Benefit Incidence Research Articles

Possible welfare benefits of basic income support: Evidence from a benefit incidence analysis in South Africa

AbstractThe study investigates the potential welfare effect of basic income support (BIS) in reducing poverty and inequality in South Africa. Using the 2017 labour force survey and a benefit incidence analysis, we consider three BIS scenarios: (i) universal income support for those aged between 18 and 59; (ii) only those who are unemployed receive the benefit; and (iii) only unemployed individuals in extremely poor households defined by the food poverty line receive the benefit. Results show that BIS can reduce poverty and inequality. However, the specific effects of the BIS will depend on the targeting scenario considered. The universal BIS is more costly and has higher leakage, with more benefits going to the non‐poor. However, this universal support has the biggest overall impact on poverty and inequality reduction because more South Africans receive income support under this scenario. Meanwhile, targeting only the unemployed and the impoverished makes the BIS more pro‐poor and progressive, as well as mitigating the leakage of the benefit to the non‐poor. This would, however, require that an appropriate targeting mechanism be in place.

Which socio-economic groups benefit most from public health expenditure in Senegal? A dynamic benefit incidence analysis

Despite efforts to enhance public investment in Senegal’s health sector, the equitable distribution of benefits between socioeconomic groups remains largely unexplored. To address this gap, our study examines the progressive (or regressive) nature of public health expenditure. Utilizing data from the latest survey on household living conditions (2018–2019) in conjunction with administrative data on health expenditure from the same period (provided by the Ministry of Health of Senegal), we performed a benefit incidence analysis. This entailed segmenting the population by poverty quintiles and subsequently estimating how each group utilized and benefitted from public health expenditure, according to level of care and geographical location. Additionally, we performed a marginal benefit analysis to discern the impact of an increase in public health expenditure on various socioeconomic groups. Our findings unveil a pro-rich distribution of benefits at both primary healthcare and hospital levels, observable both at national and regional levels. Moreover, disparities in the distribution of resource allocation between Senegal's 14 administrative regions were observed. Ultimately, our results indicate that under prevailing conditions, increasing public health expenditure would not yield a pro-poor distribution of benefits. Therefore, our research underscores the imperative of better targeting populations for greater equity between regions and social groups.

Energy subsidies: conceptual framework and measurement for distributional impacts in Argentina

Argentina has massively subsidized energy in recent decades, and the distributional impacts of those subsidies has been widely studied. However, regional disparities and public financing are two dimensions often omitted by previous research. We extend the analysis in these directions, focusing on the electricity sector. First, we develop a conceptual framework to formalize the deviation of prices from production costs. Second, by applying the “benefit incidence analysis” to household survey microdata, we measure subsidies at the household level and perform a distributional analysis. Our results indicate that regional disparities in electricity distribution costs and in the pricing schedules set by distribution companies are key drivers of the distributional impacts. Subsidies, as a percentage of the final price, vary between regions in the range of 50 to 80 percent. Additionally, omitting public financing leads to a bias in the perception of their redistributive effect: when subsidies are financed by a general consumption tax, the net benefits are less than half of the benefits from the subsidy alone. A series of globally relevant policy recommendations can be derived from the paper.

Adjusting for quality of care in primary health care utilization and benefits in Bihar, India: A benefit incidence analysis

India’s public health policies prioritize the least wealthy and vulnerable. Additionally, for Primary Health Care (PHC) to achieve equitable health outcomes, all must receive high-quality care. This study determined equality of utilization and benefit incidence of PHC services across socioeconomic (SE) groups in Bihar, with and without adjusting for quality of care. It used secondary data from linked PHC facility and household surveys in Bihar that included information on PHC facility utilization, quality of care and household expenditure patterns. Lorenz curves and concentration indices were constructed to examine relative distribution of utilization and benefits from public sector PHC services by SE status, before and after adjusting for quality of care using quality weights. We found that relative distribution of public sector PHC utilization, total and net benefits was statistically no different from perfect equality. With quality weights, utilization and benefits of PHC facilities in Bihar were slightly more pro-rich but statistically no different from perfect equality. The wealthiest do not disproportionately benefit from public sector PHC facilities, but neither do the least wealthy. In conclusion, relative utilization and benefits of public sector PHC facilities were equally distributed across socioeconomic groups in Bihar. Benefits from public sector PHC facilities are not disproportionately concentrated among the least wealthy in the community. As the Ayushman-Bharat Health and Wellness Centers are strengthened to improve public sector PHC services, it would be important to target its benefits towards the least wealthy by ensuring services are accessible and amenable.

