2007年-世界发展银行全球_The_Incidence_of_Public_Spending_on_Healthcare_31页_192kb

Summary of "The Incidence of Public Spending on Healthcare: Comparative Evidence from Asia"

Core Content

This article examines the incidence of public healthcare spending across 11 Asian countries and provinces, analyzing how public healthcare subsidies are distributed in relation to income levels. The study uses concentration curves and dominance tests to assess whether public healthcare spending is propoor (i.e., more concentrated on the poor) or prorich (i.e., more concentrated on the rich), and whether it reduces inequality.

The key focus is on comparing use and subsidy distributions to understand how public spending affects the poor. The authors test the distribution of public healthcare spending against both the Lorenz curve (which represents income distribution) and the 45° line (which represents equal distribution). The findings reveal that in some countries, public healthcare is more targeted to the poor, while in others, it is more concentrated among the rich.

Main Findings

• Public healthcare is prorich in most developing countries, with the exception of Hong Kong SAR, Malaysia, and Thailand, where it is propoor and inequality-reducing.
• The concentration curve is used to visualize the distribution of healthcare use and subsidy across income levels.
• Dominance tests are conducted to determine whether the distribution of healthcare is significantly more or less concentrated on the poor than household consumption.
• In Hong Kong SAR, Malaysia, and Thailand, the total public health subsidy dominates both the Lorenz curve and the 45° line, indicating that these countries have a propoor and inequality-reducing healthcare system.
• In Sri Lanka, the distribution of the total subsidy is not significantly different from equality, suggesting a more balanced approach.
• In Bangladesh, India, Indonesia, and Vietnam, the richest quintile receives more than 30% of the total subsidy, indicating a prorich incidence.
• The poorest quintile receives significantly more subsidy than their share of household consumption in all countries except Nepal, where it is less than 7%.

Key Insights

1. Propoor Incidence and Economic Growth

• Propoor healthcare incidence is more achievable at higher national incomes.
• Economic growth can indirectly increase propoor incidence by raising the demand for private healthcare services among richer individuals, thereby reducing the burden on public healthcare for the poor.
• Limiting user fees or protecting the poor from them is crucial for increasing propoor healthcare spending.

2. Methodological Approach

• The study uses consistent methods across all countries and provinces.
• Unit costs are derived from national health accounts where available, allowing for a more accurate assessment of subsidy incidence.
• Use data and expenditure data are both analyzed, though use data is generally more informative in determining the distribution of public healthcare benefits.

3. Limitations and Assumptions

• Quality differences across facilities and regions are not captured in the data.
• The assumption that quality is not responsive to user payments is untestable, which may lead to overstating the benefits received by the poor, especially in rural areas.
• Waiting and travel time are not valued in the subsidy calculation, which may affect the accuracy of the results.

Differences in Incidence Across Health Services

• Nonhospital care is generally more propoor than hospital care in most countries.
• In Hong Kong SAR, the concentration curve for nonhospital care is the most propoor.
• In Malaysia and Thailand, nonhospital care is the only service where the poorest quintile receives more than 20% of the subsidy.
• In India, the poorest quintile receives significantly more subsidy for nonhospital care than for hospital care.
• Hospital inpatient care is typically prorich, while outpatient care and nonhospital care are more propoor.

Conclusion

The study highlights the uneven distribution of public healthcare spending across Asian countries, with some regions successfully targeting healthcare to the poor and others not. The results suggest that nonhospital care is more effective in achieving propoor distribution, and that economic growth and reduction of user fees are important factors in improving the equity of healthcare access. The use of consistent methods and comparative analysis strengthens the validity of the findings, though limitations in data collection and assumptions about service quality remain.