Distribution Of Health Care Benefits Research Articles

Equity in health financing of Guangxi after China\u2019s universal health coverage: evidence based on health expenditure comparison in rural Guangxi Zhuang autonomous region from 2009 to 2013

BackgroundHealthcare financing should be equitable. Fairness in financial contribution and protection against financial risk is based on the notion that every household should pay a fair share. Health policy makers have long been concerned with protecting people from the possibility that ill health will lead to catastrophic financial payments and subsequent impoverishment. A number of studies on health care financing equity have been conducted in some provinces of China, but in Guangxi, we found such observation is not enough. What is the situation in Guagnxi? A research on rural areas of Guangxi can add knowledge in this field and help improve the equity and efficiency of health financing, particularly in low-income citizens in rural countries, is a major concern in China’s medical sector reform.MethodsSocio-economic characteristics and healthcare payment data were obtained from two rounds of household surveys conducted in 2009 (4634 respondents) and 2013 (3951 respondents). The contributions of funding sources were determined and a progressivity analysis of government healthcare subsidies was performed. Household consumption expenditure and total healthcare payments were calculated and incidence and intensity of catastrophic health payments were measured. Summary indices (concentration index, Kakwani index and Gini coefficient) were obtained for the sources of healthcare financing: indirect taxes, out of pocket payments, and social insurance contributions.ResultsThe overall health-care financing system was regressive. In 2013, the Kakwani index was 0.0013, the vertical effect of all the three funding sources was 0.0001, and some values exceeded 100%, indicating that vertical inequity had a large influence on causing total health financing inequity. The headcount of catastrophic health payment declined sharply between 2009 and 2013, using total expenditure (from 7.3% to 1.2%) or non-food expenditure (from 26.1% to 7.5%) as the indicator of household capacity to pay.ConclusionOur study demonstrates an inequitable distribution of government healthcare subsidies in China from 2009 to 2013, and the inequity was reduced, especially in rural areas. Future healthcare reforms in China should not only focus on expanding the coverage, but also on improving the equity of distribution of healthcare benefits.

Financing for universal health coverage in small island states: evidence from the Fiji Islands

BackgroundUniversal health coverage (UHC) is critical to global poverty alleviation and equity of health systems. Many low-income and middle-income countries, including small island states in the Pacific, have committed to...

System-wide analysis of health financing equity in Cambodia: a study protocol

BackgroundTo assess progress towards universal health coverage, countries like Cambodia require evidence on equity in the financing and distribution of healthcare benefits. This evidence must be based on a system-wide...

Racjonowanie zasobów zdrowotnych ze względu na wiek pacjenta. Głos w obronie jakości życia osób starszych

Wedlug najnowszych badan Eurostatu i GUS w Polsce oraz w innych krajach Europy postepuje proces starzenia sie ludności. Zdaniem badaczy wzrost liczby osob w wieku poprodukcyjnym powoduje, ze popyt na uslugi zdrowotne nieprzerwanie rośnie, dlatego spośrod roznego rodzaju dobr zdrowie jest dziś najcenniejsze dla czlowieka. Jak slusznie wykazal Kazimierz Szewczyk, jego wartośc jest wysoka, poniewaz nalezy ono do zasobow skonczonych. Nie wszystkie uslugi medyczne są gwarantowane przez system opieki zdrowotnej, dlatego istnieje koniecznośc stosowania ekonomicznych zasad w alokacji limitowanych dobr zdrowotnych. Wedlug opinii wiekszości lekarzy, psychologow oraz etykow, np. Jaroslawa Derejczyka, Barbary Bien, Janiny Kokoszki-Paszkot i Joanny Szczygiel, pacjenci w starszym wieku nalezą do grupy osob pokrzywdzonych. Nie tylko nie przyznaje sie im pierwszenstwa w dostepie do świadczen medycznych, ale wrecz dyskryminuje. W artykule zamierzam wymienic i opisac metody, jakie są stosowane w medycynie i sluzą ekonomicznemu rozdzielnictwu uslug zdrowotnych, oraz wyjaśnic, dlaczego w trakcie rozlozenia świadczen warto wziąc pod uwage jakośc zycia osob starszych, a nie sam wiek metrykalny.

Equity in Health Care Financing in Low- and Middle-Income Countries: A Systematic Review of Evidence from Studies Using Benefit and Financing Incidence Analyses.

