IDEAS home Printed from
   My bibliography  Save this article

Health and health expenditures in adjusting and non-adjusting countries


  • van der Gaag, Jacques
  • Barham, Tania


The focus of this study is on the impact of World Bank structural adjustment operations on health expenditures and outcomes. We compare trends and levels of real per capita public spending on health, private consumption (which is the resource base for private health expenditures), and groupings child mortality indicators in four groups of countries. These are: (i) countries that started to borrow for the adjustment process early--Early Adjustment Lending (EAL) countries, (ii) Other Adjustment Lending (OAL) countries, (iii) Non-Adjustment Lending countries whose economies grew during the period 1985-1990 (NAL+), and (iv) Non-Adjustment Lending countries whose economies did not grow (NAL-). The NAL- group provides a 'counterfactual' for comparison with the two groups of adjusting countries. The results show that the fear about possible declines in health care spending in adjusting countries is unwarranted for EAL countries, that is those countries that started the adjustment process early and took it seriously. Government spending on health care increased on average for this group of countries, as did private consumption levels. Government health care expenditures also continued to increase in OAL countries, but mixed GDP growth performance has left little room for increased private spending. However, those countries that showed negative growth in the late eighties and did not start an adjustment process, fared worse throughout: real per capita public health care spending declined during the late eighties and increased less than in the other countries during 1989-1993, while private consumption has declined steadily. The trends in child mortality indicators show tremendous and continuing progress during the past two or three decades with few discernible differences among the four country groupings.

Suggested Citation

  • 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.
  • Handle: RePEc:eee:socmed:v:46:y:1998:i:8:p:995-1009

    Download full text from publisher

    File URL:
    Download Restriction: Full text for ScienceDirect subscribers only

    As the access to this document is restricted, you may want to search for a different version of it.


    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.

    Cited by:

    1. Gyimah-Brempong, Kwabena & Wilson, Mark, 2004. "Health human capital and economic growth in Sub-Saharan African and OECD countries," The Quarterly Review of Economics and Finance, Elsevier, vol. 44(2), pages 296-320, May.
    2. 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.


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:46:y:1998:i:8:p:995-1009. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dana Niculescu). General contact details of provider: .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.