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From: EQUIDAD at LISTSERV.PAHO.ORG

Free Government Health Services:
Are They the Best Way to Reach the Poor?

Davidson R. Gwatkin, March, 2003
World Bank

Available online as PDF file [13p.] at:
http://poverty.worldbank.org/files/13999_gwatkin0303.pdf

"..........Equity is a frequently stated justification for government
involvement in the health care market. This is often taken to mean
directly
providing all segments of the population with a wide range of
government-operated health services at no cost: free universal care.

Yet a look at the record suggests that this goal all too often remains
elusive, especially in poor countries; that governments in fact serve
only a
some of the population; and that the people served are
disproportionately
concentrated among the better-off. When this happens, government health
services, far from promoting equity, work against it.

The purpose of this chapter is to illustrate that there are many ways
for
governments to pursue the goal of ensuring that the poor receive
adequate,
affordable services through alternative approaches to resource
allocation
and purchasing. The first section summarizes the information known
about the
distribution of benefits from government health services across social
groups in order to document the regressive pattern that now frequently
exists and the need for significant changes in approach if the poor are
to
benefit. The second and third sections illustrate the kinds of changes
that
might be considered....."