This paper reviews the recent empirical evidence on privatization in developing countries, with particular emphasis on new areas of research such as the distributional impacts of privatization. Thus, private ownership alone is no longer argued to automatically generate economic gains in developing economies; pre-conditions especially the regulatory infrastructure and an appropriate process of privatization are important for attaining a positive impact. These comprise a list which is often challenging in developing countries: well-designed and sequenced reforms; the implementation of complementary policies; the creation of regulatory capacity; attention to poverty and social impacts; and strong public communication. Even so, the studies do identify the scope for efficiency-enhancing privatization that also promotes equity in developing countries. There is a large body of literature about the economic effects of privatization.
However, infrastructure investments are exposed to high market and non-market risks Weber et al. Looking across country groupings, frontier market economies had somewhat higher levels of investment, facilitated by easier access to financing and stronger economic prospects. Demetriades, and E. On the other hand, in several countries, public investment has been quite low over the whole period e. The traditional literature, primarily concerning developed economies, argued that privatization had largely positive effects on the economic and financial performance of the companies involved, as well as wider spillover benefits, for example, via technological diffusion from foreign ownership of former SOEs and Butt cheeks hurt deep when sitting efficiency from the privatization of utilities and other forms of infrastructure. However, for Public private sector efficiency developing countries services to be effective, not only must they be readily available, they must be sought, understood, and used voluntarily by their Public private sector efficiency developing countries. Policy-makers also need to determine the appropriate privatization methods. Highlights the importance of closing the gap between the education system and the existing job market in developing countries; calls for the Commission to facilitate programmes and support PPPs that involve all the stakeholders concerned, from schools, universities, training centres and private sector actors in order to offer opportunities for training and education that are relevant to the marketplace; encourages the establishment of vocational dual training institutions in which young people, while undergoing a professional apprenticeship programme with an emphasis on practical aspects of a profession, can also have theoretical lectures at specialised professional schools. McMillan, M.
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Decoupling can prove functional in two fundamental respects. Kuper, and J. Home Research for Development Outputs. What should reformers and international partners look for as indicators? The complex interplay of external pressure, domestic policy reformers, and citizen demand recasts the donor role from one of convener to facilitator. These findings reinforce a conclusion that others have reached, namely that the political Public private sector efficiency developing countries analytic lens can usefully focus on the donors themselves, and not just on the countries where reforms are pursued, Public private sector efficiency developing countries point we return to in the next section. The private provision of public services in developing countries English Abstract This book has shown that the role of the private sector is pervasive in the provision of services in developing countries. In his view, these three constitute the pillars of a stable state. Warner, A. The purpose of this paper is to raise the question of the best means of Bigtimegals tittie fuck the widely acknowledged inefficiencies of the public health systems in developing countries, and in particular to ask whether improvement is best pursued by a continuation and reinforcing of attempts to improve government policy-making, planning and management structures relating to public provision, or whether there is value in market-oriented reforms that retain public financing but encourage competition between providers. Journal of Political Economy —
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This paper reviews the recent empirical evidence on privatization in developing countries, with particular emphasis on new areas of research such as the distributional impacts of privatization. Thus, private ownership alone is no longer argued to automatically generate economic gains in developing economies; pre-conditions especially the regulatory infrastructure and an appropriate process of privatization are important for attaining a positive impact.
These comprise a list which is often challenging in developing countries: well-designed and sequenced reforms; the implementation of complementary policies; the creation of regulatory capacity; attention to poverty and social impacts; and strong public communication.
Even so, the studies do identify the scope for efficiency-enhancing privatization that also promotes equity in developing countries. There is a large body of literature about the economic effects of privatization. In addition, we are particularly attentive to the process of privatization in developing countries, notably with respect to the regulatory apparatus enabling successful privatization experiences.
When governments divested state-owned enterprises in developed economies, especially in the s and s, their objectives were usually to enhance economic efficiency by improving firm performance, to decrease government intervention and increase its revenue, and to introduce competition in monopolized sectors Vickers and Yarrow Much of the earlier evidence about the economic impact of privatization concerned these topics and was based on data from developed countries and later, transition countries.
These findings have been brought together in two previous surveys, by Megginson and Netter and Estrin et al. The former assesses the findings of empirical research on the effects of privatization up to , mainly from developed and middle-income countries, while the latter concentrates on transition economies including China, over the to period.
