Benefit Incidence Analysis Are Government Health Expenditures : More Pro-Rich Than We Think?
It is generally accepted that government health expenditures should disproportionately benefit the poor. And yet in most developing countries the opposite is the case. This paper examines the implications of a central assumption of benefit incidenc...
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| Format: | Policy Research Working Paper |
| Language: | English |
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2012
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| Online Access: | http://www-wds.worldbank.org/external/default/main?menuPK=64187510&pagePK=64193027&piPK=64187937&theSitePK=523679&menuPK=64187510&searchMenuPK=64187283&siteName=WDS&entityID=000158349_20100310092201 http://hdl.handle.net/10986/3720 |
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okr-10986-37202021-04-23T14:02:12Z Benefit Incidence Analysis Are Government Health Expenditures : More Pro-Rich Than We Think? Wagstaff, Adam CLINICS DOCTORS GOVERNMENT SPENDING GOVERNMENT SUBSIDIES HEALTH CENTERS HEALTH ECONOMICS HEALTH EXPENDITURES HEALTH FACILITIES HEALTH FINANCING HEALTH INSURANCE HEALTH SECTOR HEALTH SERVICES HEALTH SYSTEMS HOSPITAL CARE HOSPITALS HUMAN DEVELOPMENT INCIDENCE ANALYSIS INCOME INPATIENT CARE INSURANCE LIVING STANDARDS MEDICINES OUTPATIENT CARE PATIENT PATIENTS PRIMARY HEALTH CARE PUBLIC PUBLIC EXPENDITURES PUBLIC HEALTH PUBLIC HEALTH SERVICES PUBLIC PROVIDERS PUBLIC SECTOR PUBLIC SECTOR PROVIDERS PUBLIC SERVICES PUBLIC SPENDING SAFETY NETS SCHOOL HEALTH SCHOOL HEALTH CARE SOCIAL SERVICES WORKERS It is generally accepted that government health expenditures should disproportionately benefit the poor. And yet in most developing countries the opposite is the case. This paper examines the implications of a central assumption of benefit incidence analysis, namely that the unit cost of a government-provided service bears no relation to the out-of-pocket payments paid by the patient. It argues that a more plausible assumption is that larger out-of-pocket payments for a given unit of utilization reflect more (or more costly) services being delivered. The paper compares -- theoretically and empirically -- the standard constant-cost assumption with two alternatives, namely that the cost of care in a specific episode of utilization is (a) proportional to or (b) linearly related to the amount of money paid out-of-pocket by the patient. An interesting special case of the linear relationship is where subsidies are focused on a basic unit of care and additional costs are met dollar-for-dollar by additional fees. The paper shows that if fees are more pro-rich than utilization, government spending will be least pro-rich under the constant-cost assumption and most pro-rich under the proportionality assumption. The linear assumption results in a concentration index for subsidies that lies between these two extremes. These results are borne out in an analysis of the incidence of government health spending in Vietnam (a country where fees are more pro-rich than utilization); indeed, under the constant-cost assumption, subsidies are pro-poor while they are pro-rich under the proportionality assumption. The paper also considers the biases created by not allowing for insurance reimbursements. 2012-03-19T18:38:37Z 2012-03-19T18:38:37Z 2010-03-01 http://www-wds.worldbank.org/external/default/main?menuPK=64187510&pagePK=64193027&piPK=64187937&theSitePK=523679&menuPK=64187510&searchMenuPK=64187283&siteName=WDS&entityID=000158349_20100310092201 http://hdl.handle.net/10986/3720 English Policy Research Working Paper ; No. 5234 CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo World Bank Publications & Research :: Policy Research Working Paper The World Region The World Region |
| repository_type |
Digital Repository |
| institution_category |
Foreign Institution |
| institution |
Digital Repositories |
| building |
World Bank Open Knowledge Repository |
| collection |
World Bank |
| language |
English |
| topic |
