Health Policy and Equity of Health Care Financing in <scp>A</scp>ustralia: 1973–2010

Hajizadeh, Mohammad; Connelly, Luke B.; Butler, James R.G.

doi:10.1111/roiw.12103

Cited by 13 publications

(14 citation statements)

References 48 publications

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“…Our study builds on previous research on the redistributive effects of state financing by taxes in general [ 16 – 19 ] and of different financing instruments in the healthcare sector (tax, social health insurance contribution, private health insurance premium, and OOPP) [ 5 – 9 , 20 – 25 ]. The study contributes to the empirical research on the redistributive effects of OOPP in several ways.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, the statistical basis for this evidence is rather old. In a more recent study for Australia covering 1975–2003, Hajiuzabeh, Connelly, and Butler find Kakwani indices for OOPP in a similar range to Austria (between −0.0975 in 2003–2004 and −0.192 in 1988–1989) [ 9 ]. For Hungary, Baji, Pavlova, Gulácsi, and Groot estimate a Kakwani index for total OOPP of −0.22 in 2005–2008 [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…This is especially true if OOPP exceed a substantial threshold and/or push the individual or household below the poverty line [ 3 – 7 ]. In addition, it is well known from the previous empirical literature that major reliance on OOPP is likely to have a regressive impact on income distribution [ 4 – 9 ]. Finally, OOPP act as a barrier for healthcare use and might have negative effects on long-term health status, especially for low-income individuals or households [ 7 , 10 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Out-of-pocket payments in the Austrian healthcare system – a distributional analysis

Sanwald

Theurl

2015

Int J Equity Health

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BackgroundOut-of-pocket spending is an important source of healthcare financing even in countries with established prepaid financing of healthcare. However, out-of-pocket payments (OOPP) may have undesirable effects from an equity perspective. In this study, we analyse the distributive effects of OOPP in Austria based on cross-sectional information from the Austrian Household Budget Survey 2009/10.MethodsWe combine evidence from disaggregated measures (concentration curve and Lorenz curve) and summary indices (Gini coefficient, Kakwani index, and Reynolds–Smolensky index) to demonstrate the distributive effects of total OOPP and their subcomponents. Thereby, we use different specifications of household ability to pay. We follow the Aronson–Johnson–Lampert approach and split the distributive effect into its three components: progressivity, horizontal equity, and reranking.ResultsOOPP in Austria have regressive effects on income distribution. These regressive effects are especially pronounced for the OOPP category prescription fees and over-the-counter pharmaceuticals. Disaggregated evidence shows that the effects differ between income groups. The decomposition analysis reveals a high degree of reranking and horizontal inequity for total OOPP, and particularly, for therapeutic aids and physician services.ConclusionsThe results – especially those for prescription fees and therapeutic aids – are of high relevance for the recent and on-going discussion on the reform of benefit catalogues and cost-sharing schemes in the public health insurance system in Austria.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Out-of-pocket payments in the Austrian healthcare system – a distributional analysis

Sanwald

Theurl

2015

Int J Equity Health

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“…The unfair distribution of OOP payment for healthcare can negatively influence equity in healthcare financing, and this can be measured using the Kakwani progressivity index (KPI), which is one of the most commonly used methods [ 9 , 14 ]. An increase in households’ OOP payment for healthcare services with an increase in income indicates a progressivity in OOP payment and an increase in OOP payment with a reduction in income shows a regressivity in OOP payment for healthcare [ 15 ]. In Iran, there is limited evidence on the trend of equity in healthcare financing.…”