The tone of the privatization debate has evolved in recent years in international financial institutions as privatization activity has shifted towards developing economies, and as a consequence of the difficulties of implementation and some privatization failures in the s and s Jomo Thus, in place of a simple pro-privatization bias characteristic of the Washington consensus Boycko, Shleifer, and Vishny , it is now proposed that governments should first provide a better regulatory and institutional framework, including a well-functioning capital market and the protection of consumer and employee rights.
In other words, context matters: ownership reforms should be tailor-made for the national economic circumstances, with strategies for privatization being adapted to local conditions. The traditional privatization objective of improving the efficiency of public enterprises also remains a major goal in developing countries, as does reducing the subsidies to state-owned enterprises SOEs.
This article therefore reviews the recent evidence on privatization, with an emphasis on developing countries. The first section presents some stylized facts. In the following section, we go on to examine the distributional impacts of privatization.
Policy recommendations are developed in the final section. The data on privatization prior to with a regional breakdown is sourced from the World Bank Privatization database but unfortunately this was discontinued in and no consolidated data is available after that date.
Since we have not been able to find disaggregated data post, we therefore present world aggregates, based on the Privatization Barometer database. The early literature focused on developed economies and Western Europe represented roughly one-third of global privatization proceeds over the period to Roland Source: World Bank, Privatization database.
Note: comparable data not available after For the rest of Asia, the picture is rather different. China, in particular, stands out. Over a year period, the Chinese government has encouraged innovative forms of industrial ownership, especially at the subnational level, that combine elements of collective and private property Brandt and Rawski New private entry and foreign direct investment have also been encouraged.
Finally, in Latin America and especially in Chile, large-scale privatization programs have been launched, especially in the infrastructure sector, starting in in Chile and peaking in the s. One needs to be cautious, however, when interpreting the raw data because of differences in the size of economies. The differences between the privatization experience of Africa, Asia, and Europe become less striking when proceeds are normalized by GDP, though privatization revenue to GDP is high in Latin America, representing, on average, 0.
Note: is an estimate as August 30, China has consistently been one of the top privatizers from to ; it was the second-largest privatizer in and the first in , , as well as the 8-month period of January to August The bulk of these privatization revenues came from the public and private placement offering of primary shares by SOEs PB report However, the state's equity ownership stake was generally only reduced indirectly, by increasing the total number of shares outstanding PB report China and India were the two top emerging countries by total privatization revenues in In the following section, we focus on the privatization experience in Africa and South Asia.
Privatization programs in sub-Saharan Africa SSA occurred in successive waves, with some countries privatizing much earlier than others Bennell The first group to start such programs in the late s to early s was composed of francophone West African countries e. These programs were often influenced by pressure from the international financial institutions Nellis though, as noted by Bennell , no significant progress was made anywhere except Nigeria until the late s.
Among this group, Tanzania, Burkina Faso and Zambia have shown a strong political commitment to privatization, whereas in the other three countries Cameroon, Ethiopia, and Sierra Leone , only minimal progress was made in the s.
In addition, privatization has generally concerned smaller manufacturing, industrial, or service firms. Bennell explains that the slow progress in privatization in the s was due to a lack of political commitment compounded by strong opposition from entrenched vested interests senior bureaucrats in ministries and SOEs themselves, as well as public sector workers concerned about their job security. For instance, in Cameroon, only five of the thirty SOEs scheduled for privatization were sold by the end of In other countries such as Nigeria, the privatization program started well but then stalled.
In Madagascar, the privatization program was also suspended in mid due to serious mismanagement and its subsequent unpopularity. In addition, Bennell reports that there were nationalist concerns about the possible political and economic consequences of increased foreign ownership as a result of privatization. However, in the late s, certain political constraints lifted.
First, a growing number of governments in SSA started to undertake significant economic reforms, under the aegis of the World Bank and the IMF, in which privatization was an integral part. Reforms and privatization were also progressively being accepted by the population. In addition, important political liberalization, with multi-party elections, broke with the previous statist policies, and created some room for maneuver to implement privatization programs.
Finally, the weak financial position of SOEs in many SSA countries and their rapid deterioration, in conjunction with the fiscal crisis the state experienced in the s, also opened the way for a sell-off of SOEs to raise government revenues and reduce expenditures. Despite this stronger commitment, Nellis notes that there were actually only a few privatization deals in Africa in the s, mainly in infrastructure, and even in these the state retained significant minority stakes; around one-third of the shares on average were retained.
