Person:
Wagstaff, Adam
Author Name Variants
Fields of Specialization
Health Economics (health financing, health insurance, health and poverty, health equity, health system reform, hospitals),
Income Distribution and Redistribution,
Bibliometrics,
Asia (China, Vietnam, India)
Degrees
ORCID
External Links
Departments
Development Research Group
Externally Hosted Work
Contact Information
Last updated
February 1, 2023
Biography
Adam Wagstaff was Research Manager in the Development Research Group (Human Development) from 2009 until his passing in May 2020. His DPhil in economics was from the University of York and, before joining the Bank, he was a Professor of Economics at the University of Sussex. He was an associate editor of the Journal of Health Economics for 20 years and published extensively on a variety of aspects of the field, including health financing and health systems reform; health, equity and poverty; the valuation of health; the demand for and production of health; efficiency measurement; and illicit drugs and drug enforcement. Much of his recent work had been on health insurance, health financing, vulnerability and health shocks, and provider payment reform. He had extensive experience of China and Vietnam but also worked on countries in Africa, Latin America, South Asia, and Europe and Central Asia, as well as other countries in East Asia. Outside health economics, he published on efficiency measurement in the public sector, the measurement of trade union power, the redistributive effect and sources of progressivity of the personal income tax, and the redistributive effect of economic growth.
Publication Search Results
1 - 10 of 93
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Research on Equity, Poverty and Health Outcomes : Lessons for the Developing World
(World Bank, Washington, DC, 2000-10)This paper provides a selective survey of the literature to date on poverty, equity and health outcomes. It begins with an overview of the methods that can be used to measure poor/non-poor inequalities in health outcomes, and then reviews the evidence on the extent of these inequalities in low and middle-income countries (LMICs). The data presented relate mostly to children, but some results are also presented on adults. The paper then presents a conceptual framework for understanding the causes of poor/non-poor inequalities in health outcomes, distinguishing between the effects of inequalities in the proximate determinants of health, and inequalities in the socioeconomic or underlying determinants. The paper goes on to review the evidence on what these determinants are, and how far inequalities in them appear to explain inequalities in health outcomes. The final part of the paper examines the influence of policies and programs on inequalities in health outcomes, reviewing both studies that shed light on the effects of broad policies. -
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Inequalitites in Child Health : Are We Narrowing the Gap?
( 2003-05)This paper reviews what is known about the causes of socioeconomic inequalities in child health and thus the points where programs aimed at reducing child health inequalities should be focused. The proximate determinants affect child health directly and include food and nutrition, indoor air pollution, hygiene and other preventive activities, and care during illness. The underlying determinants affect outcomes indirectly through their effect on the proximate determinants, and include financial barriers, health care provision, maternal education, and water, sanitation and the home environment. The authors review the socioeconomic distribution of both determinants and find that for most determinants, poor children fare significantly worse than their better-off peers. We also overview what is known about the success of actual programs in narrowing socioeconomic inequalities in child health. The paper ends with lessons learned and with a call for action - for a new approach to improving the health of all children that is evidence-based, broad, and multifaceted, and for the development of better evidence on how programs can reduce child health inequalities. -
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Inequality Aversion, Health Inequalities, and Health Achievement
(World Bank, Washington, DC, 2002-01)The author addresses two issues. First, how can health inequalities be measured so as to take into account policymakers' attitudes toward inequality? The Gini coefficient and the related concentration index embody one particular set of value judgments. Generalizing these indexes allows alternative sets of value judgments to be reflected. And second, how can information on health inequality be combined with information on the mean of the relevant distribution to obtain an overall measure of health "achievement?" Applying the approach developed by Wagstaff shows how much worse some countries perform when the focus switches from average health to an achievement index that also reflects the health gap between the poor and the better-off. -
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Poverty and Survival Prospects of Vietnamese Children under Doi Moi
(World Bank, Washington, D.C., 2002-04)By international standards, and given its relatively low per capita income, Vietnam has achieved substantial reductions in, and low levels of, infant and under-five mortality. The authors review existing evidence and provide new evidence on whether, under the economic liberalization program known as Doi Moi, this reduction in child mortality has been sustained. They conclude that it has, but that the gains have been concentrated among the better-off. As a result, socioeconomic inequalities in child survival are evident in Vietnam-a change from the early 1990s when none were apparent. The authors develop survival models to find the causes of this differential decline in child mortality, and conclude that a number of factors have been at work, including reductions among the poor (but not among the better-off) in coverage of health services and in women's educational attainment. They argue that if the experience of the late 1990s is a guide to the future, the lack of progress among the poor will jeopardize Vietnam's chances of achieving the international development goals for child mortality. The authors examine various policy scenarios, including expanding coverage of health services, water and sanitation, and find that such measures, while useful, will have only a limited effect on the mortality of poor children. They find that programs aimed at narrowing the gap between the poor and better-off may have large beneficial effects on the various determinants of child survival. -
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Inequalities in Health in Developing Countries: Swimming Against the Tide?