IntroductionHealth financing reforms in low- and middle- income countries (LMICs) over the past decades have focused on achieving equity in financing of health care delivery through universal health coverage. Benefit and financing incidence analyses are two analytical methods for comprehensively evaluating how well health systems perform on these objectives. This systematic review assesses progress towards equity in health care financing in LMICs through the use of BIA and FIA.Methods and FindingsKey electronic databases including Medline, Embase, Scopus, Global Health, CinAHL, EconLit and Business Source Premier were searched. We also searched the grey literature, specifically websites of leading organizations supporting health care in LMICs. Only studies using benefit incidence analysis (BIA) and/or financing incidence analysis (FIA) as explicit methodology were included. A total of 512 records were obtained from the various sources. The full texts of 87 references were assessed against the selection criteria and 24 were judged appropriate for inclusion. Twelve of the 24 studies originated from sub-Saharan Africa, nine from the Asia-Pacific region, two from Latin America and one from the Middle East. The evidence points to a pro-rich distribution of total health care benefits and progressive financing in both sub-Saharan Africa and Asia-Pacific. In the majority of cases, the distribution of benefits at the primary health care level favoured the poor while hospital level services benefit the better-off. A few Asian countries, namely Thailand, Malaysia and Sri Lanka, maintained a pro-poor distribution of health care benefits and progressive financing.ConclusionStudies evaluated in this systematic review indicate that health care financing in LMICs benefits the rich more than the poor but the burden of financing also falls more on the rich. There is some evidence that primary health care is pro-poor suggesting a greater investment in such services and removal of barriers to care can enhance equity. The results overall suggest that there are impediments to making health care more accessible to the poor and this must be addressed if universal health coverage is to be a reality.

Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage

Universal coverage of health care is now receiving substantial worldwide and national attention, but debate continues on the best mix of financing mechanisms, especially to protect people outside the formal employment sector. Crucial issues are the equity implications of different financing mechanisms, and patterns of service use. We report a whole-system analysis--integrating both public and private sectors--of the equity of health-system financing and service use in Ghana, South Africa, and Tanzania. We used primary and secondary data to calculate the progressivity of each health-care financing mechanism, catastrophic spending on health care, and the distribution of health-care benefits. We collected qualitative data to inform interpretation. Overall health-care financing was progressive in all three countries, as were direct taxes. Indirect taxes were regressive in South Africa but progressive in Ghana and Tanzania. Out-of-pocket payments were regressive in all three countries. Health-insurance contributions by those outside the formal sector were regressive in both Ghana and Tanzania. The overall distribution of service benefits in all three countries favoured richer people, although the burden of illness was greater for lower-income groups. Access to needed, appropriate services was the biggest challenge to universal coverage in all three countries. Analyses of the equity of financing and service use provide guidance on which financing mechanisms to expand, and especially raise questions over the appropriate financing mechanism for the health care of people outside the formal sector. Physical and financial barriers to service access must be addressed if universal coverage is to become a reality. European Union and International Development Research Centre.

Who pays and who benefits from health care? An assessment of equity in health care financing and benefit distribution in Tanzania

Little is known about health system equity in Tanzania, whether in terms of distribution of the health care financing burden or distribution of health care benefits. This study undertook a combined analysis of both financing and benefit incidence to explore the distribution of health care benefits and financing burden across socio-economic groups. A system-wide analysis of benefits was undertaken, including benefits from all providers irrespective of ownership. The analysis used the household budget survey (HBS) from 2001, the most recent nationally representative survey data publicly available at the time, to analyse the distribution of health care payments through user fees, health insurance contributions [from the National Health Insurance Fund (NHIF) for the formal sector and the Community Health Fund (CHF), for the rural informal sector] and taxation. Due to lack of information on NHIF and CHF contributions in the HBS, a primary survey was administered to estimate CHF enrollment and contributions; assumptions were used to estimate NHIF contributions within the HBS. Data from the same household survey, administered to 2224 households in seven districts/councils, was used to analyse the distribution of health care benefits across socio-economic groups. The health financing system was mildly progressive overall, with income taxes and NHIF contributions being the most progressive financing sources. Out-of-pocket payments and contributions to the CHF were regressive. The health benefit distribution was fairly even but the poorest received a lower share of benefits relative to their share of need for health care. Public primary care facility use was pro-poor, whereas higher level and higher cost facility use was generally pro-rich. We conclude that health financing reforms can improve equity, so long as integration of health insurance schemes is promoted along with cross-subsidization and greater reliance on general taxation to finance health care for the poorest.

