The abstract should provide a summary of the HiT in no more than 250 words The Box provides an example from the Philippines HiT, 2011 Philippines HiT abstract Consistent with its commitment to the Alma Ata in 1978, the Philippine Government adopted the Primary Health Care (PHC) approach in 1979 to achieve health for all Filipinos by year 2000 The promulgation of the Local Development Code (RA 7160) in 1991 was in line with the community participation ideals of PHC (1992-1999) as it devolved responsibility for health care was devolved to Local Government Units The Health Sector Reform Agenda was introduced in 2005 to address problems in health care delivery at local level brought about by the devolution proves Issues of poor accessibility, inequities and inefficiencies of the health system have been the target of health reforms over the last 30 years Hospital, public health, financing, local health system and regulatory reforms comprised the HSRA approach In 2005, the DOH streamlined the reform program to ensure access and availability of essential and basic health packages by reducing the four reform areas, namely: 1) designating providers of basic and essential health service package in strategic locations; 2) assuring the quality of both basic and specialized health services; and 3) intensifying the current efforts to reduce the public health threats brought about by endemic, vaccine-preventable and priority diseases Although studies have yet to be done on the impact of reforming health service delivery, implementation of strategies to improve the hospital services and public health programs have shown some positive gains However, huge disparities in health outcomes across income groups and geographic areas and challenges in ascertaining physical and financial access to health services as evidenced by high out-of-pocket expenditures, concentration of physical and human resources for health in urban areas and migration of health professionals still exist The focus of future developments in health should be towards providing universal health care for Filipinos, starting with improving access of the poor and vulnerable to health services Source: APO, Philippines HiT Vol 1 No 2 2011

https://www.euro.who.int/__data/assets/pdf_file/0018/231516/HiT-Estonia.pdf

Health systems in transition.

Summary Cancer is one of the major non-communicable diseases posing a threat to world health. Unfortunately, improvements in socioeconomic conditions are usually associated with increased cancer incidence. In this Commission, we focus on China, India, and Russia, which share rapidly rising cancer incidence and have cancer mortality rates that are nearly twice as high as in the UK or the USA, vast geographies, growing economies, ageing populations, increasingly westernised lifestyles, relatively disenfranchised subpopulations, serious contamination of the environment, and uncontrolled cancer-causing communicable infections. We describe the overall state of health and cancer control in each country and additional specific issues for consideration: for China, access to care, contamination of the environment, and cancer fatalism and traditional medicine; for India, affordability of care, provision of adequate health personnel, and sociocultural barriers to cancer control; and for Russia, monitoring of the burden of cancer, societal attitudes towards cancer prevention, effects of inequitable treatment and access to medicine, and a need for improved international engagement.

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Challenges to effective cancer control in China, India, and Russia

Background 

The post-Soviet countries had very similar starting points after gaining independence in 1991, yet embarked on widely varying developments. More than two decades since the collapse of the Soviet Union, it is time to review the progress the post-Soviet countries have made in reforming their health systems, and the lessons this experience offers to other countries. This abstract presents findings of a study undertaken by the European …

Trends in health systems in the former Soviet countries

This paper reviews the meaning and measurement of unobserved economies germane to tax evasion and macroeconomic information systems. These include the unreported, non-observed, underground, illegal, informal and unrecorded economies. It reviews the progress and shortcomings of national and international agency efforts to measure these unobserved economies, noting what they have in common, what distinguishes one from another and their interconnections. It then examines the meaning of Professor Schneider’s Shadow Economy (SSE), and the veracity of his claim to have accurately estimated its size and trend worldwide by employing a MIMIC model methodology. It concludes that SSE estimates suffer from conceptual flaws, apparent manipulation of results and insufficient documentation for replication, questioning their place in the academic, policy and popular literature.

Reflections on the Meaning and Measurement of Unobserved Economies: What Do We Really Know About the 'Shadow Economy'

Background In 2004, the Moldovan government introduced mandatory (social) health insurance (MHI) with the goals of sustainable health financing and improved access to services for poorer sections of the population. The government pays contributions for non-employed groups but the self-employed, which in Moldova include many agricultural workers, must purchase their own cover. This paper describes the extent to which the Moldovan MHI scheme has managed to achieve coverage of its population and the characteristics of those who remain without cover. Methods The 2008 July-October enhanced health module of the Moldovan Household Budget Survey was used. The survey uses multi-stage random sampling, identifying individuals within households within 150 primary sampling units. Numbers and characteristics of those without insurance were tabulated and the determinants of lack of cover were assessed using multivariate regression. Results 3760 respondents were interviewed. Seventy-eight per cent were covered by MHI. Factors associated with being uninsured include being self-employed (particularly in agriculture), unemployed, younger age and low income. Respondents who were self-employed in agriculture were over 27 times more likely to be uninsured than those who were employed. Agricultural workers in Moldova are responsible for purchasing their own cover; most respondents cited cost as the main reason for not doing so. Conclusion While being uninsured has an impact on utilization, financial barriers persist for those with insurance who seek care. The strengths and weaknesses of the MHI system in Moldova provide valuable lessons for policy makers in low- and middle-income countries addressing the challenges of achieving equitable coverage in health insurance schemes and the complex nature of financial barriers to access.

