PHA-Exchange> Equity in Asia-Pacific Health Systems - Health Economics

[Claudio]

From: Ruggiero, Mrs. Ana Lucia (WDC) 


 Announcement of the release of three new working papers 

EQUITAP Project Working Papers

 

EQUITAP Project: 
Equitap ("Equity in Asia-Pacific Health Systems") is a collaborative effort of more than fifteen research teams in Asia and Europe engaged in examining equity in national health systems in the Asia-Pacific region. The work of the collaboration involves both development of methodological tools, and actual assessment of the performance of national health systems in Bangladesh, China, Hong Kong SAR, India, Indonesia, Japan, Korea, Kyrgyz Republic, Malaysia, Mongolia, Nepal, Sri Lanka, Taiwan, Thailand and Viet Nam. The project is an initiative of the Asia-Pacific National Health Accounts Network 

 

Who pays for health care in Asia? 

O'Donnell, O., E. Van Doorslaer, Rannan-Eliya, R.P., Somanathan, A., et al. (2005). 

EQUITAP Project Working Paper # 1, Erasmus University, Rotterdam and IPS, Colombo.

http://www.equitap.org/publications/wps/EquitapWP1_4.pdf

 

Abstract

"We describe the structure and the distribution of health care financing in 13 territories that account for 55% of the Asian population. Survey data on household payments are combined with Health Accounts data on aggregate expenditures by source to estimate distributions of total health financing. In all territories, high-income households contribute more than low-income households to the financing of health care. In general, the better off contribute more as a proportion of ability to pay in low and lower-middle income territories. The disproportionality is in the opposite direction in three high/middle income territories operating universal social insurance. Direct taxation is the most progressive source of finance and is most progressive in poorer economies with a narrow tax base. The distribution of out-of-pocket (OOP) payments also depends on the level of development. In high-income economies with widespread insurance coverage, OOP payments absorb a larger fraction of the resources of low-income households. In poor economies, it is the better off that spend relatively more OOP. This contradicts much of the literature and suggests the poor simply cannot afford to pay for health care in low-income economies. Among the high-income territories, Hong Kong is the one example of progressive financing arising from reliance on taxation, as opposed to social insurance, and an ability to shield those on low-incomes from OOP payments. Thailand has a similar financing structure and achieves a similar distributional outcome. The equity implications of a given distribution of financing depend on the extent to which the financing structure ties health care use to payments."

 

 

Paying out-of-pocket for health care in Asia: Catastrophic and poverty impact. 

Van Doorslaer, E., O. O'Donnell, Rannan-Eliya, R.P., Somanathan, A., et al. (2005). 

EQUITAP Project Working Paper #2, Erasmus University, Rotterdam and IPS, Colombo.

http://www.equitap.org/publications/wps/EquitapWP2_1.pdf

 

Abstract

Out-of-pocket (OOP) payments are the principal means of financing health care throughout much of Asia. We describe the magnitude and distribution of OOP payments for health care in fourteen countries and territories accounting for 81% of the Asian population. We focus on expenditures that may be considered catastrophic, in the sense that they absorb a large fraction of household resources, and on the impoverishing effect of payments. Catastrophic impact is measured by the prevalence and intensity of high shares of OOP in total spending and in non-food expenditure. Impoverishment is measured by comparing poverty headcounts and gaps before and after OOP health payments. We present the first cross-country comparisons of the impoverishing effect of OOP payments measured against the international poverty standards of $1 and $2 per person per day. 

 

Bangladesh, China, India and Vietnam stand out in relying heavily on OOP financing, having a high prevalence of catastrophic payments and a large poverty impact of these payments. Sri Lanka is striking as a low-income country that manages to keep the OOP share of financing below 50% and still further because the catastrophic and poverty impact of these payments are modest. Thailand has pushed the OOP share even lower and, through a health entitlement card and now a minimal flat rate charge, has successfully limited the impact of health care payments on household living standards. At a still higher level of national income, Malaysia has been even more successful in limiting the catastrophic and impoverishing effects of OOP payments.

In most low/middle-income countries, the better-off that are more likely to spend a large fraction of total household resources on health care. This reflects the inability of the poorest of the poor to divert resources from basic needs. It also seems to reflect the protection of the poor from user charges in some countries. In China, Kyrgyz and Vietnam, where there are no exemptions of the poor from charges, the poor are as likely, or even more likely, to incur catastrophic payments. Despite the concentration of catastrophic payments on the better-off in the majority of low-income countries, OOP payments still push many Asians (further into) poverty. Seventy-eight million people in the eleven low/middle-income countries included in this study, or 2.7% of the total population, are pushed below the very low threshold of $1 per day due to payments for health care. 

 

 

Who benefits from public spending on health care in Asia?

O'Donnell, O., E. Van Doorslaer, Rannan-Eliya, R.P., Somanathan, A., et al. (2005). 

EQUITAP Project Working Paper # 3, Erasmus University, Rotterdam and IPS, Colombo.

http://www.equitap.org/publications/wps/EquitapWP3_3.pdf

 

Abstract

We examine the benefit incidence of public health care subsidies in eleven Asian territories, including India, Indonesia and two provinces of China. We distinguish between hospital and non-hospital care and between inpatient and outpatient care. We examine not only the distribution of quantities of health care but also that of the value of subsidies. Hong Kong is the only territory that achieves a strong pro-poor distribution of all public health services. Public health care is more moderately pro-poor in Malaysia and Thailand and is evenly distributed in Sri Lanka. In the remainder of the low-income territories examined, the better-off receive more of the subsidy than the poor. The pro-rich bias is greatest in Nepal, Heilongjiang (China) and Indonesia, followed by India, Gansu (China), Bangladesh and Vietnam. The pro-rich bias is stronger for inpatient care than hospital outpatient care. In most territories, non-hospital care is pro-poor. But the greater share of the subsidy goes to hospital care and so this dominates the overall distribution. While public health subsidies are typically not pro-poor, they are inequality reducing in all cases but for Nepal. This is because a given subsidy represents a greater proportionate increase in the living standards of the poor. Relative differences in welfare are narrowed. Hong Kong, Malaysia, Sri Lanka and Thailand have demonstrated that the allocation of sufficient public resources coupled with a policy of universal access can ensure far greater benefits to the poor than may have hitherto been assumed. Growing incomes not only make such policies more feasible, they also make them more effective, with respect to the target efficiency of spending, by availing the private sector opt-out.

 

Eddy van Doorslaer , Professor of Health Economics - Erasmus University 
PO BOx 1738  
3000 DR Rotterdam - The Netherlands 
Phone: +31 10 408 8555  Fax: +31 10 408 9094  E-mail: vandoorslaer at bmg.eur.nl  http://www.bmg.eur.nl/personal/vandoorslaer/ 



-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://phm.phmovement.org/pipermail/phm-exchange-phmovement.org/attachments/20050812/d8b1a4ec/attachment-0001.html>