Paying for and receiving benefits from health services in South Africa: is the health system equitable?

There is a global challenge for health systems to ensure equity in both the delivery and financing of health care. However, many African countries still do not have equitable health systems. Traditionally, equity in the delivery and the financing of health care are assessed separately, in what may be termed 'partial' analyses. The current debate on countries moving toward universal health systems, however, requires a holistic understanding of equity in both the delivery and the financing of health care. The number of studies combining these aspects to date is limited, especially in Africa. An assessment of overall health system equity involves assessing health care financing in relation to the principles of contributing to financing according to ability to pay and benefiting from health services according to need for care. Currently South Africa is considering major health systems restructuring toward a universal system. This paper examines together, for both the public and the private sectors, equity in the delivery and financing of health care in South Africa. Using nationally representative datasets and standard methodologies for assessing progressivity in health care financing and benefit incidence, this paper reports an overall progressive financing system but a pro-rich distribution of health care benefits. The progressive financing system is driven mainly by progressive private medical schemes that cover a small portion of the population, mainly the rich. The distribution of health care benefits is not only pro-rich, but also not in line with the need for health care; richer groups receive a far greater share of service benefits within both public and private sectors despite having a relatively lower share of the ill-health burden. The importance of the findings for the design of a universal health system is discussed.

Factors influencing the burden of health care financing and the distribution of health care benefits in Ghana, Tanzania and South Africa

In Ghana, Tanzania and South Africa, health care financing is progressive overall. However, out-of-pocket payments and health insurance for the informal sector are regressive. The distribution of health care benefits is generally pro-rich. This paper explores the factors influencing these distributions in the three countries. Qualitative data were collected through focus group discussions and in-depth interviews with insurance scheme members, the uninsured, health care providers and managers. Household surveys were also conducted in all countries. Flat-rate contributions contributed to the regressivity of informal sector voluntary schemes, either by design (in Tanzania) or due to difficulties in identifying household income levels (in Ghana). In all three countries, the regressivity of out-of-pocket payments is due to the incomplete enforcement of exemption and waiver policies, partial or no insurance cover among poorer segments of the population and limited understanding of entitlements among these groups. Generally, the pro-rich distribution of benefits is due to limited access to higher level facilities among poor and rural populations, who rely on public primary care facilities and private pharmacies. Barriers to accessing health care include medical and transport costs, exacerbated by the lack of comprehensive insurance coverage among poorer groups. Service availability problems, including frequent drug stock-outs, limited or no diagnostic equipment, unpredictable opening hours and insufficient skilled staff also limit service access. Poor staff attitudes and lack of confidence in the skills of health workers were found to be important barriers to access. Financing reforms should therefore not only consider how to generate funds for health care, but also explicitly address the full range of affordability, availability and acceptability barriers to access in order to achieve equitable financing and benefit incidence patterns.

Does the distribution of health care benefits in Kenya meet the principles of universal coverage?

BackgroundThe 58th World Health Assembly called for all health systems to move towards universal coverage where everyone has access to key promotive, preventive, curative and rehabilitative health interventions at an affordable cost. Universal coverage involves ensuring that health care benefits are distributed on the basis of need for care and not on ability to pay. The distribution of health care benefits is therefore an important policy question, which health systems should address. The aim of this study is to assess the distribution of health care benefits in the Kenyan health system, compare changes over two time periods and demonstrate the extent to which the distribution meets the principles of universal coverage.MethodsTwo nationally representative cross-sectional households surveys conducted in 2003 and 2007 were the main sources of data. A comprehensive analysis of the entire health system is conducted including the public sector, private-not-for-profit and private-for-profit sectors. Standard benefit incidence analysis techniques were applied and adopted to allow application to private sector services.ResultsThe three sectors recorded similar levels of pro-rich distribution in 2003, but in 2007, the private-not-for-profit sector was pro-poor, public sector benefits showed an equal distribution, while the private-for-profit sector remained pro-rich. Larger pro-rich disparities were recorded for inpatient compared to outpatient benefits at the hospital level, but primary health care services were pro-poor. Benefits were distributed on the basis of ability to pay and not on need for care.ConclusionsThe principles of universal coverage require that all should benefit from health care according to need. The Kenyan health sector is clearly inequitable and benefits are not distributed on the basis of need. Deliberate efforts should be directed to restructuring the Kenyan health system to address access barriers and ensure that all Kenyans benefit from health care when they need it.