/pdf/health-insurance-coverage-and-health-care-access-in-moldova-2k50cnccbs.pdf

Health insurance coverage and health care access in Moldova

This Report has been prepared for the European Commission, DG TAXUD under contract TAXUD/2017/DE/329, “Study and Reports on the VAT Gap in the EU-28 Member States” and serves as a follow-up to the six reports published between 2013 and 2018. This Study contains new estimates of the Value Added Tax (VAT) Gap for 2017, as well as updated estimates for 2013-2016. As a novelty in this series of reports, so called “fast VAT Gap estimates” are also presented the year immediately preceding the analysis, namely for 2018. In addition, the study reports the results of the econometric analysis of VAT Gap determinants initiated and initially reported in the 2018 Report (Poniatowski et al., 2018). It also scrutinises the Policy Gap in 2017 as well as the contribution that reduced rates and exemptions made to the theoretical VAT revenue losses.

Study and Reports on the VAT Gap in the EU-28 Member States: 2019 Final Report

This analysis serves as the Final Report for the DG TAXUD Project 2015/CC/131, “Study and Reports on the VAT Gap in the EU-28 Member States”, which is a follow up to the reports published in 2013, 2014, and 2015. In this report, we present estimates of the VAT Gap and the Policy Gap for the year 2014, as well as revised estimates for the years 2010-2013 due the transmission of Eurostat national accounts from the ESA95 to the ESA10. This update covers Croatia, which was not included in the previous updates. While it was hoped that the update would also cover Cyprus, it has not been possible due to incomplete national accounts data.

https://www.econstor.eu/bitstream/10419/157938/1/857566008.pdf

Study to quantify and analyse the VAT Gap in the EU Member States: 2015 Report

In this Report, the Authors present the new Value Added Tax (VAT) Gap estimates for 2016, as well as updated estimates for 2012-2016. In addition to the analysis of the Compliance Gap, this Report examines the Policy Gap in 2016 as well as the contribution that reduced rates and exemptions made to the theoretical VAT revenue losses. Moreover, the Report contains an econometric analysis of VAT Gap determinants, which is a novelty introduced from this year’s Study.

Study and reports on the VAT gap in the EU-28 member states: 2018 final report

This Study serves as the Final Report for the DG TAXUD TAXUD/2017/DE/329, “Study and Reports on the VAT Gap in the EU-28 Member States”, which is a follow-up to the five reports published between 2013 and 2017. 
In this Report, the Authors present the new Value Added Tax (VAT) Gap estimates for 2016, as well as updated estimates for 2012-2016. In addition to the analysis of the Compliance Gap, this Report examines the Policy Gap in 2016 as well as the contribution that reduced rates and exemptions made to the theoretical VAT revenue losses. Moreover, the Report contains an econometric analysis of VAT Gap determinants, which is a novelty introduced from this year’s Study. 
In 2016, most European Union (EU) Member States (MS) saw positive tailwinds with a combined real GDP growth of 2.0 percent. As a result of a growing base and increasing VAT compliance, VAT revenue increased in all MS with three exceptions. Most pronounced is the case of Romania, where VAT revenue decreased in response to reduction of the standard rate by four percentage points. In nominal terms, in 2016, the VAT Gap in EU-28 MS fell below EUR 150 billion and amounted to EUR 147.1 billion. In relative terms, the VAT Gap share of the VAT total tax liability (VTTL) dropped to 12.3 percent from 13.2 percent in 2015, and is the lowest value in the analysed period of 2012-2016. Denoted at the share of GDP, the VAT Gap in 2016 amounted to 0.99% compared to 1.05% in 2015. 
Of the EU-28, the VAT Gap share decreased in 22 countries and increased in six—namely, Romania, Finland, the UK, Ireland, Estonia, and France. The biggest declines in the VAT Gap—of over five percentage points—occurred in Bulgaria, Latvia, Cyprus, and the Netherlands. The smallest Gaps were observed in Luxembourg (0.85 percent), Sweden (1.08 percent), and Croatia (1.15 percent). The largest Gaps were registered in Romania (35.88 percent), Greece (29.22 percent), and Italy (25.90 percent). Overall, half of EU-28 MS recorded a Gap below 9.9 percent. 
The Policy Gaps and its components remained stable. The average Policy Gap level was 44.8 percent, out of which 9.95 percentage points are due to the application of various reduced and super-reduced rates (the Rate Gap). Countries with the most flat levels of rates in the EU, according to the Rate Gap, are Denmark (0.93 percent) and Estonia (2.97 percent). The Exemption Gap, or the average share of Ideal Revenue lost due to various exemptions, is, on average, 35 percent in the EU, whereas the Actionable Policy Gap—a combination of the Rate Gap and the Actionable Exemption Gap—is, on average, 16.5 percent of the Notional Ideal Revenue. 
The econometric analysis can be considered a successful first attempt at inferring the impact of various determinants. Firstly, it can be observed that the productive structure of the economy exerts an impact on the VAT Gap. The share of retailers has the strongest impact on the VAT Gap; however, telecommunications, industry, and art also have a positive impact. Secondly, liquidity constraints and the productive structure of the economy also play a role in determining VAT compliance. The most interesting results have to do with the impact of the variables under the direct control of the tax administration. We show that the impact of the size of the tax administration and the VAT Gap is concave. On the contrary, in the case of IT expenditure, the impact is convex, albeit small, until productivity vanishes when IT expenditure is about 9.8 percent of the total expenditure of the tax administration.

