Publication: The Impact of Resource Allocation and Purchasing Reforms on Equity
Loading...
Published
2004-09
ISSN
Date
2013-06-04
Author(s)
Editor(s)
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.
Link to Data Set
Citation
“Belli, Paolo Carlo. 2004. The Impact of Resource Allocation and Purchasing Reforms on Equity. Health, Nutrition and Population (HNP)
discussion paper;. © World Bank. http://hdl.handle.net/10986/13739 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Related items
Showing items related by metadata.
Publication PNG Health Workforce Crisis(Washington, DC, 2011-10)This report documents for the first time in over a decade the current stock of the publicly financed health workforce in PNG and their characteristics and deployment across the country by type of health facility and health cadre. It also documents the capacity of the health-related training institutions and presents the results of an important survey of health training institutions which enable unit costs, staffing and other aspects of the institutions to be analyzed together with a qualitative assessment of the quality of students and of facilities by training school principals. The report presents a set of five demand scenarios and draws out the implications for the health training system and of the health budget for these scenarios. The National Health Plan 2011-2020 (NHP) recognizes that the emerging crisis in the health human resources area is a critical issue confronting any viable strategy designed to implement the objectives it has set for the health sector. This report helps document the nature of this emerging crisis and makes specific recommendations on the way forward.Publication Health Equity and Financial Protection in Zambia(Washington, DC, 2012-05-21)This report analyzes equity and financial protection in the health sector of Zambia. In particular, it examines inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. Data are drawn from the 2007 Zambia demographic and health survey, the 2006 Zambia living conditions monitoring survey, the 2003 Zambia world health survey and the 2003 Zambia national health accounts. All analyses are conducted using original survey data and employ the health modules of the ADePT software. Overall, health care financing in Zambia in 2006 was fairly progressive, i.e. the better-off spent a larger fraction of their consumption on health care than the poor. The financing sources that contribute to the overall progressivity of health care finance are general taxation, which finances 42 per cent of domestic spending on health, and contributions made by private employers, which finance 9 per cent of spending. An additional contribution to overall progressivity is made through pre-payment mechanisms, but this remains fairly limited given that they only represent 1 per cent of total health finance. Out-of-pocket health payments, which account for 47 per cent of total health financing, appear to be proportional to income, with only slight and not statistically significant evidence of progressivity.Publication Health Equity and Financial Protection Report(Washington, DC, 2012-07-23)The health equity and financial protection reports are short country-specific volumes that provide a picture of equity and financial protection in the health sectors of low- and middle-income countries. Topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. This report analyses equity and financial protection in the health sector of Mongolia. In particular, it examines inequalities in health outcomes and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. Data are drawn from the 2005 Mongolia multiple indicator cluster survey and the 2007-08 Mongolia household socio-economic survey.Publication Health Equity and Financial Protection in Ghana(Washington, DC, 2012-05-21)The health equity and financial protection reports are short country-specific volumes that provide a picture of equity and financial protection in the health sectors of low-and middle-income countries. Topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. Ghana's government is committed to improving equity and financial protection in the health sector. In 2005, the Government of Ghana amended its growth and poverty reduction strategy report to include a new target in the country's development: to reach middle income status by the year 2015 (Republic of Ghana 2005). Ghana's Minister of health has called attention to the role that health plays in economic development and has placed equity in both access and delivery of health services as a top priority for reaching middle income status (Ministry of health 2007). Ghana spends 8.1 per cent (2009) of its gross domestic product (GDP) on health. This is greater than the spending levels in other lower middle-income countries in Africa, which spend an average of 5.8 per cent (2009) of their GDP on health. Ghana provides free health services for certain vulnerable groups, such as children under five, people over 70, and pregnant women. In addition, immunization and services to combat certain communicable diseases are provided free of charge.Publication Health Equity and Financial Protection in Vietnam(Washington, DC, 2012-05-18)This report analyzes equity and financial protection in the health sector of Vietnam. In particular, it examines inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. Data are drawn from the 1992-93 and 1997-98 Vietnam living standards survey, the 2002, 2004, 2006, and 2008 Vietnam household and living standards survey, the 2002 Vietnam demographic and health survey, the 2002 Vietnam world health survey, the 2006 Vietnam multiple indicator cluster survey and the 2006 Vietnam national health accounts. All analyses are conducted using original survey data and employ the health modules of the ADePT software. Overall, health care financing in Vietnam in 2006 was fairly progressive, i.e. the better-off spent a larger fraction of their consumption on health care than the poor. The financing sources that contribute to the overall progressivity of health care finance are general taxation, which finances 27 per cent of domestic spending on health, and out-of-pocket payments, which finance 55 per cent of spending. The most progressive source of health finance is actually Social Health Insurance (SHI) contributions, which is unsurprising given that they are paid largely by formal sector workers who are among the better-off; however, SHI contributions finance just 13 per cent of health spending. Voluntary insurance is mildly regressive, but this finances an even smaller share of total health spending.
