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Structural adjustment and public spending on health: Evidence from IMF programs in low-income countries

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  • Kentikelenis, Alexander E.
  • Stubbs, Thomas H.
  • King, Lawrence P.

Abstract

The relationship between health policy in low-income countries (LICs) and structural adjustment programs devised by the International Monetary Fund (IMF) has been the subject of intense controversy over past decades. While the influence of the IMF on health policy can operate through various pathways, one main link is via public spending on health. The IMF has claimed that its programs enhance government spending for health, and that a number of innovations have been introduced to enable borrowing countries to protect health spending from broader austerity measures. Critics have pointed to adverse effects of Fund programs on health spending or to systematic underfunding that does not allow LICs to address health needs. We examine the effects of Fund programs on government expenditures on health in low-income countries using data for the period 1985–2009. We find that Fund programs are associated with higher health expenditures only in Sub-Saharan African LICs, which historically spent less than any other region. This relationship turns negative in LICs in other regions. We outline the implications of these findings for health policy in a development context.

Suggested Citation

  • Kentikelenis, Alexander E. & Stubbs, Thomas H. & King, Lawrence P., 2015. "Structural adjustment and public spending on health: Evidence from IMF programs in low-income countries," Social Science & Medicine, Elsevier, vol. 126(C), pages 169-176.
    • Handle: RePEc:eee:socmed:v:126:y:2015:i:c:p:169-176
    DOI: 10.1016/j.socscimed.2014.12.027
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    1. Vreeland,James Raymond, 2003. "The IMF and Economic Development," Cambridge Books, Cambridge University Press, number 9780521016957, September.
    2. Summers, Lawrence H & Pritchett, Lant H, 1993. "The Structural-Adjustment Debate," American Economic Review, American Economic Association, vol. 83(2), pages 383-389, May.
    3. Shelton, Cameron A., 2007. "The size and composition of government expenditure," Journal of Public Economics, Elsevier, vol. 91(11-12), pages 2230-2260, December.
    4. Beck, Nathaniel & Katz, Jonathan N., 1995. "What To Do (and Not to Do) with Time-Series Cross-Section Data," American Political Science Review, Cambridge University Press, vol. 89(3), pages 634-647, September.
    5. Graham Bird & Dane Rowlands, 2007. "The IMF and the mobilisation of foreign aid," Journal of Development Studies, Taylor & Francis Journals, vol. 43(5), pages 856-870.
    6. Rudra,Nita, 2008. "Globalization and the Race to the Bottom in Developing Countries," Cambridge Books, Cambridge University Press, number 9780521886987, September.
    7. Benedict Clements & Sanjeev Gupta & Masahiro Nozaki, 2013. "What happens to social spending in IMF-supported programmes?," Applied Economics, Taylor & Francis Journals, vol. 45(28), pages 4022-4033, October.
    8. van der Gaag, Jacques & Barham, Tania, 1998. "Health and health expenditures in adjusting and non-adjusting countries," Social Science & Medicine, Elsevier, vol. 46(8), pages 995-1009, April.
    9. Rudra,Nita, 2008. "Globalization and the Race to the Bottom in Developing Countries," Cambridge Books, Cambridge University Press, number 9780521715034, September.
    10. David Stasavage, 2005. "Democracy and Education Spending in Africa," American Journal of Political Science, John Wiley & Sons, vol. 49(2), pages 343-358, April.
    11. Mrs. Ritha S. Khemani & Mr. Sanjeev Gupta & Mr. Calvin A McDonald & Mr. Louis Dicks-Mireaux & Marijn Verhoeven, 2000. "Social Issues in IMF-Supported Programs," IMF Occasional Papers 2000/002, International Monetary Fund.
    12. Reza Baqir, 2002. "Social Sector Spending in a Panel of Countries," IMF Working Papers 2002/035, International Monetary Fund.
    13. Bob Deacon, 2013. "The social protection floor and global social governance: Towards policy synergy and cooperation between international organizations," International Social Security Review, John Wiley & Sons, vol. 66(3-4), pages 45-67, July.
    14. Baldacci, Emanuele & Clements, Benedict & Gupta, Sanjeev & Cui, Qiang, 2008. "Social Spending, Human Capital, and Growth in Developing Countries," World Development, Elsevier, vol. 36(8), pages 1317-1341, August.
