Scientific Report - Dov Chernichovsky

NBER Working Paper No. 8470
Issued in September 2001
NBER Program(s):

Improved health, equity, macro-economic efficiency, efficient provision of care, and client satisfaction are the common goals of the health system. The relative significance of these goals varies, however, across nations, communities, and with time. As for health care finance, the attainment of these goals under varying circumstances involves alternative policy options for each of the following elements: sources of finance, allocation of finance, pay to providers, and public-private mix. The intricate set of multiple goals, elements, and policy options defies human reasoning, and, hence, hinders effective policymaking. Indeed, health system finance' is not amenable to a clear set of structural relationships. Neither is there a universe that can be subject to statistical scrutiny: each health system is unique. 'Fuzzy logic' and its underlying 'Expert System' that model human reasoning by managing knowledge' close to the way it is handled by human language, provides a powerful tool for systematic analysis of health system finance, and for guiding policy making. Assuming equal welfare weights for alternative goals, and mutually exclusive policy options under each health-financing element, the exploratory model we present here suggests that a German type health system is best. Other solutions depend on the welfare weights and mixes of policy options.

Abstract

Lack of food is no longer the major cause of malnutrition. Many households and individuals remain malnourished when income and supplies of food are adequate. Nutrition policy and programs must be based on a sound knowledge of household behaviour patterns . The microeconomic theory of the household focuses on the household's decisionmaking about scarce food resources based upon such considerations as: (i) the size of the family; (ii) the purchasing power of the family; (iii) the availability of healthful foods; (iv) the family's food preferences; (v) environmental variables (such as ethnic traditions and the homemaker's level of education); and finally (vi) family health (disease can limit the absorption of nutrients). Such determinants should be monitored to anticipate malnutrition problems unrelated to the food.

Abstract

The purpose of this paper is to estimate the level of consumption of food and of nutrients for the Indonesian population; to identify population groups with nutrient deficiencies, to identify the major sources of different nutrients, and to estimate income and price elasticites of demand for both food and nutrients. The survey data indicates that serious deficiencies in all nutrients exist in Indonesia and that the problem is more one of maldistribution than of an overall shortfall in the availability of foods, tending to affect the poorer households. The importance of rice as a contributor of most nutrients is striking. A household utility-maximization model is used to derive the household's demand for food and hence nutrients. For estimation purposes the double-logarithmic function is used. The paper concludes that there is wide scope for nutrition policies based on changes in incomes and relative prices, as food and nutrition consumption respond rather dramatically to such changes. The data also suggest that, although inadequate diets are a greater problem among poorer households, they are also prevalent among the better-off and better-educated. Alleviating malnutrition in Indonesia is a matter of nutrition education as well as one of raising incomes.

Abstract

Data from the National Socio-economic Survey for 1978 are used to give a profile of poverty in Indonesia. Households are classified into the poor and nonpoor categories according to their levels of per capita consumption, with a breakdown into urban and rural areas of Java and the Outer Islands. Poor and nonpoor households are then compared in terms of their geographical distribution, demographic characteristics, economic and noneconomic activities of individuals, sources of household income, consumption patterns, housing conditions, and schooling and health.