Privatization activity slowed in SSA with the economic downturn after One notable exception was Benin, with the privatization of the cotton and the public utility sectors. The concession for the operation of the container terminal of the Port of Cotonou and the majority stake in the cement company were awarded to a strategic private investor in September and March , respectively, and the privatization of Benin Telecom was launched in this is still ongoing; IMF Because the World Bank Privatization Database does not have data on privatization after , one cannot compare the aggregated privatization proceeds post to those of earlier decades.
Particular sectors had been reserved exclusively for SOEs, such as the infrastructure sector and capital goods and raw materials industries such as steel, petroleum, and heavy machinery. Following the balance of payment crisis of , the Indian government implemented a series of reforms under the Industrial Policy Resolution of to encourage private enterprise.
Privatization was initiated mainly through two approaches: partial privatization and strategic sales. However, the former was very limited, with the government selling only minority equity stakes until , and without transferring management control.
Political uncertainty prevented the emergence of a coherent privatization policy. In addition, the process of privatization was viewed as poor, with the secondary offering subscribed only 1. Overall, as we report below, the studies on developing economies show that a move from state to private ownership alone does not automatically yield economic gains.
Rather, a number of factors have been found to influence the success of privatization, namely: Which firms are privatized; there can be a positive or negative selection effect. Effective competition. This has been found to be critical in bringing about improvements in company performance because it is associated with lower costs, lower prices, and higher operating efficiency. We also provide an analysis of the robustness of the evidence in the literature about the impact of privatization.
As Megginson and Sutter note, researchers face numerous methodological problems when they analyze the economic effects of privatization. Other problems arise when using accounting data: the determination of the correct measure of operating performance, the selection of an appropriate benchmark and statistical tests are important challenges. We distinguish between two different empirical approaches.
The first consists of comparing the performance of government-owned firms to that of privately-owned firms. The second approach consists of comparing pre-and post-divestment performance for companies privatized via share issues public offerings; Megginson, Nash, and van Randenborgh methodology.
An obvious way to examine the impact of privatization is to compare the performance of government-owned to privately-owned firms. Studies in this tradition compare post-privatization performance changes with either a comparison group of non-privatized firms or with a counterfactual.
However, important methodological issues arise, especially in the earlier studies. First, it is difficult to determine the appropriate set of comparison firms, especially in developing countries where the private sector is limited. Second, selection effects and endogeneity may bias the comparison, as factors determining whether the firm is publicly or privately owned are also likely to affect performance Gupta, Ham, and Svejnar One of the first studies to compare SOE and private firm performance is that of Ehrlich et al.
These authors find a significant association between ownership and firm-specific rates of productivity growth. Interestingly, the empirics also suggest that the benefits derive primarily from complete privatization of the firm, and that a partial change from state to private ownership has little effect on long-run productivity growth. Other studies have employed a similar approach examining differences in efficiency between private and government-owned firms within a specific country, such as Majumdar for Indian firms and Tian with Chinese firms.
Concerning studies using a counterfactual approach, one can cite the influential study by Galal et al. These authors compare the actual post-privatization performance of twelve large firms in the airlines and utilities industry in Britain, Chile, Malaysia, and Mexico to a counterfactual performance.
La Porta and Lopez-de-Silanes study privatization in Mexico and find that privatized Mexican SOEs rapidly close a large performance gap with industry-matched private firms that had existed prior to divestment.
Another approach has been to exploit a multi-industry, multi-national cross-sectional time series to analyze the effects of government ownership on efficiency. In their seminal work, Boardman and Vining use measures of X-efficiency and profitability ratios of the largest non-U. Another important study is that of Frydman et al.
To control for the possibility that better firms are selected for privatization, these authors compare the pre-privatization performance of managerially-controlled firms with those controlled by other owners.
Frydman et al. For instance, Dinc and Gupta examine the influence of political and financial factors on the decision to privatize government-owned firms in India using data from the — period. After addressing the selection bias, they find that privatization still has a positive impact on performance in India.
This set of studies examines the effects of privatization on firm performance by comparing pre- and post-divestment data for companies privatized via public share offerings. Each firm is compared to itself a few years earlier using inflation-adjusted sales and income data.
