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Regulated prices are common in markets for medical care. We estimate the effect of changes in regulated reimbursement prices on volume of hospital care based on a reform of hospital financing in Germany. Uniquely, this reform changed the overall level of reimbursement—with increasing prices for some hospitals and decreasing prices for others—without directly affecting the relative prices for different groups of patients or types of treatment. Based on administrative data, we find that hospitals react to increasing prices by decreasing the service supply and to decreasing prices by increasing the service supply. Moreover, we find some evidence that volume changes for hospitals with different price changes are nonlinear. We interpret our findings as evidence for a negative income effect of prices on volume of care.

Considering the de-financing of the Brazilian Unified Health System (SUS), the health-related tax expenditure seems to be undesirable under the distributive justice approach. It represents an unpaid tax or public expenditure not directly applied to health policies, promoting, among others, the profit of the private sector. In the context of fiscal constraints, looking over its magnitude and inequity that favors the upper income - the government should reflect how this problem can be tackled. This rebate represents a significant amount of funds not collected by the Individual Income Tax (IRPF), which is in part transferred to states and local authorities, playing a significant role in the SUS financing at poorest regions. This working paper evaluates the deduction of medical and hospital expenses of the IRPF, taking the opportunity to debate some ideas to eliminate, reduce or target such subsidies. It appears that any changes in the design and magnitude of the tax expenditure can be applied to different purposes. However, besides its increasing growth, the subsidy size is so significant that once allocated for other priorities, it might serve as a basis for creating social programs or for boosting existing programs, or even compensate effects on the tax burden, addressing the poverty and structural inequality in the society. If managed properly, this mechanism could contribute to overcoming certain inequities in the Brazilian health system.

We seek to understand if spatial dynamics affect the population in social, economic and health terms. To carry out this study, we propose the following two stages. In the first stage we try to understand the causes of high infant mortality in rural areas in comparison to the urban areas based on literature and the changes made to the Colombian health model. The second stage is a spatial econometric analysis of the variables of interest, where the CEDE database of the Universidad de los Andes is utilized. The findings of this study confirm the importance of the inclusion of spatial effects, which is a sign that the health dynamics of populations are interrelated. This spatial interdependence corroborates the suggestion from literature where proposing policies coordinate the system and consider local and neighboring populations. Also, municipal administrations require the need to consider mechanisms of interlocution whilst working with their peers and allow these factors to be included in the planning of political measures taken that affect health conditions. Finally, we confirm differences between the rural and urban performance. Resumen Buscamos entender si la dinámica espacial afecta a la población en términos sociales, económicos y de salud. Para llevar a cabo este estudio, proponemos dos etapas. En la primera, buscamos comprender, desde la literatura y los cambios realizados en el modelo de salud colombiano, las causas de la alta mortalidad infantil en las zonas rurales en comparación con las zonas urbanas. La segunda, es un análisis econométrico espacial de las variables de interés, donde se utiliza la base de datos CEDE de la Universidad de los Andes. Los resultados de este estudio confirman la importancia de la inclusión de efectos espaciales, lo cual es una señal de que la dinámica de salud de las poblaciones está interrelacionada. Esta interdependencia espacial corrobora la sugerencia de la literatura que propone que las políticas deben estar coordinadas y considerar poblaciones locales y vecinas. Además, las administraciones municipales deberían considerar mecanismos de interlocución, mientras trabajan con sus pares, y permitir que estos factores se incluyan en la planificación de las medidas políticas en temas de salud. Finalmente, confirmamos diferencias en áreas rurales y urbanas. Résumé Nous cherchons à comprendre si la dynamique spatiale affecte la population en termes sociaux, économiques et sanitaires. Pour réaliser cette étude, nous proposons deux étapes. Dans la première, nous cherchons à comprendre, à partir de la littérature et des changements apportés au modèle de santé colombien, les causes de la haute mortalité infantile dans le milieu rural par rapport aux milieux urbaines. La deuxième étape est une analyse économétrique spatiale des variables d’intérêt, à partir de la base de données CEDE de l’Université de los Andes. Les résultats confirment l’importance de la prise en compte des effets spatiaux, puisque les dynamiques de santé des populations sont interdépendantes. Cette interdépendance spatiale montre que les politiques doivent être coordonnées et doivent également prendre en compte l’avis des populations locales. En outre, les villes devraient envisager mécanismes de dialogue et permettre que les effets spatiaux soient inclus dans la planification des politiques de santé publique. Enfin, nous confirmons les différences dans les zones rurales et urbaines.

ResumenLa transición demográfica de México en años recientes ha provocado un cambio sustancial en la estructura de su población y se observa un proceso de envejecimiento que se agudizará durante las próximos décadas, ello plantea serios dilemas a los sistemas públicos de pensiones, pues el gasto pensionario acumulado presionará las finanzas públicas a grado tal de restringir la capacidad del Estado para atender otras demandas sociales. Para resolver el problema no son suficientes las reformas que aspiren únicamente a modificar los parámetros relativos de los sistemas actuales; es preciso hacer una reforma de consenso entre los participantes, con una etapa de transición que atienda los desequilibrios a través de la creación de un organismo autónomo supervisor que tutele derechos y analice en forma permanente el equilibrio y sustentabilidad de los sistemas de salud y de pensiones. México puede evitar un colapso en sus sistemas pensionarios y de salud, para ello es preciso modificar el esquema de aseguramiento público y así darle equidad y vialilidad en el largo plazo.AbstractDemographic transition in Mexico in recent years has led to a substantial change in the structure of the population and there is an aging process that will worsen over the next few decades, it poses serious dilemmas for public pension systems, as the accumulated pension expense push public finances so much so to restrict the state’s ability to address other social demands. To solve the problem are not enough reforms that aim only to modify the parameters relative to current systems, it is necessary to reform consensus among participants, with a transition that addresses the imbalance through the creation of an autonomous supervisor that will safeguard rights and permanently analyze the balance and sustainability of health systems and pension. Mexico can avoid a collapse in their pension and health systems, it is necessary to modify the public insurance scheme and to give equity and long-term vialilidad.