Electricity subsidies targeting performance indicators in selected Latin American countries

ABSTRACT This document calculates targeting performance indicators of electricity subsidies in Mexico, Panama, the Dominican Republic, and Uruguay. To do this, beneficiary and benefit incidence indicators are calculated using official household survey data and administrative records on electricity tariffs. In addition, this paper calculates inclusion and exclusion errors in the targeting of electricity subsidies. The results show that the share of poor households that receive the subsidy is very large in Mexico, Panama, and the Dominican Republic. However, the distribution of the subsidy is regressive in absolute terms, which implies that most of every dollar spent on keeping electricity prices low will benefit the wealthiest households. This document also finds large inclusion errors suggesting that an important share of the non-poor is also benefiting from the subsidy. These results shed light on the evaluation of electricity subsidies in the region to improve targeting and optimisation of resources.

Benefit Incidence Analysis terhadap Program Bidikmisi di Universitas Diponegoro

ABSTRACTOne of the ways to improve the quality of human resources is by providing educational assistance programs for students who wish to continue their education to higher education. Bidikmisi is one of the scholarship programs provided by the government in helping prospective students, especially those who are less fortunate, to pursue higher education.This study focuses on analyzing the impact of the application of the Bidikmisi scholarship using the Benefit Incidence Analysis (BIA) method. The data used in this study are primary data. Data was collected using a survey method through questionnaires distributed to Bidikmisi students who were the sample. The sample used is Bidikmisi students with active status at Diponegoro University from class 2017, 2018 and 2019.The results of this study indicate that the Bidikmisi program at Diponegoro University is a progressive policy. The university as the organizer of the bidikmisi program is considered appropriate in providing the obligations of bidikmisi recipients to bidikmisi students at Diponegoro University. The group of students with the lowest level of parental income gets a 33 percent distribution of benefits from the Bidikmisi program funds. The concentration curve lies above the 45 degree diagonal line, so the 10 percent of students with the lowest income level (first quintile) in the population receive more than 10 percent of the benefits of the subsidy so that the distribution of benefits can be said to be progressive in absolute terms.

A study on the benefit incidence of a place-based education fee reduction program: Evidence from a local housing market in China

This paper studies an Education Fee Reduction and Exemption Program for preschool childcare in Jinan, China, to explore the benefit incidence among different stakeholders by observing how housing prices and rents change in response to this program and by employing a method of difference-in-differences combined with boundary discontinuity. The empirical findings indicate that the housing prices in the experimental area rose by 5–7 percent while the rents rose by 10–13 percent due to the capitalization effects of this equalization program. Falsification tests are conducted using artificial boundaries and fake policy implementation dates. A back-of-the-envelope welfare analysis demonstrates that a considerable portion of the program's benefits is offset by house price increases for new home buyers and rent increases for tenants, with significant distributional implications for different stakeholders.

Mapping the Socio-Economic Inequalities among Children Aged 0-5 Years in India: A Benefit Incidence Analysis of Universal Immunization Programme

Mapping the Socio-Economic Inequalities among Children Aged 0-5 Years in India: A Benefit Incidence Analysis of Universal Immunization Programme

Are institutional deliveries equitable in the southern states of India? A benefit incidence analysis

BackgroundDespite a commendable rise in the number of women seeking delivery care at public health institutions in South India, it is unclear if the benefit accrues to wealthier or poorer socio-economic groups. The study’s aim was to investigate at how the public subsidy is distributed among Indian women who give birth in public hospitals in the southern regions.MethodsData from the Indian Demographic Health Survey’s fifth wave (NFHS-5, 2019–21) was used in this study. A total of 22, 403 were institutional deliveries across all the southern states of India were included. Out-of-pocket expenditure (OOPE) on childbirth in health institutions was the outcome variable. We used summary statistics, Benefits Incidence Analysis (BIA), concentration index (CI), and concentration curve (CC) were used.ResultsMost women in the lowest, poorest, and medium quintiles of wealth opted to give birth in public facilities. In contrast, about 69% of mothers belonging to highest quintile gave birth in private health institutions. The magnitude of CI and CC of institutional delivery indicates that public sector usage was concentrated among poorer quintiles [CIX: − 0.178; SE: 0.005; p < 0.001] and private sector usage was concentrated among wealthier quintiles [CIX: 0.239; SE: 0.006; p < 0.001]. Benefit incidence analyses suggest that middle quintile of women received the maximum public subsidy in primary health centres (33.23%), followed by richer quintile (25.62%), and poorer wealth quintiles (24.84%). These pattern in the secondary health centres was similar.ConclusionPoorer groups utilize the public sector for institutional delivery in greater proportions than the private sector. Middle quintiles seem to benefit the most from public subsidy in terms of the median cost of service and non-payment. Greater efforts must be made to understand how and why these groups are being left behind and what policy measures can enhance their inclusion and financial risk protection.