The first study using this methodology is by Megginson, Nash, and van Randenborgh As Megginson and Netter note, this methodology suffers from several drawbacks, among which selection bias is probably the greatest concern, since privatizations through share sales—Share Issue Privatization SIPs —represent the largest companies sold during a privatization program.
Another weakness is that the Megginson, Nash, and van Randenborgh methodology can only examine simple accounting variables assets, sales, etc. These studies also cannot account for the impact on privatized firms of regulatory or market-opening initiatives that are often launched in parallel with privatization programs.
Research in this tradition has focused on specific industries banking [ Verbrugge, Owens, and Megginson ] and tele-communications [ D'Souza and Megginson ] ; has used data from a single country Chile [ Maquieira and Zurita ] and employed multi-industry, multinational samples. However, the significance of many of the operating and financial improvements is not robust to adjustments for changes experienced by other firms over the study period.
Forgot password? The governance and public sector management literature has had a robust stream of analysis and practice pointing out the importance of politics and political mapping that predates these historical framings Brinkerhoff, , but these frameworks have increased the salience of institutional perspectives. Special Issue Article Open Access. Andrews illustrates how the PDIA approach can enable a better contextual fit of reforms, as they can be adapted to newly recognized features of the reform environment. We conclude that despite recent progress in assessing and incorporating such inefficiencies in economic analysis, the composition of public capital and its interlinkages with other factors of production and with structural economic conditions should remain a key area of future research. Tatom, J.
Public private sector efficiency developing countries. Introduction
NCBI Bookshelf. An important current issue in the health sector in developing countries concerns the appropriate degree of reliance on the private sector and on private spending for the provision of health care. Proponents of user charges and greater privatization claim that such reliance will conserve scarce public funds and promote efficiency in the sense of cost-effectiveness and responsiveness to consumer preferences Akin et al.
Opponents retort with two arguments. The first is an efficiency and effectiveness argument: that in the past in developing countries, the public sector has been successful in providing health care.
The second is an equity argument: that because of their reliance on ability to pay as a rationing criterion, user charges for public services and privatization will have negative distributional effects that are likely to outweigh any efficiency gains e.
In the first section we set forth a brief statement of public choice theory, which predicts that, in general, government actions may be neither efficient nor equitable. Instead, they may be directed toward increasing the real income of influential middle-and upper-income groups, often in inefficient ways.
The next section draws, as a central point of this paper, an important corollary of public choice theory for the health field: that the past successes of the public sector are not likely to be repeated in the future.
The reason is an increasing tension between the health needs of the rich versus the poor, with the greatest potential mortality gains coming from attention to the latter but political forces often dictating a flow of resources to the former. The third section provides numerous examples of this misallocation and suggests ways that selective use of fees and privatization may improve equity, efficiency, and returns to future public health spending. In the conclusion, we summarize the crux of the political economy problem raised in the earlier sections.
If the inefficiency and inequity of government health programs are endogenous and politically determined, how can they be fixed? Why are governments often inefficient and inequitable? The following section extends public choice theory to the health sector in developing countries and shows how it implies a deteriorating effectiveness of government spending and a need to place greater reliance on private spending, in order to improve both efficiency and equity.
Classical welfare theory gives us a normative view of what government should do. The main economic role of government is to correct market failure by funding public goods, by subsidizing or taxing goods that generate positive or negative externalities, and by compensating for capital market or insurance market failure, in addition to simply setting the framework within which private enterprise will function.
Opinions vary widely on whether a "social welfare function" exists, what an "equitable" distribution would be, and whether it is possible to aggregate diverse preferences to arrive at a consensus on this matter. We use the term "equity" as a shortened form of Robin Hood redistribution in this paper.
According to this theory, politicians do not seek to maximize efficiency but rather to maximize their own chances of staying in power; bureaucrats seek to maximize their budgets; and individuals use governments to augment their real income via the creation of protected market positions and the direct provision of services and transfers Mueller, ; Borcherding, Politicians and political parties have some discretionary power because of barriers to entry and because they are in a position to shape as well as respond to people's tastes.
At the same time, threats from actual or potential competitors limit the scope of their monopoly power. Thus, natural selection operates in political life as well as in economic or biological life. Where democracy does not exist, a similar process often occurs, but with greater discretionary monopoly powers for government officials who control the political market. Public policies designed to maximize private interests will not necessarily be inefficient.
