دانلود رایگان مقاله تاثیر مشروعیت صندوق بین المللی پول بر هزینه های بهداشتی دولت

Abstract

How do International Monetary Fund (IMF) policy reforms—so-called ‘conditionalities’— affect government health expenditures? We collected archival documents on IMF programmes from 1995-2014 to identify the pathways and impact of conditionality on government health spending in 16 West African countries. Based on a qualitative analysis of the data, we find that IMF policy reforms reduce fiscal space for investment in health, limit staff expansion of doctors and nurses, and lead to budget execution challenges in health systems. Further, we use cross-national fixed effects models to evaluate the relationship between IMF-mandated policy reforms and government health spending, adjusting for confounding economic and demographic factors and for selection bias. Each additional binding IMF policy reform reduces government health expenditure per capita by 0.248 percent (95% CI -0.435 to -0.060). Overall, our findings suggest that IMF conditionality impedes progress toward the attainment of Universal Health Coverage.

4. Quantitative results

Having identified three areas of conditionality linked to reductions in government health expenditure, we turn to evaluating this relationship using quantitative methods. Table 2 presents the results of the cross-national statistical model of the association of IMF conditionality and programme participation with government health spending, adjusted for potential confounding economic and demographic factors. Since the dependent variable has been log-transformed, effects of predictors are interpreted as percent changes in government health spending equivalent to the coefficient multiplied by 100 (except where a predictor is also log-transformed in which case the multiplication is not required). In Model 1, we exclude the IMF conditionality variable but include the IMF programme dummy variable, which yields a positive but statistically non-significant association with government health spending. This indicates that the combined effect of the IMF’s credit, technical assistance, aid catalysis, and conditionality on government health spending is no different from zero.