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Ghana National Health Insurance Scheme (NHIS) was established in 2003 as a major vehicle to achieve the country's commitment of Universal Health Coverage. The government has earmarked value-added tax to finance NHIS in addition to deduction from Social Security Trust (SSNIT) and premium payment. However, the scheme has been running under deficit since 2009 due to expansion of coverage, increase in service use, and surge in expenditure. Consequently, Ghana National Health Insurance Authority (NHIA) had to reduce investment fund, borrow loans and delay claims reimbursement to providers in order to fill the gap. This study aimed to provide policy recommendations on how to improve efficiency and financial sustainability of NHIS based on health sector expenditure and NHIS claims expenditure review. The analysis started with an overall health sector expenditure review, zoomed into NHIS claims expenditure in Volta region as a miniature for the scheme, and followed by identifictation of factors affecting level and efficiency of expenditure. This study is the first attempt to undertake systematic in-depth analysis of NHIS claims expenditure. Based on the study findings, it is recommended that NHIS establish a stronger expenditure control system in place for long-term sustainability. The majority of NHIS claims expenditure is for outpatient consultations, district hospitals and above, certain member groups (e.g., informal group, members with more than five visits in a year). These distribution patterns are closely related to NHIS design features that encourages expenditure surge. For example, year-round open registration boosted adverse selection during enrollment, essentially fee-for-service provider mechanisms incentivized oversupply but not better quality and cost-effectiveness, and zero patient cost-sharing by patients reduced prudence in seeking care and caused overuse. Moreover, NHIA is not equipped to control expenditure or monitor effect of cost-containment policies. The claims processing system is mostly manual and does not collect information on service delivery and results. No mechanisms exist to monitor and correct providers' abonormal behaviors, as well as engage NHIS members for and engaging members for information verification, case management and prevention.
Efficiency --- Expenditure Control --- Financial Sustainability --- Ghana --- Health Insurance --- National Health Insurance Scheme (Ghana) --- Ghana.
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The public expenditure management system is in a state of flux. Traditional approaches of expenditure management have serious limitations in addressing current and future tasks. The new approaches toward improved expenditure management, which emphasize the creation of task-oriented agencies, performance agreements, and competitive tendering and contracting, have considerable potential in meeting the tasks. But it is essential to address the detailed operational aspects of these new approaches so that they do not contribute to a shadow government or a government that continues to be weak in regard to contracts and third-party transactions.
Budgeting --- Public Finance --- National Government Expenditures and Related Policies: General --- National Government Expenditures and Related Policies: Procurement --- National Budget --- Budget Systems --- Public finance & taxation --- Budgeting & financial management --- Expenditure control --- Expenditure --- Budget planning and preparation --- Central government spending --- Public financial management (PFM) --- Expenditures, Public --- Budget --- Finance, Public --- New Zealand
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Country-specific factors prevent a strong linear relationship between the legislature's budgetary powers and the extent of its separation from the executive. Electoral and voting systems, bicameralism, constitutional and legal constraints, voluntary contracts of political parties, and long-standing traditions all influence the relative budgetary powers of executives and legislatures. Differences in the legislature's budgetary authority in twenty-eight countries with five different forms of government are examined. It is concluded that differences in budgetary powers within a particular form of government are as great as those between different forms of government.
Budget. --- Comparative economics. --- Electronic books. -- local. --- Legislative bodies. --- Parliamentary practice. --- Budgeting --- Macroeconomics --- Public Finance --- National Budget --- Budget Systems --- National Government Expenditures and Related Policies: General --- Fiscal Policy --- Budgeting & financial management --- Public finance & taxation --- Financial administration & public finance law --- Budget planning and preparation --- Expenditure --- Fiscal law --- Expenditure control --- Fiscal rules --- Budget --- Expenditures, Public --- Finance, Public --- Law and legislation --- Fiscal policy --- United States
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This technical note elaborates the objectives of commitment controls. The focus on commitment controls is justified on the grounds of their important role in developing an overall expenditure control framework, as well as controlling the accumulation of payment arrears. The note describes the preconditions for successful implementation of commitment controls. It elaborates the main institutional forms and operational arrangements of commitment controls. Implications for the IMF’s operational work and technical assistance are also discussed.