Indeed, politically influential groups would have a potentially larger pie to capture if the Pareto frontier were reached; compensatory mechanisms could then make everyone better off. Taxes could be imposed on some less influential groups and transferred to others. However, the allocation of resources resulting from public choice politics is often inefficient, for the following reasons:. In a context of imperfect information, people may not know the degree and direction of redistribution going on.
In that case, efficiency imposes cost to the "gainers" by reducing the amount they will be potentially able to extract; they are therefore likely to choose inefficient transfer mechanisms. Our second point is closely related: Imperfect information and uncertainty also surround the relationship between the tax structure and the bundle of public services provided.
Although these may be interdependent components of a long-run political equilibrium e. Similarly, some goods may be oversupplied because their chief beneficiaries are politically powerful and expect to avoid much of the tax burden Buchanan, ; Pommerehne and Schneider, The real costs of publicly produced private goods may be above minimal levels because government imposes bureaucratic rules and red tape in part as a substitute for the profit motive and often lacks competitive pressures for internal efficiency perhaps because politicians reap a surplus from monopolistic provision.
Heads of bureaucratic agencies who wish to maximize their prestige and perks, and have greater information than the politicians and citizens they supposedly serve, are often able to argue successfully for larger budgets than are needed for least-cost production. In addition, distortionary tax financing also raises the nonprogram costs of publicly produced private goods Niscanen, ; Romer and Rosenthal, ; Borcherding et al. The diversion of entrepreneurial energies toward extracting a surplus from public agencies rather than toward productivity-enhancing market activities also impedes private sector efficiency and growth.
Rent-seeking activities thus misallocate private as well as public resources Krueger, ; Buchanan et al. The resulting distribution of real income is likely to depend upon political power as well as market power. Political power, of course, will vary across societies and through time, depending on the size of different producer and consumer groups, the coalitions among them, and the long-run "rules of the game" that have been set up e.
How could we expect these divergent forces to sort themselves out in the developing country context? On the one hand, the gulf between rich and poor and the relative number of poor people are much greater there, so under "one man, one vote" we would expect to find the poor gaining from politically induced redistributions. Indeed, in a few countries e. However, differences in education hence, in organizational and communication skills are also much greater in developing countries, and democratic institutions are often primitive, limiting the power of the poor.
This is not to say that there will be no redistribution to the poorer classes. In fact, even when the rich are in control, we would expect to find some such redistribution of income. In developed countries, historically, the provision of certain merit goods to the poor e. Out-of-power groups must be appeased by giving them "just enough" to prevent opposition parties from gaining strong support a "contestable market" view of political equilibrium , but just enough may not be very much.
For example, it may imply that the poor are given low-cost services or very limited access to high-cost services from which the rich are the main beneficiaries. Governmental expenditures on high-quantity, low-quality primary-level school systems and on selective high-cost universities are common illustrations of these two phenomena. In short, in many situations, perverse distributional rather than efficiency or equity criteria determine the allocation of government funds, and these criteria imply large benefits to powerful upper-income groups, combined with small redistributions to the poor Behrman and Birdsall, We believe that these pessimistic predictions of public choice theory are consistent with the observed actions of developing countries in health today.
Can the past success of governments in reducing mortality and improving health be maintained? In this section we argue that, on grounds of public choice theory, there are strong reasons for doubt about the future contribution of government. Past gains have come from expenditures that benefited a wide spectrum of the population. However, future gains will require additional expenditures targeted toward the poor, behavioral changes among the poor, and indeed, the elimination of some aspects of poverty.
But, for the reasons given above, governments are unlikely to spend disproportionately on the poor, and the behavior of the poor is unlikely to change rapidly; hence, the gains of the past are unlikely to continue into the future. This tension between rich and poor is exacerbated by the tension between old and young. As the population ages, its disease profile changes; the prevalence of cancer, heart disease, and other diseases of adulthood and old age increases Feachem et al.
These are expensive diseases to treat, requiring hospitalization and modern technology, in comparison to the relatively low cost of inoculating children against measles and polio. Yet public choice theory again tells us that this is unlikely to be the case: Children do not vote or make political contributions, as older people do.
