Over the last two decades, the Peruvian government has made great efforts to improve access to health care by significantly augmenting the coverage of the non-contributory public health care system Seguro Integral de Salud (SIS). This expansion has a positive impact on welfare and public health indicators, as it limits the risk of catastrophic health-related costs for previously uninsured individuals and allows for the appropriate treatment of illnesses. However, it also entails some unintended consequences for informality, tax revenues, and GDP, since a few formal agents are paying for a service that the majority of (informal) agents receive for free. In this paper, we use a general equilibrium model calibrated for Peru to simulate the expansion of SIS to quantify the unintended effects. We find that overall welfare increases, but informality rises by 2.7 percent, while tax revenues and output decrease by roughly 0.1 percent. Given the extent of the expansion in eligibility, the economic relevance of these results seems negligible. However, this occurs because the expansion of coverage was mostly funded by reducing the spending per-insured person. In fact, we find larger costs if public spending is increased to improve the quality of service given universal coverage.
Deon Filmer, Roberta Gatti, Halsey Rogers, Mr. Nikola Spatafora, and Drilona Emrullahu
We discuss existing shortfalls and inequalities in the accumulation of human capital—knowledge, skills, and health. We analyze their immediate and systemic causes, and assess the scope for public intervention. The broad policy goals should be to improve: the quality, and not just the quantity, of education and health care; outcomes for disadvantaged groups; and lifelong outcomes. The means to achieve these goals, while maximizing value for money, include: focusing on results rather than just inputs; moving from piecemeal interventions to systemic reform; and adopting a “whole-of-society” approach. Reforms must be underpinned by a robust evidence base.
International Monetary Fund. External Relations Dept.
This paper focuses on millennials who are increasingly looking to find their way in the sharing economy, a phenomenon made possible by the emergence of digital platforms that facilitate the matching of buyer and seller. Jobs in the sharing economy—like driving for Uber or Lyft—help some millennials make ends meet, even if such temporary gigs are a far cry from the fulltime jobs with traditional pension plans and other benefits their parents often enjoyed. This generation also enthusiastically embraces the services of the sharing economy, which provides access to everything from beds to cars to boats without the hassle of ownership. Loath to buy big-ticket items such as cars and houses, millennials have sharply different spending habits from those of preceding generations. Millennials confront obstacles to prosperity that their parents didn’t face. They are better educated than previous generations—but in today’s world, that is not enough to guarantee financial success.
This paper reviews public expenditure in Lithuania to identify areas where deeper structural
reforms may be warranted to improve spending efficiency and contain future spending
pressures. The analysis benchmarks spending in Lithuania against other European countries
focusing on spending levels, spending composition, and spending outcomes, and for both
economic and functional spending classifications. While recent expenditure consolidation efforts
have kept public spending among the lowest in Europe, a transition from broad-based measures
to more structural measures will be required: to ensure that low spending levels remain
sustainable, to address poor social outcomes such as high inequality and poor health and
education outcomes, and to efficiently and equitably contain spending pressures arising from an