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At least part of the effort toward MDG attainment in the social sector could come from improvements in efficiency of delivery mechanisms. Hence, it is important to know which countries - or which regions within countries - are able to attain higher MDG outcomes even after controlling for resource inputs. This information can be useful for policymakers and enable a second-stage analysis of why is it that some are doing better than others. This paper reviews the methodology for measuring efficiency in macro systems using the health and education sectors as examples. A simpler characterization of efficiency that is less dependent on econometric specifications is introduced. As an example, this method of measuring efficiency is applied to assess health system outcomes at the district (kabupatam) level in Indonesia.

This dissertation consists of three chapters on development economics. The first two chapters are in the area of international macroeconomics. The third chapter is in an area that is the intersection of macroeconomics and population economics. The first chapter studies currency substitution in an environment where agents' inflation tax evasive demand for foreign money is balanced by the concern for the possibility that the government may impose economy-wide capital controls under which foreign currency transactions are costly. We contrast implications of constant beliefs regarding capital controls with those obtained under endogenous beliefs. With endogenous beliefs, agents expect a greater likelihood of capital controls as economy-wide currency substitution rises. Our results show a persistent demand for foreign money under endogenous beliefs despite efforts by the government to reduce inflation. The second chapter is a theoretical study of currency substitution in an overlapping-generations economy. We focus on the role of beliefs in determining the relative demands for domestic and foreign money. Domestic money suffers from a lack of confidence leading agents to demand foreign money as an alternate store-of-value. We study equilibria in which the level of confidence in domestic money evolves as a function of expected future aggregate domestic money demand: agents increase their demand for domestic money only if aggregate economy-wide real domestic money demand is expected to rise. The third chapter is a study of intertemporal substitution and fertility dynamics. The demographic experience of Iran after the revolution poses an interesting puzzle. A brief increase in period fertility after the 1979 revolution interrupted a trend of decline that had started in the 1950s. The rise in fertility, however, appears to have lasted only a few years: in the late 1980s fertility decline resumed its course at an even faster pace. We present evidence that suggests that the changes in Iranian fertility since the revolution were in part a birth timing phenomenon. The revolution may well have been a transient economic shock which temporarily depressed the relative "price" of children and caused adjustment in fertility patterns which, at least in an ex post sense, is suggestive of intertemporal substitution. ; Ph. D.

Over the past two decades Vietnam has made enormous progress towards achieving universal coverage (UC) for its population. Significant challenges remain, however, in terms of improving equity with continuing low rates of enrollment. Ensuring financial protection also remains an elusive goal. The Master Plan for Universal Coverage approved in 2012 by the Prime Minister directly addresses both these deficiencies in coverage. The objective of this report is to assess the implementation of Vietnam SHI and provide options for moving towards UC. This is a joint assessment with development partners

As countries undergo their health financing transitions, moving away from external and out-of-pocket (OOP) financing toward domestically sourced public financing, the issue of fiscal space – that is, of finding ways to increase public financing in an efficient, equitable, and sustainable manner -- is front and center in the policy dialogue around universal health coverage (UHC). Although how money is expended is just as critical as the overall resource envelope, we analyze changes in per capita public financing for health in real terms, a proxy for realized fiscal space, within and across 151 countries over time. This allows for an assessment not just of trends in public financing for health but also of contributions from three macro-fiscal drivers -- economic growth, changes in aggregate public spending, and reprioritization for health -- exploiting a macroeconomic identity that captures the relationship between these factors. Analysis of data from 2000 to 2015 shows per capita public financing for health in low- and middle-income countries increased by 5.0 percent per year on average: up from US$60 (2.2 percent of GDP) in 2000 to US$117 (2.8 percent of gross domestic product [GDP]) in 2015. Some of the largest increases were in countries in the Europe and Central Asia (ECA) and East Asia and Pacific (EAP) regions. At 3.1 percent per year, annual growth in public financing for health was lower among high-income countries, albeit from a much higher baseline in 2000. Increases in on-budget external financing comprised most of the changes among low-income countries, whereas domestic government revenues dominated changes in composition of public financing among lower- and upper-middle-income countries. Public financing increased at a faster rate than OOP sources for health in most regions except for South Asia. Although there are important country-specific differences, it is notable that more than half of the increase in public financing for health was due to economic growth alone. For the remainder of the increase, aggregate public spending contributed more than reprioritization across low and lower-middle-income countries, whereas the reverse was true in high-income countries. One key point of note from the landscaping exercise summarized in the paper is the diversity of growth trajectories across countries and, especially, the volatility in trends over time. The implications are clear: capturing public financing with a single growth rate is not the best metric to characterize country experiences, many of which are punctuated by episodes wherein trends are flat or have varying degrees of growth rates (positive or negative). Although country context matters, the importance of economic growth for public financing for health underscores the critical need to situate, integrate, leverage, and proactively manage health financing reforms within a country's overall macro-fiscal context and to assess different pillars of fiscal space holistically.

