الريادة لاقتصاديات الأعمال
Volume 12, Numéro 2, Pages 345-371
2026-06-21

Fiscal Policies And Health Financing In Algeria: The Role Of Institutional Quality



Authors : Mekki Houssam . Bensafta Kamel Malik .

Abstract

In rentier economies such as Algeria, health financing is constrained by dependence on volatile hydrocarbon revenues. This study examines the effects of fiscal policy, focusing on non-hydrocarbon tax instruments—including direct and indirect taxes, GDP per capita, government expenditure, and out-of-pocket spending—on government health expenditure over 1995–2022, while treating institutional accountability as a moderating factor. Results indicate that direct taxes have a weak positive effect, limited by a narrow tax base, a large informal sector (25–40%), and hydrocarbon dependence (>60% of the budget and ~95% of exports). whereas indirect taxes are positive in the short run but negative in the long run due to regressive and inflationary effects. Government expenditure has a positive but weak long-run impact that strengthens under institutional accountability, indicating that governance quality enhances the allocation of public resources to health. Similarly, the fiscal effects of both direct and indirect taxes on health spending become more pronounced when accountability is introduced. Out-of-pocket spending reduces public expenditure but becomes complementary under stronger accountability. Overall, institutional accountability emerges as the main transmission channel of fiscal policy effects on health financing in Algeria, highlighting the need to strengthen direct taxation, improve tax administration (DGI), modernize healthcare management through cost accounting and medical monitoring systems, and establish National Health Accounts (NHA), alongside economic diversification in Algeria to ensure fiscal sustainability.

Keywords

Health Financing ; Universal Health Coverage ; Fiscal Policy ; Institutional Quality

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