Budgeting --- Money and Monetary Policy --- Public Finance --- National Government Expenditures and Related Policies: General --- National Budget --- Budget Systems --- Monetary Systems --- Standards --- Regimes --- Government and the Monetary System --- Payment Systems --- Public finance & taxation --- Budgeting & financial management --- Monetary economics --- Expenditure --- Budget planning and preparation --- Expenditure control --- Currencies --- Public financial management (PFM) --- Expenditures, Public --- Budget --- Money --- Finance, Public
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Significant changes with far-reaching impact have taken place during recent years in public expenditure management. These changes which are being implemented in a few industrial countries are likely to be emulated by other industrial and developing countries. The content of these changes is enumerated in some detail, and their impact is assessed in terms of specified criteria. Other continuing problems that are not addressed by these advances are also considered in detail.
Accounting --- Budgeting --- Public Finance --- Fiscal Policies and Behavior of Economic Agents: General --- National Government Expenditures and Related Policies: General --- Accounting and Auditing: General --- National Budget --- Budget Systems --- Public Administration --- Public Sector Accounting and Audits --- Public finance & taxation --- Budgeting & financial management --- Public finance accounting --- Budget planning and preparation --- Expenditure --- Expenditure control --- Budget execution processes --- Fiscal accounting and reporting --- Public financial management (PFM) --- Expenditures, Public --- Budget --- Budget process --- Finance, Public --- United States
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La acumulación de atrasos en el pago de los gastos públicos es uno de los problemas más comunes de la gestión financiera pública (GFP). En esta nota técnica se definen los atrasos del gasto y los diferentes tipos de atrasos que surgen. Se destaca el impacto económico de la acumulación crónica de atrasos del gasto. Se analizan las causas subyacentes y los mecanismos para evitar y controlar nuevas acumulaciones de atrasos. Por último, se presentan algunas estrategias para gestionar y regularizar los atrasos.
Accounting --- Budgeting --- Exports and Imports --- Public Finance --- National Government Expenditures and Related Policies: General --- National Budget, Deficit, and Debt: General --- National Budget --- Budget Systems --- Debt --- Debt Management --- Sovereign Debt --- Forecasts of Budgets, Deficits, and Debt --- Public Administration --- Public Sector Accounting and Audits --- International Lending and Debt Problems --- International economics --- Public finance & taxation --- Budgeting & financial management --- Public finance accounting --- Arrears --- Expenditure --- Budget planning and preparation --- Fiscal accounting and reporting --- Expenditure control --- Debts, External --- Expenditures, Public --- Budget --- Finance, Public --- Brazil
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This paper discusses key findings of the Technical Assistance report on Mali. The expenditure chain in Mali is vulnerable, even though it is organized along traditional lines and is subject to a number of controls. The process establishes the separation of the payment authorization officer and accountant and includes numerous exante verifications. The Auditor General identified shortfalls in the amount of CFAF 35 billion, or a little more than 3 percent of the 2012 budget, in 17 audits conducted. This report also focuses on the expenditure chain and its complexities and weaknesses, and makes 10 practical recommendations.
