Economia da Segurança Social
Unidade 08
-Procura
e oferta de segurança social.
Modelos de segurança social.
Carlos Arriaga Costa
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Uma protecção social
eficiente deve
contribuir para um
welfare condigno!

Que oferta de protecção
social?
Como reage a procura?
Carlos Arriaga Costa
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Resultados de aprendizagem desta unidade
. Descrever variaveis da oferta de protecção social e
da procura.
. Compreender a elasticidade da oferta e da procura
na protecção social relativamente ao preço dos
serviços de protecção social
. compreender os equilíbrios em protecção social
Carlos Arriaga Costa
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Interacções da oferta e da procura
A construção das funções de oferta da protecção
social levanta problemas de ordem metodológica
e conceptual:
 1. O seguro de doença provoca um estimulo
mas também um racionamento na procura de
cuidados de saúde.
 A evolução das cotizações de saúde e de
prestações de reforma explicam-se em parte por
considerações eleitorais.

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Interacções da oferta e da procura
Como surge a oferta de protecção social?
 Que produtos estão incluídos nessa
oferta?
 Como se mede a oferta?
 Em que consistem os preços dos serviços
oferecidos?

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Estimulo e racionamento da
procura
A oferta e procura de um bem subvencionado
com preço administrativo fixado pode levar a
um racionamento da procura ou da oferta.
 A oferta e procura de cuidados subvencionados
a preços livres pode levar a uma desslocação da
curva de procura para a direita ( o preço
aumenta e a procura tambem)

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Preços administrativos subvencionados
Bem
subvencionado
oferta
Q1
Q0*
procura
M3
M2 P0
Carlos Arriaga Costa
P preço
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P PREÇO PAGO AO PRODUTOR DE UM
BEM DE SAUDE FIXADO
ADMNISTRATIVAMENTE
 M TAXA MODERADORA (pago pelo
consumidor)
 P-M Pago pelo seguro ou pelo Estado e
funciona como uma subvenção que faz
diminuir o preço pago pelo consumidor

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O problema fiscal

Em consequência da despesa publica nos anos 1970s
e 1980s, os paises europeus são caracterizados por:
– Divida publica elevada.
– Impostos elevados para financiar o welfare state.

Devido a um crescimento mais lento que o previsto e
uma taxa de desemprego crescente na maior parte
dos paises europeus, as reformas fiscais requeridas
pelo tratado de Maastricht têm sido difíceis de
implementar. Em consequência:
– A maior parte das alterações têm sido de curto prazo. Em
alguns casos simples ajustamentos contabilísticos. Os
problemas fiscais de longo prazo não têm sido resolvidos.
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Globalização e os limites à
redistribuição

Limites sobre a política fiscal:
– Significante sobre o imposto de capitais.
– Principio geral – a taxa de imposição deve estarbrelacionada com a
elasticidade da oferta.
– A globalização tem aumentado elasticidade da oferta de capital devido
à forte mobilidade de capital
– Menos importante quando o imposto é baseado mais na cidadania do
que na residencia e quando há uma forte percepção da cidadania por
parte da população. Todavia, com a globalização existe uma maior
flexibilidade no que respeita à cidanania e à residência.
– A globalização tem aumentado a elasticidade de oferta de trabalhadores
qualificados mas essa elasticidade tende a ser menor que a
elasticidade de oferta de capital.
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Globalização e os limites à
redistribuição

O efeito pode ser perverso pois há um elemento
importante na redistribuição nos programas do sector
público:
– Segurança social (pensões de velhice) e cuidados de saude.
– Pode contribuir para forçar a privatização de funções públicas.


Implicações importantes no desenvolvimento das
sociedades:
Pode afectar o bem estar social e o crescimento
económico.
– Actividades com potencial são tambem as de maior risco ,
tomadas de posição em risco podem afectar a segurança social…
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
Sistemas de pensões e de saude generosos
associados a um envelhecimento da população
causaram:
– Um passivo crescente no sistema de pagamentos de pensões
do sector publico
– Um passivo crescente no sistema de pagamentos de
despesas de saude do sector publico
– Problemas no financiamento do welfare state o qual é dificil
de eliminar devido a interesses vários .
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Procura de protecção social
A procura de serviços de saude é menos
elastica que de outros bens
 Quanto maior a oferta tambem maior a
procura...
 Depende mais de uma situação estrutural
que conjuntural

