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The political economy of health services provision and access in Brazil

Author

Listed:
  • Mushfiq Mobarak, Ahmed
  • Rajkumar, Andrew Sunil
  • Cropper, Maureen
Abstract
The authors examine the impact of local politics and government structure on the allocation of publicly subsidized (SUS) health services across municipios (counties) in Brazil, and on the probability that uninsured individuals who require medical attention actually receive access to those health services. Using data from the 1998 PNAD survey they demonstrate that higher per capita levels of SUS doctors, nurses, and clinic rooms increase the probability that an uninsured individual gains access to health services when he, or she seeks it. The authors find that an increase in income inequality, an increase in the percentage of the population that votes, and an increase in the percentage of votes going to left-leaning candidates are each associated with higher levels of public health services. The per capita provision of doctors, nurses, and clinics is also greater in counties with a popular local leader, and in counties where the county mayor and state governor are politically aligned. Administrative decentralization of health services to the county decreases provision levels, and reduces access to services by the uninsured, unless it is accompanied by good local governance.

Suggested Citation

  • Mushfiq Mobarak, Ahmed & Rajkumar, Andrew Sunil & Cropper, Maureen, 2005. "The political economy of health services provision and access in Brazil," Policy Research Working Paper Series 3508, The World Bank.
    • Handle: RePEc:wbk:wbrwps:3508
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    References listed on IDEAS

    as
    1. World Bank, 2003. "Decentralization of Health Care in Brazil : A Case Study of Bahia," World Bank Publications - Reports 14761, The World Bank Group.
    2. Dilip Mookherjee & Pranab K. Bardhan, 2000. "Capture and Governance at Local and National Levels," American Economic Review, American Economic Association, vol. 90(2), pages 135-139, May.
    3. Bardhan, Pranab & Mookherjee, Dilip, 1998. "Expenditure Decentralization and the Delivery of Public Services in Developing Countries," Center for International and Development Economics Research (CIDER) Working Papers 233623, University of California-Berkeley, Department of Economics.
    4. David Strömberg, 2004. "Radio's Impact on Public Spending," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 119(1), pages 189-221.
    5. Dani Rodrik, 2000. "Participatory Politics, Social Cooperation, and Economic Stability," American Economic Review, American Economic Association, vol. 90(2), pages 140-144, May.
    Full references (including those not matched with items on IDEAS)

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    Cited by:

    1. Soares, Rodrigo R., 2007. "Health and the evolution of welfare across Brazilian municipalities," Journal of Development Economics, Elsevier, vol. 84(2), pages 590-608, November.
    2. Gamper-Rabindran, Shanti & Khan, Shakeeb & Timmins, Christopher, 2010. "The impact of piped water provision on infant mortality in Brazil: A quantile panel data approach," Journal of Development Economics, Elsevier, vol. 92(2), pages 188-200, July.
    3. Fabio Sánchez, 2006. "Descentralización Y Progreso En El Acceso A Los Servicios Sociales De Educación, Salud Y Agua Y Alcantarillado," Documentos CEDE 2287, Universidad de los Andes, Facultad de Economía, CEDE.

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