Como os formuladores de política podem lidar com a aspiração de produzir um sistema de saúde universal, em um contexto de restrição fiscal do Estado? Parece haver uma contradição entre o modelo redistributivo pressuposto na Constituição brasileira e o nível de gasto público em saúde. Neste quadro, o aumento de recursos financeiros é uma precondição para negarmos o SUS da 'não-universalidade' e da 'não-descentralização', para que ele não negue si mesmo enquanto direito social. Tal como o modelo de descentralização preconizado pelos ideólogos do SUS, que sofreu com a escassez de recursos, boa parte dos problemas de gestão decorre da crise crônica de financiamento, e a adoção de medidas de eficiência não pode servir de base para se cortar o nível de recursos financeiros ou organizacionais do SUS. Pelo contrário: a melhoria da eficiência pode, na realidade, significar e exigir o aumento dos gastos.How can those who formulate policies deal with the aspiration of producing a universal health context in a context of fiscal restrictions of the State? There seems to be a contradiction between the redistributive model the Brazilian Constitution predicates and the level of public expenditure with health. In this scenario, increasing financial resources is a precondition in order to deny the 'non-universal' and 'non-decentralized' SUS, so it will not deny itself as a social right. Such as the model of decentralization professed by SUS ideologues, a system that suffered from the scarcity of resources, most of the management problems result from the chronic funding crisis, and adopting efficiency measures cannot serve as the base to cut the SUS' level of financial or organizational resources. On the contrary: improved efficiency can, in fact, mean and require increased spending.

Health spending has risen rapidly in Japan. We find two-thirds of the spending increase in 1990–2011 resulted from ageing, and the rest from excess cost growth. The spending level will rise further: ageing alone will raise it by 3½ percentage points of GDP in 2010–30, and excess cost growth at the rate observed in 1990–2011 will lead to an additional increase of 2–3 percentage points of GDP. This will require a sizable increase in government transfers. Japan can introduce micro- and macro-reforms to contain health spending, and financing options should be designed to enhance equity.

Como os formuladores de política podem lidar com a aspiração de produzir um sistema de saúde universal, em um contexto de restrição fiscal do Estado? Parece haver uma contradição entre o modelo redistributivo pressuposto na Constituição brasileira e o nível de gasto público em saúde. Neste quadro, o aumento de recursos financeiros é uma precondição para negarmos o SUS da 'não-universalidade' e da 'não-descentralização', para que ele não negue si mesmo enquanto direito social. Tal como o modelo de descentralização preconizado pelos ideólogos do SUS, que sofreu com a escassez de recursos, boa parte dos problemas de gestão decorre da crise crônica de financiamento, e a adoção de medidas de eficiência não pode servir de base para se cortar o nível de recursos financeiros ou organizacionais do SUS. Pelo contrário: a melhoria da eficiência pode, na realidade, significar e exigir o aumento dos gastos. How can those who formulate policies deal with the aspiration of producing a universal health context in a context of fiscal restrictions of the State? There seems to be a contradiction between the redistributive model the Brazilian Constitution predicates and the level of public expenditure with health. In this scenario, increasing financial resources is a precondition in order to deny the 'non-universal' and 'non-decentralized' SUS, so it will not deny itself as a social right. Such as the model of decentralization professed by SUS ideologues, a system that suffered from the scarcity of resources, most of the management problems result from the chronic funding crisis, and adopting efficiency measures cannot serve as the base to cut the SUS' level of financial or organizational resources. On the contrary: improved efficiency can, in fact, mean and require increased spending.

The measurement of the efficiency of public education expenditure using parametric and non-parametric methods has proven challenging. This paper seeks to overcome the difficulties of earlier studies by using a hybrid approach to measure the efficiency of secondary education spending in emerging and developing economies. The approach accounts for the impact of the level of development on education outcomes by constructing different efficiency frontiers for lower- and higher-income economies. We find evidence of large potential gains in enrollment rates by improving efficiency. These are largest in lower-income economies, especially in Africa. Reallocating expenditure to reduce student-to-teacher ratios (where these are high) and improving the quality of institutions (as measured by the "governance effectiveness" indicator in the World bank's Governance Indicators database) could help improve the efficiency of education spending. Easing the access to education facilities and reducing income inequality (as measured by the Gini coefficient) could also help improve efficiency.

The purpose of this paper is to present an empirical study regarding density and penetration on accident & health premiums. At the beginning of this paper we have presented the motivations of this research, highlighting and explaining the specific factors which influence the density and insurance penetration. Implementation of Solvency Directive at European level, in the field of insurance and its transition from Solvency I to Solvency II is through specific consequences, an important motivation for the development of this sector of the national economy. The changes made to accounting legislation at national, European and international level, with immediate consequences on specific information presented in the financial statements of insurance companies, was another predominant reason of our research. The appearance of International Financial Reporting Standards in general, particularly the IFRS 4 named “Insurance contracts”, followed by its evolution phases (from Phase I to Phase II) allowed the creation of XBRL's in as the international standard of publication, exchange and financial analysis of data reported. Also, we cannot forget that the legislative changes in accounting have interesting consequences on economic risk management specific to this field, in terms of huge efforts from national and European supervisory authorities to control and prevent the bankruptcy of its firms.