Carlos Arriaga Costa
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Procura de protecção social
- Função de procura de serviços de saude
(estudo empírico : An Economic Analysis of Health Care in China, Gregory C
Chow , Princeton University,June 8, 2006)

The amount of health care services measured in
1995 prices q = health care expenditure /relative
price index of health care service table

Regression of lnq on lny and lnp based on the
9 annual observations from 1995 to 2003 yields:
lnq =1.194(.382) lny–0.730(.241) lnp–4.831(4.027)
R2/s = 0.620/.0447
----- (1)
next
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2. Changes in Health Care System
§Institutions before 1980’s

A cost-effective three-tear health care system
improved the health of the Chinese people:
.reduction of diseases
.decline in the annual death rate
17 per 1000 population in 1952→6.34 per 1000 in 1980
.increase in life expectancy
early 1950s: 40.8 years→ early 1960s: 49.5 years → late 1970s:
65.3 years
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§ Institutions since 1980’s

Rural:
.Privatization of farming led essentially to the
abandonment of public health provided by the government.

Urban:
.Privatization of state-owned enterprises was a very slow
process that took over two decades.
.The government tried to provide a substitute for the public
provision of health care through the state-owned
enterprises.
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Time-Series Data on Aggregate Demand for Health Care
Year
Consumer GDP
Price
Index
Price
index of
healthcare
Government
revenue
Total
consumption
expenditure
Quantity
of health
services
1995
3.028
58478.1
1.000
6242.20
33635.0
2257.8
1996
3.279
67884.6
1.124
7407.99
40003.9
2542.0
1997
3.371
74462.6
1.381
8651.14
43579.4
2451.0
1998
3.344
78345.2
1.619
9875.95
46405.9
2085.5
1999
3.297
82067.5
1.808
11444.08
49722.7
2311.2
2000
3.310
89468.1
2.009
13395.23
54600.9
2283.0
2001
3.333
97314.8
2.220
16386.04
58927.4
2263.9
2002
3.306
105172.3
2.402
18903.64
62798.5
2410.5
2003
3.346
117390.2
2.616
21715.25
67493.5
2516.9
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§Health Care Expenditures and
Funding Resources
Health Care Expenditure
100 million
7000
6000
5000
4000
3000
2000
1000
0
1995
1996
1997
1998
total expenditure
social expenditure
1999
2000
2001
2002
2003
government budget
resident individual
Carlos Arriaga Costa
year
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Estimating Income Elasticity with
Cross-section Data

Regressing the log of medical expenditure per capita
on the log of total expenditure per capita yields table:
total expenditure elasticity se
Urban
1.080
0.023 0.9981
Rural 1.003
0.023 0.9980

Adj-R2
Corresponding data for 2003 yield similar total
expenditure elasticities.
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Cross-section data on per capita health expenditure and total expenditure in 2002
Low income
households
Lower Middle
income
households
Middle
income
households
Upper middle
income
households
High income
households
Urban:
Total
expenditur
es
3259.59
4205.97
5452.94
6939.95
8919.94
Medicine
and
medical
services
225.67
286.56
382.83
510.15
657.33
Rural:
Total
expenditur
es
1006.35
1310.33
1645.04
2086.61
3500.08
Medicine
and
medical
services
57.57
74.88
90.73
116.49
201.72
Carlos Arriaga Costa
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Price Elasticity by Combining Crosssection and Time Series Data

Take an average of 1.080 and 1.003 or 1.042 as our
estimate of income elasticity of demand for health care,
which is close to the estimate based on time series data
alone as reported in equation (1)

Use time series data to estimate the price elasticity :
(lnq -1.042 lny) = -0.636 (.047) lnp - 3.228 (.033)
----(2)
R2/s = 0.9637/.04192

Price elasticity is 0.636
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Income and elasticity by Provincial Data
for Urban and Rural Residents

Adding lnp to both sides of equation (1) yields
ln(pq) = c + a lny + (1- b) ln p + e

---- (3)
If the lnp on the right-hand side of (3) is uncorrelated with
lny , using provincial data on health care expenditure from
CSY 2005, we have:
Urban: ln(pq) = -2.237(1.415) + 0.919(0.154) lny R2 =0.5501
Rural: ln(pq) = -4.434(1.299) + 1.162(0.163) lny R2 =0.6379

The average of the above two income elasticities is (0.919
+ 1.162)/2=1.041.
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§ Inequality in Health Care Spending
from Regression Analysis

s(lnpq) = (a/R)s(lny)

For urban residents across provinces, the factor a/R
equals 0.919/0.742 or 1.239. For rural residents it is
1.162/0.799 or 1.454.(in 2004)

Inequality in medical expenditure is larger than inequality
in income across provinces for both urban and rural
residents.