In some cases e. In other cases e. This group was the easiest clientele to reach and serve; hence, such expenditures bore a high rate of return, as well as strong political support. Thus, such policies will be costlier, will bear a lower rate of return, and, for political economy reasons, are unlikely to be adopted.
What is the evidence that further mortality declines will be harder to achieve—because they will have to reach the poor? First, within developing countries, the differentials in mortality associated with income and other measures of socioeconomic status have persisted, even when overall mortality has fallen substantially. In Brazil, deaths from infectious and parasitic diseases have declined drastically. These accounted for 45 percent of all deaths in but only 11 percent in Briscoe, Other causes of death, however, are highly concentrated among the poor.
The poverty rate works better than average income as a predictor of infant mortality and life expectancy in a sample of 86 developing countries Anand and Ravallion, Second, there is a difference in the nature of diseases that kill people in developing countries today and those that predominated in developed countries when they had similar overall mortality levels.
For example, the proportion of deaths due to diarrhea is much higher in the developing world than it was in the West when overall mortality levels were similar, in large part because the prevalence of other diseases has been reduced by technological interventions Preston et al. Bobadilla, personal correspondence, Diarrhea is a disease of the poor; it is found along with, and contributes to, malnutrition, and it is caused by lack of access to clean water, simple health services, and basic education.
To date, diarrhea has been relatively impervious to the programs and technologies that have reduced other causes of mortality. It has been hoped that the "new technology" of oral rehydration therapy ORT can reduce mortality due to diarrhea, but use of ORT itself requires change in the behavior of mothers and other caretakers.
Third, there is evidence across countries of continuing huge disparities in disease risks, including risk of chronic disease, that are also clearly associated with overall differences in income, education, and the effectiveness of the public health infrastructure. For example, the annual risk of infection from tuberculosis is 50 to times greater in developing than in developed countries Mosley et al.
Reductions in mortality will continue in developing countries at a moderate rate, if further increases in educational opportunities, especially for women, and in family income are assumed. Of critical importance are family planning, nutritional supplementation for children, prenatal and obstetrical care, clean water, and the correct use of effective drugs against respiratory infections, tuberculosis, and malaria.
However, for such services to be effective, not only must they be readily available, they must be sought, understood, and used voluntarily by their clientele.
The time and money costs will decline only if government targets its health spending to the poor, making basic health services easily accessible in the rural areas and urban neighborhoods where the poor are concentrated.
For the reasons of political economy given above, such targeting appears unlikely. Similarly, it will be difficult to inform the poor and change their health habits e. Indeed, if the poor had access to substantially improved and heavily subsidized health, education, water, and sanitation facilities, there would be drastic improvements in their mortality rates and therefore the overall mortality rates of their countries, but a drastic redistribution of real income and utility would be implied.
In this sense, continued high rates of health improvement and income redistribution go hand in hand, and both will be opposed by powerful groups intent on maintaining the distributional status quo. The aging of the population in developing countries, a result of fertility declines over the last two decades and falling death rates, means that the prevalence of such chronic "adult" diseases as cancer, hypertension, and heart disease in comparison to parasitic diseases and childhood infectious and diarrheal diseases is increasing.
By the year , this elderly group will exceed 10 percent of the population in many developing countries, a proportion close to that in the United States today Mosley et al. Brazil provides a telling example of the effects of past improvements in health technology and future changes in demographic structure on the pattern of disease. In , heart disease, stroke, cancer, and accidents accounted for 20 percent of deaths there; in , they accounted for approximately 50 percent.
The increase in their relative contribution over the period was due largely to a decline in the proportion of deaths caused by infectious and parasitic diseases. However, the changing age structure means that from now on their prevalence is likely to rise as the proportion of the elderly in the population increases.
Age structure changes alone imply a 60 percent increase in deaths due to these diseases from to Briscoe, Increases in age-specific death rates from some of these chronic diseases will further change epidemiological patterns. Age-specific death rates are likely to rise because of increasing exposure to such risks as smoking, poor diet, and urban pollution. These changing demographic and epidemiological patterns will put new financial pressure on health systems in developing countries.
By in Brazil, the allocation of public health resources for curative care had increased to 85 percent of all spending from 36 percent in , and the treatment of patients with heart disease accounted for an estimated 25 percent of all inpatient costs.
Per capita health expenditures on persons over 60 were 3.