Section: Introductionmentioning

confidence: 99%

Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect

Rezaei

Woldemichael

Ebrahimi

et al. 2020

J. Egypt. Public. Health. Assoc.

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Background Equity in the distribution of health care resources and mitigating the risk of out-of-pocket (OOP) catastrophic healthcare expenditures (CHE) are the major objectives of the health system of a country. This study aims to measure equity in OOP payments for healthcare and the incidence of CHE among Iranian households over time. Methods This retrospective cross-sectional study utilized data extracted from the household income and expenditure survey (HIES) of Iran, collected by the Statistical Center of Iran. The analysis included a total of 174,341 households’ five yearly data of 6 years starting from 1991 to 2017. Kakwani progressivity index (KPI) was used to measure the equity in OOP payment for each year and examine the households’ incidence of CHE at 20%, 30%, and 40% of their capacities to pay (CTP). The trend series regression analysis was used to examine the trend in the KPI and the incidence of the CHE over time. Results The findings indicated that the households’ expenditure on health out of their monthly budgets for the years 1991 and 2017 were 2.1% and 10.1%, respectively. The KPI for the OOP payment was negative for all 6-year observations (1991 = − 0.680; 1996 = − 0.608; 2001 = − 0.554; 2006 = − 0.265; 2011 = − 0.225, and 2017 = − 0.207), indicating that the OOP payments for healthcare are regressive and more concentrated among the socioeconomically disadvantaged households. There was a statistically significant (p = 0.003) increase in the KPI (i.e., decline in the regressivity) over time. The incidence of the CHE (1.12, 1.93, and 3.71%) in 1991 at the CTP levels of 20%, 30%, and 40% was lower than the incidence at the corresponding levels of CTP (5.26, 10.88, and 22.16) in 2017. The findings of the time-series regression indicated a statistically significant (p < 0.05) increase in the incidence of the CHE at the 20%, 30%, and 40% levels of the households’ CTP. Conclusions The current study demonstrated that OOP payment as a source of healthcare funding in Iran is inequitable. While the use of interventions such as the prepaid and publicly funded programs may contribute to the reduction of CHE and improvement of equity in healthcare financing, further inequality analyses in the incidence of the CHE among households and its main determinants can contribute to evidence-informed planning to reduce the CHE in the context.

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“…An appropriate method for determining the progressivity of financing systems is the use of the indicators that represent payments based on the proportion of income [8]. The Kakwani index, which is in fact derived from the difference between the concentration index (inequality in healthcare payments) and the Gini coefficient (income inequality) is used to understand the progressivity (increases in the health payments with increased income) or regressivity (increases in the health payments with reduced income) of the health financing system [9].…”

Section: Introductionmentioning

confidence: 99%

Equity in healthcare financing: a case of Iran

Jalali

Jafari

Bayati

et al. 2019

Int J Equity Health

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Background Fair financial contribution in healthcare financing is one of the main goals and challengeable subjects in the evaluation of world health system functions. This study aimed to investigate the equity in healthcare financing in Shiraz, Iran in 2018. Materials and methods This was a cross- sectional survey conducted on the Shiraz, Iran households. A sample of 740 households (2357 persons) was selected from 11 municipal districts using the multi-stage sampling method (stratified sampling method proportional to size, cluster sampling and systematic random sampling methods). The required data were collected using the Persian format of “World Health Survey” questionnaire. The collected data were analyzed using Stata14.0 and Excel 2007. The Gini coefficient and concentration and Kakwani indices were calculated for health insurance premiums (basic and complementary), inpatient and outpatient services costs, out of pocket payments and, totally, health expenses. Results The Gini coefficient was obtained based on the studied population incomes equal to 0.297. Also, the results revealed that the concentration index and Kakwani index were, respectively, 0.171 and − 0.125 for basic health insurance premiums, 0.259 and − 0.038 for health insurance complementary premiums, 0.198 and − 0.099 for total health insurance premiums, 0.126 and − 0.170 for outpatient services costs, 0.236 and − 0.061 for inpatient services costs, 0.174 and − 0.123 for out of pocket payments (including the sum of costs related to the inpatient and outpatient services) and 0.185 and − 0.112 for the health expenses (including the sum of out of pocket payments and health insurance premiums). Conclusion The results showed that the healthcare financing in Shiraz, Iran was regressive and there was vertical inequity and, accordingly, it is essential to making more efforts in order to implement universal insurance coverage, redistribute incomes in the health sector to support low-income people, strengthening the health insurance schemes, etc.

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Health Policy and Equity of Health Care Financing in Australia: 1973–2010

Cited by 13 publications

References 48 publications

Out-of-pocket payments in the Austrian healthcare system – a distributional analysis

Out-of-pocket payments in the Austrian healthcare system – a distributional analysis

Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect

Equity in healthcare financing: a case of Iran

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