In 2004 the Indonesian government made a commitment to provide its entire population with health insurance coverage through a mandatory public health insurance scheme. It has moved boldly already provides coverage to an estimated 76.4 million poor and near poor, funded through the public budget. Nevertheless, over half the population still lacks health insurance coverage, and the full fiscal impacts of the government's program for the poor have not been fully assessed or felt. In addition, significant deficiencies in the efficiency and equity of the current health system, unless addressed will exacerbate cost pressures and could preclude the effective implementation of universal coverage (UC) and the desired result of improvements in population health outcomes and financial protection.For Indonesia to achieve UC, systems' performance must be improved and key policy choices with respect to the configuration of the health financing system must be made. Indonesia's health system performs well with respect to some health outcomes and financial protection, but there is potential for significant improvement. High-level political decisions are necessary on key elements of the health financing reform package. The key transitional questions to get there include: the benefits that can be afforded and their impacts on health outcomes and financial protection; how the more than 50 percent of those currently without coverage will be insured; how to pay medical care providers to assure access, efficiency, and quality; developing a streamlined and efficient administrative structure; how to address the current supply constraints to assure availability of promised services; how to raise revenues to finance the system, including the program for the poor as well as currently uninsured groups that may require government subsidization such as the more than 60

The Government of India has publicly committed to a doubling or trebling of government health spending by 2012 and launched a major program, the National Rural Health Mission (NRHM), to help spend the additional funds and achieve better health outcomes. This paper reviews recent data on trends in government spending and various scenarios of central and state funding to assess the feasibility of achieving these financing goals. The goal of 2 percent of Gross Domestic Product (GDP) for government health spending is unlikely to be achieved, although there is clear evidence of program growth. Much larger state-level spending is needed to accelerate overall government spending in India's federal system. In addition, there is evidence of constraints in the ability to spend significantly increased budgets in a timely way and possible state substitution of increased central funding for existing state budgets. Significantly increasing government health spending in India requires more than simply raising budgets at the central level. NRHM does show some positive effects, but the rapid gains envisaged will require greater efforts to address the shortcomings of government systems and creative approaches to India complex federal financing system.

We address two long-standing survey research problems: measuring complicated concepts, such as political freedom and efficacy, that researchers define best with reference to examples; and what to do when respondents interpret identical questions in different ways. Scholars have long addressed these problems with approaches to reduce incomparability, such as writing more concrete questions—with uneven success. Our alternative is to measure directly response category incomparability and to correct for it. We measure incomparability via respondents' assessments, on the same scale as the self-assessments to be corrected, of hypothetical individuals described in short vignettes. Because the actual (but not necessarily reported) levels of the vignettes are invariant over respondents, variability in vignette answers reveals incomparability. Our corrections require either simple recodes or a statistical model designed to save survey administration costs. With analysis, simulations, and cross-national surveys, we show how response incomparability can drastically mislead survey researchers and how our approach can alleviate this problem.

We address two long-standing survey research problems: measuring complicated concepts, such as political freedom & efficacy, that researchers define best with reference to examples; & what to do when respondents interpret identical questions in different ways. Scholars have long addressed these problems with approaches to reduce incomparability, such as writing more concrete questions -- with uneven success. Our alternative is to measure directly response category incomparability & to correct for it. We measure incomparability via respondents' assessments, on the same scale as the self-assessments to be corrected, of hypothetical individuals described in short vignettes. Because the actual (but not necessarily reported) levels of the vignettes are invariant over respondents, variability in vignette answers reveals incomparability. Our corrections require either simple recodes or a statistical model designed to save survey administration costs. With analysis, simulations, & cross-national surveys, we show how response incomparability can drastically mislead survey researchers & how our approach can alleviate this problem. 3 Tables, 6 Figures, 2 Appendixes, 42 References. Adapted from the source document.

We address two long-standing survey research problems: measuring complicated concepts, such as political freedom and efficacy, that researchers define best with reference to examples; and what to do when respondents interpret identical questions in different ways. Scholars have long addressed these problems with approaches to reduce incomparability, such as writing more concrete questions—with uneven success. Our alternative is to measure directly response category incomparability and to correct for it. We measure incomparability via respondents' assessments, on the same scale as the self-assessments to be corrected, of hypothetical individuals described in short vignettes. Because the actual (but not necessarily reported) levels of the vignettes are invariant over respondents, variability in vignette answers reveals incomparability. Our corrections require either simple recodes or a statistical model designed to save survey administration costs. With analysis, simulations, and cross-national surveys, we show how response incomparability can drastically mislead survey researchers and how our approach can alleviate this problem.