Following a benchmarking exercise, we estimate the spending required to reach satisfactory progress in the Sustainable Development Goals in the health, education, and infrastructure sectors in Brazil. We find that there is room for savings in education (up to 1.5 percentage point of GDP) and health (up to 2.5 percentage points of GDP) without compromising the quality of services but additional investments for over 3 percent of GDP per year are needed to close large infrastructure gaps in roads, water, and electricity by 2030. Brazil can do more with less, but increasing efficiency of public spending will require substantial reforms.
7. Health Expenditure
8. HealthExpenditureDistribution and Efficiency
9. Capital Stock and Quality of Infrastructure
10. Public and Total Gross Fixed Capital Formation
11. Adequacy of Roads, Electricity, and Water Infrastructure
12. Infrastructure SDG Cost Estimates
13. Total SDG Cost Estimates
1. Cost Estimates for Education
2. Cost Estimates for Health
3. Cost Estimates for Roads
4. Cost Estimates for Electricity
5. Cost Estimates for Water
Valentina Flamini, Mauricio Soto, and Mr. Antonio Spilimbergo
health insurance premiums (about 0.3 percent of GDP) are regressive ( World Bank, 2017 ). Spending also seems inefficient. Peer countries achieve similar or better health outcomes with less resources. This is consistent with the World Bank (2017) finding that the same outcomes could be achieved with 23 less resources in primary health and 34 percent less resources in secondary and tertiary care, with most inefficiencies in the smaller hospitals and municipalities.
Figure 8. HealthExpenditureDistribution and Efficiency
Source: World Bank (2018) and IMF
The study examines the effect of health care reform in Bulgaria in 1999 on the equity of health care financing. It explores the distribution of different types of health care financing by income. Furthermore, it separates the financial and social reasons for these differences, dividing them into economic and social inequalities. It suggests a method of distinguishing between financially based and "exclusion based" reasons for having progressive/regressive health care financing. Moreover, it looks at the social factors that shape health expenditure patterns and identifies those social characteristics that lead to exclusion from the health care system.
. For the upper quintiles, the occurrence of disease does not appear to play such a significant role. Long-term disability also shapes the expenditure curves, and there is a positive trend in both out-of-pocket and total payments with the increase of the income. In comparison, the healthexpendituredistribution in 2001 seems to have a much clearer trend in that there is an increase in spending with an increase in income. This may be influenced by the relatively low number of ill and disabled in the lowest quintile. Still, the occurrence of both risks has significant