CLINICS DOCTORS GOVERNMENT SPENDING GOVERNMENT SUBSIDIES HEALTH CENTERS HEALTH ECONOMICS HEALTH EXPENDITURES HEALTH FACILITIES HEALTH FINANCING HEALTH INSURANCE HEALTH SECTOR HEALTH SERVICES HEALTH SYSTEMS HOSPITAL CARE HOSPITALS HUMAN DEVELOPMENT INCIDENCE ANALYSIS INCOME INPATIENT CARE INSURANCE LIVING STANDARDS MEDICINES OUTPATIENT CARE PATIENT PATIENTS PRIMARY HEALTH CARE PUBLIC PUBLIC EXPENDITURES PUBLIC HEALTH PUBLIC HEALTH SERVICES PUBLIC PROVIDERS PUBLIC SECTOR PUBLIC SECTOR PROVIDERS PUBLIC SERVICES PUBLIC SPENDING SAFETY NETS SCHOOL HEALTH SCHOOL HEALTH CARE SOCIAL SERVICES WORKERS |
| spellingShingle |
CLINICS DOCTORS GOVERNMENT SPENDING GOVERNMENT SUBSIDIES HEALTH CENTERS HEALTH ECONOMICS HEALTH EXPENDITURES HEALTH FACILITIES HEALTH FINANCING HEALTH INSURANCE HEALTH SECTOR HEALTH SERVICES HEALTH SYSTEMS HOSPITAL CARE HOSPITALS HUMAN DEVELOPMENT INCIDENCE ANALYSIS INCOME INPATIENT CARE INSURANCE LIVING STANDARDS MEDICINES OUTPATIENT CARE PATIENT PATIENTS PRIMARY HEALTH CARE PUBLIC PUBLIC EXPENDITURES PUBLIC HEALTH PUBLIC HEALTH SERVICES PUBLIC PROVIDERS PUBLIC SECTOR PUBLIC SECTOR PROVIDERS PUBLIC SERVICES PUBLIC SPENDING SAFETY NETS SCHOOL HEALTH SCHOOL HEALTH CARE SOCIAL SERVICES WORKERS Wagstaff, Adam Benefit Incidence Analysis Are Government Health Expenditures : More Pro-Rich Than We Think? |
| geographic_facet |
The World Region The World Region |
| relation |
Policy Research Working Paper ; No. 5234 |
| description |
It is generally accepted that government
health expenditures should disproportionately benefit the
poor. And yet in most developing countries the opposite is
the case. This paper examines the implications of a central
assumption of benefit incidence analysis, namely that the
unit cost of a government-provided service bears no relation
to the out-of-pocket payments paid by the patient. It argues
that a more plausible assumption is that larger
out-of-pocket payments for a given unit of utilization
reflect more (or more costly) services being delivered. The
paper compares -- theoretically and empirically -- the
standard constant-cost assumption with two alternatives,
namely that the cost of care in a specific episode of
utilization is (a) proportional to or (b) linearly related
to the amount of money paid out-of-pocket by the patient. An
interesting special case of the linear relationship is where
subsidies are focused on a basic unit of care and additional
costs are met dollar-for-dollar by additional fees. The
paper shows that if fees are more pro-rich than utilization,
government spending will be least pro-rich under the
constant-cost assumption and most pro-rich under the
proportionality assumption. The linear assumption results in
a concentration index for subsidies that lies between these
two extremes. These results are borne out in an analysis of
the incidence of government health spending in Vietnam (a
country where fees are more pro-rich than utilization);
indeed, under the constant-cost assumption, subsidies are
pro-poor while they are pro-rich under the proportionality
assumption. The paper also considers the biases created by
not allowing for insurance reimbursements. |
| format |
Publications & Research :: Policy Research Working Paper |
| author |
Wagstaff, Adam |
| author_facet |
Wagstaff, Adam |
| author_sort |
Wagstaff, Adam |
| title |
Benefit Incidence Analysis Are Government Health Expenditures : More Pro-Rich Than We Think? |
| title_short |
Benefit Incidence Analysis Are Government Health Expenditures : More Pro-Rich Than We Think? |
| title_full |
Benefit Incidence Analysis Are Government Health Expenditures : More Pro-Rich Than We Think? |
| title_fullStr |
Benefit Incidence Analysis Are Government Health Expenditures : More Pro-Rich Than We Think? |
| title_full_unstemmed |
Benefit Incidence Analysis Are Government Health Expenditures : More Pro-Rich Than We Think? |
| title_sort |
benefit incidence analysis are government health expenditures : more pro-rich than we think? |
| publishDate |
2012 |
| url |
http://www-wds.worldbank.org/external/default/main?menuPK=64187510&pagePK=64193027&piPK=64187937&theSitePK=523679&menuPK=64187510&searchMenuPK=64187283&siteName=WDS&entityID=000158349_20100310092201 http://hdl.handle.net/10986/3720 |
| _version_ |
1764387989232812032 |