    15. Suzanna De Boef & Luke Keele, 2008. "Taking Time Seriously," American Journal of Political Science, John Wiley & Sons, vol. 52(1), pages 184-200, January.
    16. Nooruddin, Irfan & Simmons, Joel W., 2006. "The Politics of Hard Choices: IMF Programs and Government Spending," International Organization, Cambridge University Press, vol. 60(4), pages 1001-1033, October.
    17. Gould, Erica R., 2003. "Money Talks: Supplementary Financiers and International Monetary Fund Conditionality," International Organization, Cambridge University Press, vol. 57(3), pages 551-586, July.
    18. Gupta, Sanjeev, 2000. "Social issues in IMF: supported programs," Sede de la CEPAL en Santiago (Estudios e Investigaciones) 34725, Naciones Unidas Comisión Económica para América Latina y el Caribe (CEPAL).
    19. Benson, John S., 2001. "The impact of privatization on access in Tanzania," Social Science & Medicine, Elsevier, vol. 52(12), pages 1903-1915, June.
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    8. Rickard, Stephanie J. & Caraway, Teri L., 2019. "International demands for austerity: examining the impact of the IMF on the public sector," LSE Research Online Documents on Economics 86636, London School of Economics and Political Science, LSE Library.
    9. Grigorakis, Nikolaos & Floros, Christos & Tsangari, Haritini & Tsoukatos, Evangelos, 2018. "Macroeconomic and financing determinants of out of pocket payments in health care: Evidence from selected OECD countries," Journal of Policy Modeling, Elsevier, vol. 40(6), pages 1290-1312.
    10. Mr. Sanjeev Gupta & Michela Schena & Mr. Seyed Reza Yousefi, 2018. "Expenditure Conditionality in IMF-supported Programs," IMF Working Papers 2018/255, International Monetary Fund.
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    13. Gurgen OHANYAN, 2015. "Recent Changes of IMF Conditionality and Its Effects on Social Spending," REVISTA DE MANAGEMENT COMPARAT INTERNATIONAL/REVIEW OF INTERNATIONAL COMPARATIVE MANAGEMENT, Faculty of Management, Academy of Economic Studies, Bucharest, Romania, vol. 16(5), pages 591-602, December.
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    16. Chletsos, Michael & Sintos, Andreas, 2023. "The effects of IMF conditional programs on the unemployment rate," European Journal of Political Economy, Elsevier, vol. 76(C).
    17. Daoud, Adel & Herlitz, Anders & Subramanian, S.V., 2022. "IMF fairness: Calibrating the policies of the International Monetary Fund based on distributive justice," World Development, Elsevier, vol. 157(C).
    18. Valentin Lang, 2021. "The economics of the democratic deficit: The effect of IMF programs on inequality," The Review of International Organizations, Springer, vol. 16(3), pages 599-623, July.
    19. Forster, Timon & Kentikelenis, Alexander E. & Stubbs, Thomas H. & King, Lawrence P., 2020. "Globalization and health equity: The impact of structural adjustment programs on developing countries," Social Science & Medicine, Elsevier, vol. 267(C).
    20. Pfeiffer, James & Gimbel, Sarah & Chilundo, Baltazar & Gloyd, Stephen & Chapman, Rachel & Sherr, Kenneth, 2017. "Austerity and the “sector-wide approach” to health: The Mozambique experience," Social Science & Medicine, Elsevier, vol. 187(C), pages 208-216.
    21. Xuejie Ding & Francesco C. Billari & Stuart Gietel-Basten, 2017. "Health of midlife and older adults in China: the role of regional economic development, inequality, and institutional setting," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 62(8), pages 857-867, November.
    22. Armenia ANDRONICEANU & Gurgen OHANYAN, 2016. "Comparative Approach on Education and Healthcare in Romania and Bulgaria as Beneficiaries of the IMF Financial Assistance," REVISTA ADMINISTRATIE SI MANAGEMENT PUBLIC, Faculty of Administration and Public Management, Academy of Economic Studies, Bucharest, Romania, vol. 2016(26), pages 25-48, June.
    23. Kentikelenis, Alexander E., 2017. "Structural adjustment and health: A conceptual framework and evidence on pathways," Social Science & Medicine, Elsevier, vol. 187(C), pages 296-305.
    24. MacPherson, Eleanor E. & Phiri, Mackwellings & Sadalaki, John & Nyongopa, Victoria & Desmond, Nicola & Mwapasa, Victor & Lalloo, David G. & Seeley, Janet & Theobald, Sally, 2020. "Sex, power, marginalisation and HIV amongst young fishermen in Malawi: Exploring intersecting inequalities," Social Science & Medicine, Elsevier, vol. 266(C).

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