Conclusions
A broad range of experiences cited in this chapter demonstrates that fiscal and health policies interact in a number of areas. Although substantial research has focused on tobacco and alcohol, other links—for example the promotion of health in the workplace—have been much less recognized or studied, particularly in developing countries.
The research presented in this chapter suggests that fiscal policy can be a useful tool for influencing health in developing countries. Nevertheless, budgetary limitations to withstand pressure for program expansion, leakages to unintended beneficiaries, public compliance with the tax system, and corruption among both government officials and the public are important factors to take into account in design and implementation. Table 11.4 summarizes some lessons learned on the use of fiscal policy to promote health.
[Table .]
Governments may find it worthwhile to examine their use of fiscal policies to identify the entire range of effects and have health ministries participate in this exercise. More generally, the chapter indicates an area for increased interaction between ministries of health and finance. Healthy fiscal policy and fiscal policy for health should be topics that are debated, agreed on, and formalized between the two areas of policy making to guarantee that those developing fiscal policy take both its economic and its health implications into account.
Rigorous evaluation studies are needed of most of the fiscal policy interventions discussed in this chapter. Such studies should address the health, fiscal, macroeconomic, and distributional effects of using fiscal policy to achieve health goals and should be performed in a range of countries with mixed public and private sector capacity to deliver health services. The studies should also examine the differing effects of policies in urban and rural settings and across income quintiles. Of particularly high priority are further studies of the results of subsidizing drugs, medical supplies, and hygiene interventions with or without education campaigns. Those areas may reveal new fiscal approaches for addressing the disease burden in developing countries.
Notes
1. The idea of healthy fiscal policy is discussed in Cook and Vlaisavljevich (1994), Joffe and Mindell (2004), and Secretaria de Salud (2001).
2. Social marketing is defined as the use of marketing principles to influence behavior for a socially desirable outcome. It provides a desirable product at an affordable price with adequate promotion and placement (that is, access).