Psychiatric morbidity and work participation in patients with congenital ventricular septal defects: a case-controlled study.

The burden of psychiatric morbidity, level of education, and work participation are currently unknown in patients with congenital ventricular septal defects (VSD). In a Danish population-based cohort study using nationwide medical registries, the burden of psychiatric disorders, use of psychotropic agents, level of education, and work participation were examined in patients with isolated congenital VSD and controls from the general population matched by age and sex. Subjects with known chromosomal abnormalities were excluded. To compute estimates, Cox proportional regression model, Fine and Gray's competing risk regression, and Kaplan-Meier failure function were used. We included 8006 patients and 79568 controls born before 2018. Median follow-up was 23 years. Compared with controls, patients with VSD displayed a hazard ratio (HR) of 1.24 [95% confidence interval (CI): 1.17-1.32] for any psychiatric disorder where the hazard for intellectual disabilities was most pronounced [HR of 3.66 (95% CI: 2.98-4.50)]. The use of psychotropic agents was higher in patients compared with controls [HR 1.14 (95% CI: 1.09-1.20)]. The work participation was lower in patients with VSD compared with controls (P<0.001) and was lower in patients with VSD with a psychiatric disorder compared with those without (P<0.001). The 40-year cumulative incidence of permanent social security benefits was 29% in patients with psychiatric disorders (vs. 21% in controls with psychiatric disorders) and 8% in patients without psychiatric disorders (vs. 4% in controls). Patients with isolated VSD suffer from a higher burden of psychiatric disorders and display lower work participation compared with matched controls from the general Danish population. It is important to consider longer-term impacts on mental health, education, and subsequent employment in patients with VSD, in addition to cardiovascular effects, as these factors severely affect quality of life and have direct socioeconomic implications on an individual and societal level.

The redistributive effect ofthe public health system: the case ofSierra Leone.

Universal health coverage (UHC), health equity and reduction of income inequalities are key objectives for the Sierra Leone government. While investing in health systems may drive economic growth, it is less clear whether investing in health systems reduces income inequality. Therefore, a crucial issue is to what extent the Sierra Leone public healthcare system reduces income inequality, and finances and provides healthcare services equitably. We use data from the Sierra Leone Integrated Household Survey 2018 to complete a financing and benefit incidence analysis of the Sierra Leone public healthcare system. We extend these analyses by assessing the redistributive effect of the public healthcare system (i.e.fiscal incidence analysis). We compute the redistributive effect as the change in Gini index induced by the payments for, and provision of, public healthcare services. The financing incidence of the Sierra Leone public healthcare system is marginally progressive (i.e.Kakwani index: 0.011*, P-value <0.1). With regard to public healthcare benefits, while primary healthcare (PHC) benefits are pro-poor, secondary/tertiary benefits are pro-rich. The result is that overall public healthcare benefits are equally distributed (concentration index (CI): 0.008, not statistically different from zero). However, needs are concentrated among the poor, so benefits are pro-rich when needs are considered. We find that the public healthcare system redistributes resources from better-off quintiles to worse-off quintiles (Gini coefficient reduction induced by public healthcare system = 0.5%). PHC receives less financing than secondary/tertiary care but delivers a larger reduction in income inequality. The Sierra Leone public healthcare system redistributes resources and reduces income inequality. However, the redistributive effect occurs largely thanks to PHC services being markedly pro-poor, and the Sierra Leone health system could be more equitable. Policy-makers interested in improving Sierra Leone public health system equity and reducing income inequalities should prioritize PHC investments.

Health care service use by people diagnosed with invasive melanoma in Queensland: a benefit incidence analysis.