The ratio of inequality for rural residents is higher partly
because the rural residents have a higher income
elasticity of demand for medical expenditure.
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4.Government’s Program for Health Care
§ On Demand Side

"Decision on Health Reform and Development by the
Central Party Committee and State Council." (January
15, 1997)

Basic objective : to insure that every Chinese will have
access to basic health protection.

Rural : to develop and improve CMS through education,
by mobilizing more farmers to participate and gradually
expanding its coverage; 40 yuan subsidy per account.

Urban：a basic medical insurance system was
established in 1998, financed by 6％of the wage bill of
employing units and 2％
theCosta
personal wages.
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Arriaga
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§

On Supply Side
In 2004 the government is in the process of
allowing some hospitals in urban and rural areas
to be run privately to reduce the burden to the
government.
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5. Supply of Health care and
Prospects for Future Development
§ Constant Supply

The amount of health care supplied remained
approximately constant between 1989 and
2003(as with the quantity q in Table 2).
1989
1997
2002
2003
# of Hospital Beds
per 10 000 Population
22.8
23.5
23.2
23.4
# of Doctors
per 10 000 Population
15.2
16.1
14.7
14.8
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Change
of No. of
Doctors
and No.
Graduat
es
Year
Number
of
Doctors
1000’s
Number of
Graduates
1000’s
Retirees
(1/35 No.
in year
before)
Estimated
Increase in
No.
Doctors
Actual
Increase
in No.
Doctors
Implie
d % of
Retire
ment
1997
1985
61.239
1998
1999
61.379
56.714
4.665
14
.02387
1999
2045
61.545
57.114
4.431
46
.00778
2000
2076
59.857
58.429
1.428
31
.01411
2001
2100
62.638
59.314
10.738
24
.01861
2002
1844
79.500
60.000
3.324
-256
.15976
2003
1868
111.356
52.686
58.67
24
.04737
2004
1905
154.187
53.371
100.816
37
.06273
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§ Shift of Health Resources from Rural
to Urban Population

In 2001 the number of health clinics in villages and
townships was reduced by 1139; the number of doctors
and health care personnel was reduced by 30,000.

From 1990 to 2000, government spending in total health
care spending in rural areas was reduced from 12.5
percent to 6.6 percent.

The shifts in relative demand in favor of urban residents
who could afford to pay and received more government
funding for medical care resulted in the shifts of supply to
the urban residents atCarlos
theArriaga
expense
of rural residents. 28
Costa
§ Forecast of Rate of Increase in the
Supply of Doctors

Assuming the number of doctors in the next few years to be 2400
thousand (with 160 thousand graduates per year, and number of
graduates to be 200 thousand per year.

The number retired will be 2400/35 = 68.57 thousand, resulting in a
net increase of 200 – 68.57 = 131.43 thousand, or a rate of increase of
131.43/2400 = 0.05476.

After subtracting annual population increase of 0.006 we obtain a
rate of increase of 0.049. This is substantially less than the increase
in demand due to increase in real income.
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7. Conclusions





We have estimated an income elasticity of demand for health services to be
unity for urban population and slightly above unity for rural population, and
a price elasticity of about 0.6 by combining cross-section and time-series
data.
Demand analysis can explain the increase in expenditure on healthcare and
the increase in price as income increases given limited supply. It also
explains the increase in the ratio of health expenditure to GDP.
There is large inequality in health expenditure per capita between the urban
and the rural population associated with income inequality.
Rapid increase in income and government support account for much better
healthcare for the urban population.
A market economy in rural China fails to provide as much health care as
under the former collectively managed and collectively paid system. The
government is attempting to reintroduce features of this system, with
results yet uncertain.
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