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ppt课件-poverty,equityandhealthlinkingresearchandpolicy
Equity in health and health care:lessons from an Asian comparative study Eddy van Doorslaer Erasmus School of Economics Erasmus Medical Centre Rotterdam Merck Foundation Lecture London School of Economics, 16 March 2007 Introduction - background Inequality and inequity in the distribution of Health Health care Health care payments Some analogies with measurement of income inequality, but not perfect Approaches to study equity in health care finance and delivery in high-income (EU/OECD) countries, developed in ECuity Project Usefulness for low-to-middle income countries, examined in EQUITAP Project (Asian-Pacific) Draws on several papers Van Doorslaer, E, O O’Donnell, R Rannan-Eliya et al (20 authors) Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data, The Lancet, 2006, 368, Dec O’Donnell, O, E van Doorslaer, R Rannan-Eliya et al (18 authors) The incidence of public spending on health care: comparative evidence from Asia, World Bank Economic Review, (Published online, Jan 2007) Van Doorslaer, E, O O’Donnell, R Rannan-Eliya et al (23 authors) Catastrophic expenditures on health care in Asia, Health Economics, (Published online, Feb 2007) I. Distribution of health care payments In OECD context: mostly publicly financed health care systems with universal coverage have disconnected receipt of care from payment for care Payments according to ability to pay Tools of progressivity and redistribution can be used to examine health payments by income Descriptive x-country comparative results informative on potential consequences of alternative health care financing choices E.g out-of-pocket payments most regressive source The health care financing triangle - OECD(Wagstaff, Van Doorslaer et al, JHE, 1999) Overall progressivity hc finance — OECD(Wagstaff, Van Doorslaer et al, JHE, 1999) Distribution of health care finance In low-income settings: high shares of out-of-pocket spending, small pre-pai
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