To quantify differences, by residential remoteness and socio-economic status, in health care service use by people diagnosed with invasive melanoma in Queensland. Benefit incidence analysis of CancerCostMod data, comprising Queensland Cancer Registry data linked with Queensland Hospital Admitted Patient Data Collection (QHAPDC), Medicare Benefits Schedule (MBS), and Pharmaceutical Benefits Scheme (PBS) data. Adults (18 years or older) newly diagnosed with invasive melanoma in Queensland during 1 July 2011 - 31 June 2015 and alive three years after diagnosis. Concentration curves and indices quantifying differences by residential postcode-based remoteness (Australian Statistical Geography Standard - Remoteness Area) and socio-economic disadvantage (Index of Relative Socioeconomic Disadvantage) in hospital admissions (overall and by type) and use of MBS (overall and by type) and PBS services during the three years following diagnosis of invasive melanoma. A total of 13 145 adults diagnosed with invasive melanoma during 2011-15 were alive three years after the diagnosis. Public hospital admissions were more frequent for people living in areas of greater socio-economic disadvantage (concentration index, -0.15; 95% confidence interval [CI], -0.19 to -0.12) or outside major cities (concentration index, -0.10; 95% CI, -0.13 to -0.06); private hospital admissions (concentration index, 0.11; 95% CI, 0.07-0.15) and specialist consultations (concentration index, 0.08; 95% CI, 0.07-0.10) were more frequent in areas of lesser disadvantage and in major cities (private hospital admissions: 0.10; 95% CI, 0.06-0.13; specialist services: 0.07; 95% CI, 0.06-0.09). Differences in other melanoma health care service use by residential remoteness and socio-economic disadvantage were not statistically significant. Variation in health care service use by Queenslanders with primary diagnoses of invasive melanoma by residential socio-economic disadvantage and remoteness were generally minor. Our analysis suggests that access to health care for people with melanoma is fairly equitable in Queensland.

Equity assessment of maternal and child healthcare benefits utilization and distribution in public healthcare facilities in Bangladesh: a benefit incidence analysis

BackgroundThe distribution of healthcare services should be based on the needs of the population, regardless of their ability to pay. Achieving universal health coverage implies first ensuring that people of all income levels have access to quality healthcare, and then allocating resources reasonably considering individual need. Hence, this study aims to understand how public benefits in Bangladesh are currently distributed among wealth quintiles considering different layers of healthcare facilities and to assess the distributional impact of public benefits.MethodsTo conduct this study, data were extracted from the recent Bangladesh Demographic and Health Survey 2017–18. We performed benefit incidence analysis to determine the distribution of maternal and child healthcare utilization in relation to wealth quintiles. Disaggregated and national-level public benefit incidence analysis was conducted by the types of healthcare services, levels of healthcare facilities, and overall utilization. Concentration curves and concentration indices were estimated to measure the equity in benefits distribution.ResultsAn unequal utilization of public benefits observed among the wealth quintiles for maternal and child healthcare services across the different levels of healthcare facilities in Bangladesh. Overall, upper two quintiles (richest 19.8% and richer 21.7%) utilized more benefits from public facilities compared to the lower two quintiles (poorest 18.9% and poorer 20.1%). Benefits utilization from secondary level of health facilities was highly pro-rich, while benefit utilization found pro-poor at primary levels. The public benefits in Bangladesh were also not distributed according to the needs of the population; nevertheless, poorest 20% household cannot access 20% share of public benefits in most of the maternal and child healthcare services even if we ignore their needs.ConclusionsBenefit incidence analysis in public health spending demonstrates the efficacy with which the government allocates constrained health resources to satisfy the needs of the poor. Public health spending in Bangladesh on maternal and child healthcare services were not equally distributed among wealth quintiles. Overall health benefits were more utilized by the rich relative to the poor. Hence, policymakers should prioritize redistribution of resources by targeting the socioeconomically vulnerable segments of the population to increase their access to health services to meet their health needs.

Public Spending, Governance, and Mortality Probability in the Indian Subnational: A Two-Level Random Intercept Analysis

