992, has been
widely studied. The partial equilibrium studies evaluating the reforms have
concentrated on the economic impact to the health sector and impacts to the
population’s health status. The functioning of the health sector generates
cascade effects as it is interlinked with both productive labour supply and
other sectors in the economy. The economy-wide impacts of healthcare reforms
in Uganda have not been researched. The objective of this study is to assess
the economy-wide impacts of changes in policies and strategies for healthcare
provision in Uganda. Specifically, the study aims to: i) Present results from
a dynamic computable general equilibrium (CGE) model for the Ugandan economy
that includes healthcare reform effects. The aim is to represent the
interaction of the healthcare system with the rest of the economy and
incorporate key features of Uganda’s healthcare system in the model. ii)
Present an updated Ugandan social accounting matrix (SAM) with a disaggregated
health sector defined by three new accounts: non-government health, government
primary health, and government other health. The aim of the enhanced SAM is
also to capture health consumption expenditure by multiple households defined
by residence and main economic activity (i.e. rural-farming, rural
non-farming, urban-farming, urban-non-farming, Kampala-non-farming); and
productive health sector labour by skill level (i.e. self-employed, unskilled,
skilled). ii) Determine the impact of changes in healthcare policies and
strategies on: a) factors of production; b) households; c) non-healthcare
sectors; and d) macroeconomic indicators. iv) Assess how policies aimed at
improving healthcare delivery compare. 2. Design and methods: The analysis is
based on a dynamic computable general equilibrium model of Uganda calibrated
to the enhanced Uganda 2007 social accounting matrix. The CGE method of
evaluation is a move from the narrow internal focus on the health sector to
wider national effects. Additionally, the study is in a developing country
setting and hence lessons to draw on the likely macroeconomic impacts of
healthcare reforms for low- and middle-income countries generally. 2.1 The
Uganda social accounting matrix The Uganda SAM 2007 is a 122 by 122 matrix
representing 50 sectors (comprising of agriculture, industry, and services); 6
factors of production (labour, livestock capital, physical capital, and land);
and 8 institutions (enterprises, government, multiple households, and the rest
of the world). My role in this pre-existing Uganda SAM 2007 is to disaggregate
the health sector into three new accounts namely non-government-health,
government-primary-health, and government-other-health; and balance the new
SAM. While creating the new accounts, aggregate totals from the original SAM
are preserved (that is, shares are used from other sources rather than actual
numbers). Household health consumption expenditure and health sector labour
supply shares are derived from the Uganda national household survey (UNHS)
2005 and the UNHS 2005 labour survey module respectively. Shares for capital
and health intermediate inputs are derived from the national accounts and
government health expenditure for 2007/2008; government health consumption
shares are taken from the government medium term expenditure framework (MTEF)
2006/2007. 2.2 The model The analysis is based on a recursive dynamic model to
capture the dynamics of health policy changes in the economy. The Labour force
growth rates for the different policy simulations are exogenously supplied
from a demographic model. I present two policy scenarios representing
exogenous changes in the economic conditions of the country, which are
compared to a baseline scenario of business as usual. The base run is for the
period 2010-2025 and assumes government budget allocation remains the same
throughout the model period. The first simulation considers reallocation of
resources to the health sector. Thus, the base year government health
expenditure is raised by some percentage (informed by the literature), as a
share of GDP. In the second experiment, the reallocation of resources to
health sector is coupled with improved efficiency in the use of resources.
Thus, I increase health expenditure by some percentage from the base, with
increased factor productivity in the health sector (both total factor
productivity and health specific factor productivity). 3. Results/Expected
Results The creation of three new health accounts (out of the original single
account) in the Uganda SAM 2007 is my innovation. Specifically, the health
sector is now represented by non-government-health, government-primary-health,
and government-other-health. The scenarios described above are a work in
progress and final results will be presented in the full conference paper. |