Methods to promote equity in health resource allocation in low- and middle-income countries: an overview

Abstract

Unfair differences in healthcare access, utilisation, quality or health outcomes exist between and within countries around the world. Improving health equity is a stated objective for many governments and international organizations. We provide an overview of the major tools that have been developed to measure, evaluate and promote health equity, along with the data required to operationalise them. Methods are organised into four key policy questions facing decision-makers: (i) what is the current level of inequity in health; (ii) does government health expenditure benefit the worst-off; (iii) can government health expenditure more effectively promote equity; and (iv) which interventions provide the best value for money in reducing inequity. Benefit incidence analysis can be used to estimate the distribution of current public health sector expenditure, with geographical resource allocation formulae and health system reform being the main government policy levers for improving equity. Techniques from the economic evaluation literature, such as extended and distributional costeffectiveness analysis can be used to identify 'best buy' interventions from a health equity perspective. A range of inequality metrics, from gap measures and slope indices to concentration indices and regression analysis, can be applied to these approaches to evaluate changes in equity. Methods from the economics literature can provide policymakers with a toolkit for addressing multiple aspects of health equity, from outcomes to financial protection, and can be adapted to accommodate data commonly available in low-and middle-income settings.

Call for Action to Address Equity and Justice Divide During COVID-19

“…The social and economic determinants of health mediate the impact of crises such as a pandemic (41)(42)(43)(44)(45)143). Factors related to individual socioeconomic status, underlying morbidity and external factors such as diminishing access to healthcare and justice systems could deepen the inequity and injustice divide during and beyond the COVID-19 era (13,131,141). Factors such as universal health care access, provision of education for all, protection from disasters including caused by pandemics and climate change, justice to all, and equality in opportunity affect how communities and nations respond and cope with the crisis (51,131).…”

“…These systems provide “safety nets” to the most vulnerable communities in hours of crisis. A more equitable allocation of funds for the improvement of primary healthcare in all countries across the globe is the need of the hour ( 141 ). The doctor-patient ratio has to be improved to provide a uniform distribution of healthcare to remote locations and lower socioeconomic status ( 142 ).…”

A Multi-Stage Stochastic Programming Approach to Epidemic Resource Allocation with Equity Considerations

“…Among the most commonly-used equity measures are the sum of absolute deviations (SAD), the mean absolute deviation (MAD), the minimum effect (ME), and the Gini coefficient (GC). Love-Koh et al (2020) categorize methods used to define equity measures into five: 1) gap measures, regression-based measures, Lorenz and concentration curves, measures incorporating inequality aversion, and health-related social welfare. The equity measures defined by absolute and relative gaps are commonly used by international agencies, such as the WHO, to distribute resources, such as vaccines and medical treatment, between population groups in low- and middle-income countries (Casey et al, 2017).…”

Does Descending Health Resources Reform Impact Patient Low-level Hospital Selection Behavior? Evidence from Zhejiang, China

“…Different from reforms in developing countries, which focus on designing different health resource formulae and financing mechanisms [26] , China's descending resources reform is paving a new way to correct the uneven allocation of health resources. The contribution of this paper is to explore this reform's effect on patient hospital-selection behavior using a SEM model.…”