ABSTRACT: One of the most fundamental yet unresolved health policy issues is whether public expenditure on healthcare leads to improved health outcomes. Given that health reflects one of the critical aspects of human capital, having implications for economic growth and other development goals, there has been enormous advocacy towards investing significantly in the health systems across the countries to improve the overall health status. However, the effect of public spending on health outcomes remains inconclusive. The present paper analyses the impact of public health spending on mortality probability, taking into account the role of governance while treating public spending as an endogenous variable. The study uses individual level data from the National Family Health Survey (NFHS) Round 5 and a few state-level characteristics. For estimation purpose, it uses a two-level mixed effect model to capture the benefit incidence of public spending on Individual mortality probability. The findings reveal that public spending has a significant but differential impact on mortality across the Indian States, whereas the quality of governance is found to be a mediator. Given a level of public spending, States with better government effectiveness and rule of law can translate public health spending more effectively in reducing mortality at the individual level. The study also found heterogeneous mortality status across gender, location of stay, wealth status, and age groups with a differential impact of public spending across gender, wealth, and age groups. The variation in average distance of mortality probability level in each state from the overall mean mortality probability indicates that the states are very different in terms of health challenges that they are facing. The policy options call for state-specific health interventions to reduce the mortality rather than one-size-fits-all health policies. There needs to more unconditional grants/transfers from the Union Government to the States so that states will be able to tailor policy responses to address the unique challenges faced by the respective states. At the same time, states need to adopt output-based conditions with greater flexibility to deliver services and greater accountability to improve transparency, governance quality, and implementation capacity.

Stroke Following Coronavirus Disease 2019 Vaccination: Evidence Based on Different Designs of Real-World Studies.

We aimed to evaluate whether coronavirus disease 2019 (COVID-19) vaccination was associated with stroke. We conducted a systematic meta-analysis of studies using cohort, self-controlled case series (SCCS), and case-crossover study (CCOS) designs to evaluate incidence risk ratios (IRRs) and 95% confidence intervals (CIs) of ischemic stroke (IS), hemorrhagic stroke (HS), and cerebral venous sinus thrombosis (CVST) following COVID-19 vaccination. Risks of stroke were pooled among subpopulations categorized by vaccine type, dose, age, and sex. Sensitivity analysis was performed by different defined risk periods. Fourteen studies involving 79 918 904 individuals were included. Cohort studies showed decreased risks of IS (IRR, 0.82 [95% CI, .75-.90]) and HS (IRR, 0.75 [95% CI, .67-.85]) postvaccination, but not CVST (IRR, 1.18 [95% CI, .70-1.98]). SCCS identified increased risks 1-21 days postvaccination (IRRIS, 1.05 [95% CI, 1.00-1.10]; IRRHS, 1.16 [95% CI, 1.06-1.26]) or 1-28 days postvaccination (IRRIS, 1.04 [95% CI, 1.00-1.08]; IRRHS, 1.37 [95% CI, 1.15-1.64]), similar to CVST (IRR, 1.58 [95% CI, 1.08-2.32]). CCOS reported an increased risk of CVST after ChAdOx1 vaccination (IRR, 2.9 [95% CI, 1.1-7.2]). Although different study designs yielded inconsistent findings, considering the relatively low background incidence of stroke and benefits of vaccination, even a potentially increased risk of stroke postvaccination should not justify vaccine hesitancy.

On the welfare effect of retail electricity subsidy in Vietnam

PurposeThis research investigates how subsidy programs in Vietnam's residential electricity market affect consumers' well-being.Design/methodology/approachTwo perspectives are employed: cash transfer and quantity-based subsidy. The effectiveness of cash transfer is measured in three ways: benefit incidence, beneficiary incidence and materiality. The quantity-based subsidy is established under the increasing block rate pricing, with the first two block rates being lower than the marginal cost. To improve the quantity-based subsidy, the research examines the consumer surplus under four proposals.FindingsThe results show that both types of subsidies are ineffective in supporting the poor.Research limitations/implicationsIn order to achieve a more equal distribution among households, the subsidy program should remove all subsidized blocks and reflect the full marginal cost. Changes should be made to the price structure regarding both marginal price and intervals.Practical implicationsTo mitigate the impact of the quantity-based subsidy, the government should improve the cash transfer by reducing extortion and improving targeting efficiency, especially for poor households living in rented houses.Originality/valueThis paper is the first to discuss the welfare effect of the electricity subsidy in Vietnam. First, it comprehensively evaluates the cash transfer subsidy in Vietnam. Second, it suggests a modification in the residential electricity tariff.

EE493 Equity in Healthcare Utilization and Reimbursement for Patients with Multiple Sclerosis in China: A Benefit Incidence Analysis Using Nationwide Patient-Reported Outcome Data

Multiple sclerosis (MS) is a chronic, autoimmune neurologic disorder resulting in substantial economic burden. With cost of illness research on MS being extensively studied worldwide, however, little is known about the equity concern of utilization and reimbursement. This study aimed to evaluate the distribution of utilization, cost, and reimbursement received by MS patients with different socio-economic status (SES) in China.