/pdf/study-and-reports-on-the-vat-gap-in-the-eu-28-member-states-1qa07krj6l.pdf

Study and Reports on the VAT Gap in the EU-28 Member States: 2018 Final Report

This analysis serves as the Final Report for the DG TAXUD Project 2015/CC/131, “Study and Reports on the VAT Gap in the EU-28 Member States”, which is a follow up to the reports published in 2013, 2014, and 2015. In this report, we present estimates of the VAT Gap and the Policy Gap for the year 2014, as well as revised estimates for the years 2010-2013 due the transmission of Eurostat national accounts from the ESA95 to the ESA10. This update covers Croatia, which was not included in the previous updates. While it was hoped that the update would also cover Cyprus, it has not been possible due to incomplete national accounts data.The VAT Gap is a measure of VAT compliance and enforcement that provides an estimate of revenue loss due to fraud and evasion, tax avoidance, bankruptcies, financial insolvencies, as well as miscalculations. It is defined as the difference between the amount of VAT collected and the VAT Total Tax Liability (VTTL), which is expressed in the report in both absolute and relative terms. The VTTL is the theoretical tax liability according to tax law, and is estimated using a “top-down” approach. As the capacity and willingness to pay taxes is affected by economic cycles, the reviving 2014 economic situation in the European Union (EU) has, therefore, provided good conditions for narrowing the VAT Gap in EU Member States. The year 2014 saw numerous changes in tax enforcement and monitoring, such as anti-smuggling measures, electronic reporting functionalities, limits on cash transactions and the extension of lists of goods applicable to the reverse VAT charge mechanism. On the other hand, only three EU Member States implemented significant changes in their VAT regimes. Positive economic tailwinds, stable VAT regimes, and measures introduced against tax non-compliance led to a decrease in the relative size of the VAT Gap. In nominal terms, in 2014, the VAT Gap in the EU-27 Member States amounted to EUR 159.5 billion. The VTTL accounted for EUR 1,136.3 billion, whereas the revenue was EUR 976.9 billion. Expressed as a percent of VTTL, the VAT Gap reached 14.06 percent. As a result, the overall VAT Gap as a percent of the VTTL marked its first decrease since 2011. The EUR 2.5 billion decline of the VAT Gap in 2014 compared to 2013 was equivalent to the decrease of the ratio of the Gap and the VTTL by approximately 0.69 percentage point (in the EU-26).The smallest Gaps were observed in Sweden (1.24 percent), Luxembourg (3.80 percent), and Finland (6.92 percent). The largest Gaps were registered in Romania (37.89 percent), Lithuania (36.84 percent), and Malta (35.32 percent). Overall, half of the EU-27 Member States recorded a Gap below 10.4 percent.

https://www.econstor.eu/bitstream/10419/179705/1/nr483.pdf

Mikhail Bonch-Osmolovskiy

Papers

Study and Reports on the VAT Gap in the EU-28 Member States: 2019 Final Report

Study to quantify and analyse the VAT Gap in the EU Member States: 2015 Report

Study and reports on the VAT gap in the EU-28 member states: 2018 final report

Study and Reports on the VAT Gap in the EU-28 Member States: 2018 Final Report

Study and reports on the VAT gap in the EU-28 member states: 2016 final report