Benefit Incidence Analysis Are Government Health Expenditures : More Pro-Rich Than We Think?

Wagstaff, Adam

关键词: CLINICS;    DOCTORS;    GOVERNMENT SPENDING;    GOVERNMENT SUBSIDIES;    HEALTH CENTERS;   

DOI  :  10.1596/1813-9450-5234
RP-ID  :  WPS5234

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

It is generally accepted that governmenthealth expenditures should disproportionately benefit thepoor. And yet in most developing countries the opposite isthe case. This paper examines the implications of a centralassumption of benefit incidence analysis, namely that theunit cost of a government-provided service bears no relationto the out-of-pocket payments paid by the patient. It arguesthat a more plausible assumption is that largerout-of-pocket payments for a given unit of utilizationreflect more (or more costly) services being delivered. Thepaper compares -- theoretically and empirically -- thestandard constant-cost assumption with two alternatives,namely that the cost of care in a specific episode ofutilization is (a) proportional to or (b) linearly relatedto the amount of money paid out-of-pocket by the patient. Aninteresting special case of the linear relationship is wheresubsidies are focused on a basic unit of care and additionalcosts are met dollar-for-dollar by additional fees. Thepaper shows that if fees are more pro-rich than utilization,government spending will be least pro-rich under theconstant-cost assumption and most pro-rich under theproportionality assumption. The linear assumption results ina concentration index for subsidies that lies between thesetwo extremes. These results are borne out in an analysis ofthe incidence of government health spending in Vietnam (acountry where fees are more pro-rich than utilization);indeed, under the constant-cost assumption, subsidies arepro-poor while they are pro-rich under the proportionalityassumption. The paper also considers the biases created bynot allowing for insurance reimbursements.