(World Bank, Washington, D.C, 2002-02)Inequalities in health have recently started to receive a good deal of attention in the developing world. But how large are they? An how large are the differences across countries? Recent data from a 42-country study, show large, but varying inequalities in health across countries. The author explores the reasons for these inter-country differences, and concludes that large inequalities in health, are not apparently associated with large inequalities in income, or with small shares of publicly financed health spending. But they are associated with higher per capita incomes. Evidence from trends in health inequalities - in both the developing, and the industrial world - supports the notion that health inequalities rise with rising per capita incomes. The association between health inequalities, and per capita incomes is probably due in part, to technological change going hand-in-hand with economic growth, coupled with a tendency for the better-off to assimilate new technology ahead of the poor. Since increased health inequalities, associated with rising per capita incomes is a bad thing, and increased average health levels associated with rising incomes are a good thing, the author outlines a way of quantifying the tradeoff between health inequalities, and health levels. He also suggests that successful anti-inequality policies can be devised, but that their success cannot be established simply by looking at "headline" health inequality figures, since these reflect the effects of differences, and changes in other variables, including per capita income. The author identifies four approaches that can shed light on the impacts of anti-inequality policies on health inequalities: cross-country comparative studies, country-based before-and-after studies with controls, benefit-incidence analysis, and decomposition analysis. The results of studies based on these four approaches do not give as many clear-cut answers as one might like on how best to swim against the tide of rising per capita incomes, and their apparent inequality-increasing effects. But they ought at least to help us build our stock of knowledge on the subject. -
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Correcting the Concentration Index : A Comment
( 2009)In a recent article in this journal, Erreygers [Erreygers, G., 2008. Correcting the concentration index. Journal of Health Economics] has proposed a new measure of income-related health inequality to overcome three shortcomings of the concentration index (CI). I think Erreygers is absolutely right to probe on these issues, and I welcome his generalization of my normalization which was specific to the case of a binary health indicator. However, I have misgivings about his paper. His goal of correcting the CI so as to make it usable with interval-scale variables seems misguided. The CI reflects a commitment on the part of the analyst to measuring relative inequality. Armed only with an interval-scale variable, one simply has to accept that one can meaningfully measure only differences and therefore settle for measuring absolute inequality. Erreygers, index inevitably ends up as a measure of absolute inequality. His objection to my approach to getting round the bounds problem is that my normalization of the CI does not produce a measure of absolute inequality. But that was never my intention! In this comment I also show that--somewhat paradoxically at first glance--my index is also not a pure index of relative inequality. This seems to be an inevitable consequence of tackling the bounds issue. -
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The Millennium Development Goals for Health : Rising to the Challenges
(Washington, DC: World Bank, 2004)The extent of premature death and ill health in the developing world is staggering. In 2000 almost 11 million children died before their fifth birthday, an estimated 140 million children under five are underweight, 3 million died from HIV/AIDS, tuberculosis claimed another 2 million lives, and 515,000 women died during pregnancy or child birth in 1995, almost all of them in the developing world. Death and ill health on such a scale are matters of concern in their own right. They are also a brake on economic development. These concerns led the international community to put health at the center of the Millennium Development Goals when adopting them at the Millennium Summit in September 2000. This report focuses on the health and nutrition Millennium Development Goals agreed to by over 180 governments. It assesses progress to date and prospects of achieving the goals. The report identifies what developing country governments can do to accelerate the pace of progress while ensuring that benefits accrue to the poorest and most disadvantaged households. It also pulls together the lessons of development assistance and country initiatives and innovations to improve the effectiveness of aid, based on a number of country case studies. It highlights some of the principles of effective development assistance: country driven coordination; strategic coherence expressed in comprehensive poverty reduction strategies, which fully address the issues of health, nutrition, and population; financial coherence embodied in medium term expenditure framework; pooling of donor funds; and a common framework for reporting and assessing progress. -
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Better Health Systems for India's Poor : Findings, Analysis, and Options
(Washington, DC: World Bank, 2002)This report focuses on four areas of the health system in which reforms, and innovations would make the most difference to the future of the Indian health system: oversight, public health service delivery, ambulatory curative care, and inpatient care (together with health insurance). Part 1 of the report contains four chapters that discuss current conditions, and policy options. Part 2 presents the theory, and evidence to support the policy choices. The general reader may be most interested in the overview chapter, and in the highlights found at the beginning of each of the chapters in part 2. These highlights outline the empirical findings, and the main policy challenges discussed in the chapter. The report does not set out to prescribe detailed answers for India's future health system. It does however, have a goal: to support informed debate, and consensus building, and to help shape a health system that continually strives to be more effective, equitable, efficient, and accountable to the Indian people, and particularly to the poor. -
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Getting Incentives Right : An Impact Evaluation of District Hospital Capitation Payment in Vietnam
(World Bank, Washington, DC, 2013-11)With the movement toward universal health coverage gaining momentum, the global health research community has made significant efforts to advance knowledge about the impact of various schemes to expand population coverage. The impacts on efficiency, quality, and gaps in service utilization of reforms to provider payment methods are less well studied and understood. The current paper contributes to this limited knowledge by evaluating the impact of a shift by Vietnam's social health insurance agency from reimbursing hospitals on a fee-for-service basis to making a capitation payment to the district hospital where the enrollee lives. The analysis uses panel data on hospitals over the period 2005-2011 and multiple cross-section data sets from the Vietnam Household Living Standards Surveys to estimate impacts on efficiency, quality, and equity. The paper finds that capitation increases hospitals' efficiency, as measured by recurrent expenditure and drug expenditure per case, but has no effect on surgery complication rates or in-hospital deaths. In response to the shift to capitation, hospitals scaled down service provision to the insured and increased provision to the uninsured (who continue to pay out-of-pocket on a fee-for-service basis). The study points to the need to anticipate the intended and unintended effects of any payment reform and the trade-offs among policy objectives. -
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Extending Health Insurance to the Rural Population : An Impact Evaluation of China's New Cooperative Medical Scheme
( 2009)In 2003, China launched a heavily subsidized voluntary health insurance program for rural residents. We combine differences-in-differences with matching methods to obtain impact estimates, using data collected from program administrators, health facilities and households. The scheme has increased outpatient and inpatient utilization, and has reduced the cost of deliveries. But it has not reduced out-of-pocket expenses per outpatient visit or inpatient spell. Out-of-pocket payments overall have not been reduced. We find heterogeneity across income groups and implementing counties. The program has increased ownership of expensive equipment among central township health centers but has had no impact on cost per case.