Marginal benefit incidence of public health spending: Evidence from Indonesian sub-national data

Kruse, Ioana; Pradhan, Menno; Sparrow, Robert

doi:10.1016/j.jhealeco.2011.09.003

Cited by 33 publications

(17 citation statements)

References 13 publications

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“…After decentralization, increased fiscal independence at the district level was recognized in the majority of districts across Indonesia. 49,50 The increase allowed DHO to manage their spending and prioritize according to their local health needs. However, in Bantul, Mataram, Kutai Kartanegara, and Ngada districts, budget constraints were more common after decentralization than before, due to public health budget reduction.…”

Section: Who Building Block: Financingmentioning

confidence: 99%

District‐level impacts of health system decentralization in Indonesia: A systematic review

Rakmawati

Hinchcliff

Pardosi

2019

Health Planning & Management

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Summary The local‐level impacts of decentralizing national health systems are significant yet infrequently examined. This review aims to assess whether localized health services delivery in Indonesia, which commenced a health system decentralization process in 2001, achieved its objectives or could be enhanced. A systematic review was undertaken to collate published evidence regarding this topic and synthesize key findings holistically using the six building blocks framework of the World Health Organization (WHO) to categorize health system performance. Four research databases were searched in 2016 for relevant evidence published between 2001 and 2015. The inclusion criteria were relevance to the topic of decentralization impacts at the district level, original research, and published in English. Included articles were appraised for quality using a standardized tool, with key findings synthesized using the WHO building blocks. Twenty‐nine articles met the inclusion criteria and categorized under the WHO building blocks categories. The findings highlight problematic impacts of decentralization related to three building blocks: service delivery, health financing, and workforce. In the 15 years of post‐decentralization in Indonesia, the service delivery, health workforce, and health financing blocks should be prioritized for further research and policy evaluation to improve the overall health system performance at the district level.

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Section: Who Building Block: Financingmentioning

confidence: 99%

District‐level impacts of health system decentralization in Indonesia: A systematic review

Rakmawati

Hinchcliff

Pardosi

2019

Health Planning & Management

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“…It generally examines only health care consumption and coverage rather than health outcomes, and looks at the average benefits of current expenditure rather than the marginal benefits of potential future changes in expenditure. Some recent benefit incidence analyses, however, have used data on subnational variation and change in expenditure and outcomes to estimate the health outcomes of marginal changes in spending in a way that could be used more directly to inform priority setting [44].…”

Section: Equity Impact Analysismentioning

confidence: 99%

Using Cost-Effectiveness Analysis to Address Health Equity Concerns

et al. 2017

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This articles serves as a guide to using cost-effectiveness analysis (CEA) to address health equity concerns. We first introduce the "equity impact plane," a tool for considering trade-offs between improving total health—the objective underpinning conventional CEA—and equity objectives, such as reducing social inequality in health or prioritizing the severely ill. Improving total health may clash with reducing social inequality in health, for example, when effective delivery of services to disadvantaged communities requires additional costs. Who gains and who loses from a cost-increasing health program depends on differences among people in terms of health risks, uptake, quality, adherence, capacity to benefit, and—crucially—who bears the opportunity costs of diverting scarce resources from other uses. We describe two main ways of using CEA to address health equity concerns: 1) equity impact analysis, which quantifies the distribution of costs and effects by equity-relevant variables, such as socioeconomic status, location, ethnicity, sex, and severity of illness; and 2) equity trade-off analysis, which quantifies trade-offs between improving total health and other equity objectives. One way to analyze equity trade-offs is to count the cost of fairer but less cost-effective options in terms of health forgone. Another method is to explore how much concern for equity is required to choose fairer but less cost-effective options using equity weights or parameters. We hope this article will help the health technology assessment community navigate the practical options now available for conducting equity-informative CEA that gives policymakers a better understanding of equity impacts and trade-offs.

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“…There are studies, such as those by Chakraborty, Singh, and Jacob (2013) for India; and Kruse, Pradhan, and Sparrow (2012) for Indonesia, that examine the distribution of benefits from public health spending, by income groups in general, or from health-care financing reforms. Examining both inpatient and outpatient health services, Chakraborty, Singh, and Jacob (2013) found that India's public health expenditure tends to be inequitable.…”

Section: Public Spending On Health Carementioning

confidence: 99%

“…The poorest quintile captured around 9% of the total net public expenditure in the health sector, while the richest group got around 40%. On the other hand, for Indonesia, Kruse, Pradhan, and Sparrow (2012) found that the health system tends to be pro-poor as increased local public health spending led to net transfers from the richest to the poorest quarter of the population, which increased public health-care utilization by the poor and average health benefits. Given initial utilization shares, however, the bulk of the benefits were still captured by the middle-income groups; thus, it was recommended that increased public health spending be complemented by more directly targeted demand-side interventions for the poor, such as price subsidies or social health insurance.…”

Section: Public Spending On Health Carementioning

confidence: 99%

Fiscal Policy for Inclusive Growth: An Overview

2014

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Marginal benefit incidence of public health spending: Evidence from Indonesian sub-national data

Cited by 33 publications

References 13 publications

District‐level impacts of health system decentralization in Indonesia: A systematic review

District‐level impacts of health system decentralization in Indonesia: A systematic review

Using Cost-Effectiveness Analysis to Address Health Equity Concerns

Fiscal Policy for Inclusive Growth: An Overview

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