Users also downloaded
Showing related downloaded files
Publication Digital Africa(Washington, DC: World Bank, 2023-03-13)All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.Publication Electrification and Household Welfare(World Bank, Washington, DC, 2018-09)As many as 50 million people in Pakistan may still live without connection to the electric grid. Pakistan also has some of the world's worst power outages. Using data from a nationally representative two-period panel survey, this paper presents the first empirical evidence on the cost of unreliable electricity supply to households in Pakistan. The results show that lack of connectivity and poor reliability may be costing the country at least $4.5 billion (1.7 percent of gross domestic product) a year. Addressing the problem requires energy sector reforms to correct regulatory and institutional distortions in the gas and electricity sectors.Publication Nepal Infrastructure Sector Assessment(World Bank, Washington, DC, 2019-02-28)Despite several severe shocks in the past, conflict, unstable governments, earthquakes, and trade disruptions, Nepal has made strong progress in reducing poverty and boosting shared prosperity. With the decade-long peace and constitutional process concluded, the Government of Nepal is keen to accelerate economic growth and become a middle-income country by 2030. Between 1996 and 2011, the proportion of households living in extreme poverty fell from 46 to 15 percent. Nepal's macroeconomic fundamentals have remained sound. This report takes place as Nepal transitions to a federal structure. This poses a unique and unprecedented opportunity to establish clarity of functions, expenditures, and revenue assignments, as well as changing jurisdictions across various levels of governments and agencies, including as they interface with the private sector. The new government is in place and emphasizing the need for stronger cooperation between the public and private sectors. Against this background, this report assesses the energy (electricity generation, transmission, and distribution), transport (roads, airports, and urban transport), and urban (water supply, sanitation, and solid waste management) infrastructure sectors. The report recommends interventions that combine short-term and longer-term structural and policy changes with tailored project implementation approaches. Completing projects will help stress test the framework and system and identify potential bottlenecks that can be corrected. Such a learning-by-doing approach will further help prioritize the implementation of the initiatives proposed in this report and target capacity development initiatives in the areas of greatest need.Publication Cybersecurity Economics for Emerging Markets(Washington, DC: World Bank, 2024-09-17)In our increasingly interconnected world, where digital technologies are rapidly transforming multiple aspects of daily life, the critical role of cybersecurity cannot be overstated, especially in developing nations. As these countries strive to harness the power of modern technology to drive economic growth, enhance public services, and elevate living standards, they concurrently face heightened risks associated with cyber threats. The increasing exposure of developing countries to cyber incidents is often compounded by various factors, including scarce resources, inadequate infrastructure, political unrest, inefficiencies in cybersecurity and technology markets, shortages of skilled cybersecurity professionals, legislative voids, and rapid rates of digital adoption. "Cybersecurity Economics for Emerging Markets" is a pioneering research work that delves into the drivers and profound consequences of cyber incidents worldwide. From economic setbacks that can destabilize entire economies to interruptions of vital services and impediments to social and economic development, the impacts of cyber incidents are far-reaching. This book analyzes hundreds of scholarly works and thousands of publicly disclosed cyber incidents over the past decade across some 190 countries. It sheds light on these incidents’ characteristics and trends, as well as the proactive roles that private market players and governments can assume to safeguard infrastructure in cyberspace effectively. The book presents practical, evidence-based policy suggestions that include efforts to strengthen the resilience of the most essential and interconnected sectors. It advocates for bolstering the national cybersecurity industries, strategizing cybersecurity research and development, addressing market failures through cybersecurity awareness and training programs, and taking proactive steps to reduce and control contagion effects from cyber incidents. By revealing crucial empirical and theoretical dimensions of cybersecurity economics, this book provides insights that could inform the creation of effective cybersecurity investments, with a focus on developing countries. These insights are invaluable for policy makers and stakeholders committed to fortifying the digital ecosystem against the ever-evolving landscape of cyber threats.Publication World Development Report 2004(World Bank, 2003)Too often, services fail poor people in access, in quality, and in affordability. But the fact that there are striking examples where basic services such as water, sanitation, health, education, and electricity do work for poor people means that governments and citizens can do a better job of providing them. Learning from success and understanding the sources of failure, this year’s World Development Report, argues that services can be improved by putting poor people at the center of service provision. How? By enabling the poor to monitor and discipline service providers, by amplifying their voice in policymaking, and by strengthening the incentives for providers to serve the poor. Freedom from illness and freedom from illiteracy are two of the most important ways poor people can escape from poverty. To achieve these goals, economic growth and financial resources are of course necessary, but they are not enough. The World Development Report provides a practical framework for making the services that contribute to human development work for poor people. With this framework, citizens, governments, and donors can take action and accelerate progress toward the common objective of poverty reduction, as specified in the Millennium Development Goals.