公義為綱、融資為目: 香港醫療制度改革的社會公義問題

LANGUAGE NOTE | Document text in Chinese; abstract also in English.本文討論香港醫療制度的融資安排與改革，並探討進行改革所帶來的社會公義問題。本文認為一個符合社會公義的公共醫療制度要保證市民得到一個得體而又最基本（decent minimum）的服務，這個服務水平要由一個公開和有廣泛公眾參加的醫療配給制度。本文建議香港確立一個這樣的配給制度監按公共醫療服務的增長，並且透過改革收費制度或輕微地增加稅收，便可以在符合社會公義的大前提下解決融資安排問題。本文反對採用強制性儲蓄計劃、保險計劃或保健組織（HMO） 制度對香港的醫療制度進行改革，因為這些供款計劃會帶來不少道德危險問題，有違社會公義。This paper discusses the financial arrangement of the healthcare system and the issues of justice arising from healthcare reform in Hong Kong. The current Hong Kong public healthcare system is quite efficient. The population of Hong Kong has higher life expectancy and lower infant and maternity mortality rates than that of many developed countries, such as the United States. However, the public expenditure in healthcare in Hong Kong only amounts to 2.18% of GDP. This is much lower than most of the developed countries although the per capita income of Hong Kong has surpassed that many industrialized nations, including Canada and Australia. But more than 90% of the hospital services is provided by public hospitals. Moreover, the all-inclusive per diem hospital charge is HK$68 (roughly US$8.5), which only covers 2% of the average cost of a patient day, and so the system is almost universally accessible as well. In fact, since 1974, the government has adopted the policy that no one should be denied adequate medical treatment through lack of means.However, the current system has been under stress mainly for three reasons: (1) aging population, (2) increasing medical expenditure arising from the advancement of medical technology, and (3) rising expectation from the community triggered by the rapid economic development over the past one to two decades. Various proposals have been put forward to reform the healthcare system in Hong Kong so as to make it more financially sustainable in the long term. These proposals include: increase in personal and corporate income tax;increase in the per diem charge of public health care services;mandatory savings scheme;coordinated voluntary or mandatory insurance scheme;health maintenance organization scheme.This paper concedes that healthcare reform is not only a technical issue in financial management, but will have long term impact on the distribution of healthcare benefits and burdens in Hong Kong society. So the problem of justice must be addressed before launching any healthcare reform plan.This paper discusses the major approaches to the justice problem in healthcare financing. The libertarian approach is rejected because the free market mechanism advocated by the approach, such as voluntary insurance schemes, will put the worse off in a vulnerable position. The paper on the one hand agrees with the egalitarian approach that the claims of healthcare needs have their moral force, but on the other hand maintains that the egalitarian approach may overburden the public healthcare system. Based on the ideas of public choice theory and socialized care, it is argued that a just healthcare system needs only to guarantee a decent minimum level of healthcare services for all that is regarded as affordable by the general public.The paper maintains that what constitutes such a level of services should be determined by a rationing system. Various utilitarian approaches to rationing are critically examined. It is found that although these approaches provide useful indices for decision-making in healthcare rationing, none of them could provide a mechanical procedure that could substitute for a fair deliberative process. The paper argues that the decent minimal level of healthcare services guaranteed for all should be determined by an open and a democratic process, and recommends that such a rationing system be set up in Hong Kong.Since various performance indices have shown that the healthcare system in Hong Kong is quite efficient, the claim that the existing system is "on the verge of reaching a crisis situation" is likely to be an exaggeration. Those who uphold this claim tend to support the more radical proposal of introducing various contributory schemes, including proposals (3) - (5), to reform the financial arrangement of the existing healthcare system. The paper rejects this approach, because social justice could be undermined by the moral hazard problems created by these contributory schemes and the government would consequently not be able to uphold the policy already adopted in 1974, which guarantees that no one will be denied adequate medical treatment because of inability to pay.It is believed that the stress of the public healthcare system in Hong Kong can be alleviated to a large extent by setting up an open and a democratic rationing system to monitor the increase of medical costs, a modest increase in service charges, a further improvement in the efficiency of the existing system, and perhaps a small increase in tax rates too. For the sake of justice, as the paper maintains, the government must be very cautious in adopting any more radical reform initiative.DOWNLOAD HISTORY | This article has been downloaded 159 times in Digital Commons before migrating into this platform.