Economic development. --- International finance. --- International monetary system --- International money --- Finance --- International economic relations --- Development, Economic --- Economic growth --- Growth, Economic --- Economic policy --- Economics --- Statics and dynamics (Social sciences) --- Development economics --- Resource curse --- Budgeting --- Public Finance --- National Government Expenditures and Related Policies: General --- National Budget --- Budget Systems --- National Budget, Deficit, and Debt: General --- Public finance & taxation --- Budgeting & financial management --- Expenditure --- Expenditure control --- Budget execution processes --- Budget planning and preparation --- Budget execution and treasury management --- Public financial management (PFM) --- Expenditures, Public --- Budget process --- Budget --- Mali
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L'accumulation d’arriérés de dépenses publiques est l'un des problèmes les plus courants de la gestion des finances publiques (GFP). Cette note technique définit les arriérés de dépenses et leur typologie. Elle expose l'impact économique de l'accumulation d'arriérés de dépenses chroniques. Elle aborde les causes profondes des arriérés de dépenses et les mécanismes de prévention et de contrôle des arriérés de dépenses. Elle présente enfin des stratégies de gestion et de régularisation des arriérés de dépenses.
Accounting --- Budgeting --- Exports and Imports --- Public Finance --- National Government Expenditures and Related Policies: General --- National Budget, Deficit, and Debt: General --- National Budget --- Budget Systems --- Debt --- Debt Management --- Sovereign Debt --- Forecasts of Budgets, Deficits, and Debt --- Public Administration --- Public Sector Accounting and Audits --- International Lending and Debt Problems --- International economics --- Public finance & taxation --- Budgeting & financial management --- Public finance accounting --- Arrears --- Expenditure --- Budget planning and preparation --- Fiscal accounting and reporting --- Expenditure control --- Debts, External --- Expenditures, Public --- Budget --- Finance, Public --- Brazil
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The report contributes to the Mozambican authorities on strengthening budgetary execution controls.
Money and Monetary Policy --- International Economics --- Public Finance --- Budgeting --- Monetary Policy --- International Agreements and Observance --- International Organizations --- National Budget --- Budget Systems --- National Government Expenditures and Related Policies: General --- National Budget, Deficit, and Debt: General --- Monetary economics --- International institutions --- Budgeting & financial management --- Public finance & taxation --- Monetary policy --- International organization --- Budget execution and treasury management --- Public financial management (PFM) --- Budget planning and preparation --- Expenditure --- Budget execution processes --- Expenditure control --- International agencies --- Budget --- Expenditures, Public --- Budget process --- Mozambique, Republic of
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This paper proposes that, to increase the efficiency of public spending in oil-rich economies, some or all of the oil revenues be transferred to citizens, and fiscal instruments such as taxation be used to finance public expenditures. The authors develop the case as follows. First, they confirm the well-known result that public-expenditure efficiency is lower in oil-rich countries compared with other developing countries. Second, they show that this efficiency gap is associated with differences in accountability to citizens of government's spending decisions. They find that various measures of accountability are systematically weaker in oil-rich countries. They attribute this difference to the fact that oil revenues typically accrue directly to the government, unlike tax revenues, which pass through the hands of citizens. Third, they show that, controlling for a number of factors, accountability is stronger in countries that rely more on direct taxation to finance public spending. They conclude that accountability, and hence public expenditure efficiency, can be increased by transferring oil revenues to citizens and then taxing them to finance public spending. The paper reviews existing schemes that redistribute oil revenues to the population, such as the Alaska Citizen Fund, to assess the feasibility of a modest proposal in African countries. The authors conclude that, while it may be difficult to implement such a proposal in existing oil producers, there is scope for introducing it in some of Africa's new oil producers.
Central government --- Debt Markets --- Expenditure control systems --- Expenditure Efficiency --- Expenditure per Capita --- Finance and Financial Sector Development --- Governance --- Macroeconomic stability --- Macroeconomics and Economic Growth --- Medium-term expenditure --- National Governance --- Policy recommendations --- Public budgets --- Public Expenditure --- Public expenditures --- Public Sector Development --- Public Sector Economics --- Public Sector Expenditure Policy --- Public spending --- Redistribution --- Revenue collection --- Subnational Economic Development --- Tax --- Tax administration --- Tax administration capacity --- Tax base --- Tax policy --- Tax revenues --- Taxation
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