Identifying the Rich: Registration, Taxation, and Access to the State in Tanzania

How do states build their informational capacity? This article argues that distributive politics conditions how the state’s capacity develops. I study civil registration, where citizens comply with the state’s informational demands in exchange for documentary proof of identity, which may simultaneously facilitate access to public resources and exposure to taxation. Though the rich are particularly threatened by taxation, the narrow benefits of registration induce their compliance over that of the poor. I leverage a set of reforms in early postindependence Tanzania which provide quasi-random variation in citizens’ registration status and show that registration promotes access to narrow-based resources, rather than broad-based ones, while increasing tax payment. In turn, citizens’ decisions to comply reflect the economically stratified local incidence of these net benefits. The results suggest how nominally universal state-building schemes can have regressive effects on the state’s coverage.

Distribution of capitalized benefits from land conservation

Land conservation efforts throughout the United States sustain ecological benefits while generating wealth in the housing market through capitalization of amenities. This paper estimates the benefits of conservation that are capitalized into proximate home values and quantifies how those benefits are distributed across demographic groups. Using detailed property and household-level data from Massachusetts, we estimate that new land conservation led to $62 million in new housing wealth equity. However, houses owned by low-income or Black or Hispanic households are less likely to be located near protected areas, and hence, these populations are less likely to benefit financially. Direct study of the distribution of this new wealth from capitalized conservation is highly unequal, with the richest quartile of households receiving 43%, White households receiving 91%, and the richest White households receiving 40%, which is nearly 140% more than would be expected under equal distribution. We extend our analysis using census data for the entire United States and observe parallel patterns. We estimate that recent land conservation generated $9.8 billion in wealth through the housing market and that wealthier and White households benefited disproportionately. These findings suggest regressive and racially disparate incidence of the wealth benefits of land conservation policy.

The benefits and burden of health financing in Indonesia: analyses of nationally representative cross-sectional data

Indonesia has committed to deliver universal health coverage by 2024. Reforming the country's health-financing system is key to achieving this commitment. We aimed to evaluate how the benefits and burden of health financing are distributed across income groups and the extent to which Indonesia has achieved equity in the funding and delivery of health care after financing reforms. We conducted benefit incidence analyses (BIA) and financing incidence analyses (FIA) using cross-sectional nationally representative data from several datasets. Two waves (Feb 1 to April 30, 2018, and Aug 1 to Oct 31, 2019) of the Equity and Health Care Financing in Indonesia (ENHANCE) study household survey involving 7500 households from ten of the 34 provinces in Indonesia were used to obtain health and socioeconomic status data for the BIA. Two waves (2018 and 2019) of the National Socioeconomic Survey (SUSENAS), the most recent wave (2014) of the Indonesian Family Life Survey, and the 2017 and 2018 National Health Accounts were used to obtain data for the FIA. In the BIA, we calculated a concentration index to assess the distribution of health-care benefits (-1·0 [pro-poor] to 1·0 [pro-rich]), considering potential differences in health-care need. In the FIA, we evaluated the equity of health-financing contributions by socioeconomic quintiles by calculating the Kakwani index to assess the relative progressivity of each financing source. Both the BIA and FIA compared results from early 2018 (baseline) with results from late 2019. There were 31 864 participants in the ENHANCE survey in 2018 compared with 31 215 in 2019. Women constituted 50·5% and men constituted 49·5% of the total participants for each year. SUSENAS had 1 131 825 participants in 2018 compared with 1 204 466 in 2019. Women constituted 49·9% of the participants for each year, whereas men constituted 51·1%. The distribution of health-care benefits in the public sector was marginally pro-poor; people with low income received a greater proportion of benefits from health services than people with high income between 2018 (concentration index -0·008, 95% CI -0·075 to 0·059) and 2019 (-0·060, -0·139 to 0·019). The benefit incidence in the private health sector was significantly pro-rich in 2018 (0·134, 0·065 to 0·203, p=0·0010) and 2019 (0·190, -0·192 to 0·572, p=0·0070). Health-financing incidence changed from being moderately progressive in 2018 (Kakwani index 0·034, 95% CI 0·030 to 0·038) to mildly regressive in 2019 (-0·030, -0·034 to -0·025). Although Indonesia has made substantial progress in expanding health-care coverage, a lot remains to be done to improve equity in financing and spending. Improving comprehensiveness of benefits will reduce out-of-pocket spending and allocating more funding to primary care would improve access to health-care services for people with low income. UK Health Systems Research Initiative, UK Department of International Development, UK Economic and Social Research Council, UK Medical Research Council, and Wellcome Trust.