Russian Federation: Linking Health, Poverty and Economic Growth

1
Russian FederationLinking Health, Poverty and
Economic Growth

• Jack Langenbrunner
• The World Bank
• Moscow
• July 2004

2
Why Invest In Health?

• Poverty and Ill-health are intertwined
• Poorer health outcomes in/within poorer countries
• Poverty breeds ill-health (due to diet,
  education, transportation, etc)
• Ill health keeps poor people poor
• Invest in health reduce ill health and poverty

3
Why Invest in Health? Impact on Economic Growth

• Macro-Economic Commission on Health
• 10 increase in life expectancy 0.35 growth in
  GDP
• Productivity
• 17 of productivity gains attributable to health
  status
• Poor Outcomes
• Sick leave, absenteeism, etc.

4
Health Status Varies by Income
5
Russia vs. Canada Health Status
6
Poorer Groups More Likely to Engage in Risky
Behaviors

• Vodka
• Cognac
• Liquers
• Other Spirits
• Several times
• per week
• or daily

7
Russian Federation General Health Status
8
Probability of Russian Man Dying, Ages 15-60
9
Re-Emergence of Infectious Diseases AIDS

• 60 20-30 Years old
• 2.3 million by 2010
• 10 drop in GDP by 2020
• Larger drops in labor supply and investments

10
Regional Variations Growing (Infant Mortality)
11
Finance and Delivery System Reform Needed

• Access to Services
• Social Solidarity/Risk Pooling
• Efficiency in Delivery
• Equity
• Protection of Poor and Vulnerable Groups
• Pensioners

12
Limited and Declining PublicSector Funding for
Health
13
Selected International ComparisonsLevels of
Funding ( Share of GDP)
14
Fragmented Funding Streams

• Russia

• International Best Practice

Fund
Rayon
Budget
Pooled Funds
Doctor
Hospital
Doctor
Hospital
15
Inefficiency Too Many Beds and Physicians
16
Too Much Reliance on Hospital Care
(admissions/1,000)
17
Geographic Inequity Over 7-fold Regional
Variation in Funding (even after adjusting)
18
Impact on Poor and Vulnerable Groups
19
NOBUS Survey (1) Poor Pay More as of
Consumption
20
NOBUS Survey (2) of Consumption for Paid
Services
21
NOBUS Survey (3)Poor Cant Afford to Follow
Treatment Regimens
22
Recommendations

• 1. Formalize informal payments
• Standardized co-payment system
• Explicit protections for the poor and medically
  vulnerable groups
• Inform and educate
• 2. Restructure financing and delivery system
• pooling, geographic formula, autonomize
  facilities, etc.
• 3. Improve Measures for Public Health
• Cross sectoral strengthening
• Cost-effective practices and behaviors
• Increase funding for AIDS and lower price of ARVs