Publication: The Impact of Resource Allocation and Purchasing Reforms on Equity
Date
2004-09
ISSN
Published
2004-09
Author(s)
Belli, Paolo Carlo
Abstract
This paper introduces a conceptual
framework to investigate the equity consequences of resource
allocation, strategic purchasing and payment system reforms
(RAP) in health, and reviews the empirical literature that
has analyzed the impact of these reforms on equity. In the
first part, the paper reviews the existing evidence on the
distribution of health and health care utilization across
socio-economic groups in developing countries. Such evidence
shows a striking consistency in the association between
poverty and poor health, and that the distribution of health
benefits across socio-economic groups is highly unequal,
favoring the wealthier segments of the population. At the
same time it shows that the issue of quality of services is
as important as the issue of their accessibility. Then the
paper addresses the meaning of equity in health care: we
argue that the concept of equity and that of an equitable
distribution of resources in health are not as
straightforward as they appear. In the second part, the
paper reviews the core elements of RAP reforms, and it
presents a survey of the empirical literature that has
investigated the impact of RAP reforms from an equity
perspective. We argue that some RAP reform components, such
as the new resource allocation mechanisms, bear a strong
pro-poor potential, but that other components can lead to
the emergence of trade-offs between conflicting objectives,
such as efficiency and equity. For instance, the new
purchasing contracts and payment systems devised to enhance
efficiency can create adverse equity effects. Conceptually,
these trade-offs are significant and operating at several levels.
Citation
“Belli, Paolo Carlo. 2004. The Impact of Resource Allocation and Purchasing Reforms on Equity. Health, Nutrition and Population (HNP)
discussion paper;. © World Bank, Washington, DC. http://openknowledge.worldbank.org/entities/publication/450c7ccc-526e-54b3-ab9f-4cd9979a9ceb License: CC BY 3.0 IGO.”