Is tax funding of health care more likely to be regressive than systems based on social insurance in low and middle-income countries?
DOI:
https://doi.org/10.17533/udea.le.n78a15770Keywords:
health systems financing, progressivity, equityAbstract
One of the main functions of health care systems is to collect enough revenue to finance health expenditures. This revenue can be obtained through different sources (taxes, social insurance contributions, out-of-pocket payments, donations), each of which has different implications in terms of equity. The equity implications of the different forms of revenue collection are an important component of health systems performance evaluation. The international evidence suggests that tax funded systems seem to be a more progressive health care financing mechanism than systems based on social insurance in low- and middle-income countries. However, progressivity results are sensitive to the choice of ability to pay measures and, therefore, policy makers must be aware of this fact when interpreting results of studies on health care financing.
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Abu-zaineh, Mohammad; Mataria, Awad; Luchini, Stéphane & Moatti, Jean Paul (2008). “Equity in health care financing in Palestine: The valueadded of the disaggregate approach”, Social Science & Medicine, Vol. 66, Issue 11, pp. 2308-2320.
Castaño, Ramón; Arvelaez, José; Giedion, Úrsula & Morales, Luis (2002). “Equitable financing, out-of-pocket payments and the role of health care reform in Colombia”, Health Policy and Planning, vol. 17, Suppl. 1, pp. 5-11.
Cissé, Boubou; Luchini, Stéphane & Moatti, Jean Paul (2007). “Progressivity and horizontal equity in health care finance and delivery: What about Africa?”, Health Policy, Vol. 80, Issue 1, pp. 51-68.
Hajizadeh, Mohammad & Connelly, Luke (2009). “Equity of health care financing in Iran”. ACERH Working Paper, Issue 5, available at https://goo.gl/jhD3c8 (31 March 2009).
Kakwani, Nanak C. (1977). “Measurement of Progressivity: An International Comparison”, The Economic Journal, Vol. 87, No. 345, pp. 71-80.
McIntyre, Diane (2007). Learning from experience: health care financing in low- and middle-income countries, Geneva, Global Forum for Health Research.
Mossialos, Elias & Dixon, Anna (2002). “Funding health care: An introduction”. In: Mossialos, Elias; Dixon, Anna; Figueras, Josep & Kutzin, Joe (Eds.). Funding Health Care. Options for Europe (pp.1-30). Buckingham, Open University Press.
O’donnell, Owen; van Doorslaer, Eddy; Wagstaff, Adam & Lindelow, Magnus (2008a). Analyzing Health Equity Using Household Survey Data, Washington, The World Bank.
O’donnell, Owen; van Doorslaer, Eddy; Rannan-eliya, Ravi; Somanathan, Aparnaa; Adhikari, Shiva Raj; Akkazieva, Baktygul... Yuxin, Zao (2008b). “Who pays for health care in Asia?”, Journal of Health Economics, Vol. 27, Issue 2, pp. 460-475.
Rannan-eliya, Ravindra & Somanathan, Aparnaa (2006). “Equity in health and health care systems in Asia”. In: Jones, Andrew (Ed.). The Elgar Companion to Health Economics (pp. 205-218). Cheltenham, UK & Northampton, USA, Edward Elgar.
Savedoff, William (2004). “Tax-Based Financing for Health Systems: Options and Experiences”. World Health Organization, available at: https://goo.gl/ezuetj (31 March 2009)
Ugá, M., and Santos, I. (2007). “An analysis of equity in Brazilian health system financing”, Health Affairs (Millwood), vol. 26, issue 4, pp. 1017- 1028.
Wagstaff, Adam (2002). “Reflections on and alternatives to WHO’s fairness of financial contribution index”, Health Economics, Vol. 11, Issue 2, pp. 103-15.
Wagstaff, Adam (2007). “Social Health Insurance Reexamined”, World Bank Policy Research Working Paper, Issue 4111, available at: https://goo.gl/M5ayR2 (31 March 2009).
Wagstaff Adam, van Doorslaer, Eddy, Van Der Burg H, et al. (1999). “Equity in the finance of health care: some further international comparisons”, Journal of Health Economics, Vol. 18, No. 3, pp. 263-90.
Wagstaff, Adam and van Doorslaer, Eddy (2000). “Equity in Health Care Finance and Delivery”. In: Culyer, Anthony and Newhouse, Joseph (Eds.). Handbook of Health Economics, (Vol. 2) (pp. 1803-1862). Amsterdam, Elsevier Science B. V.
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