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- Title
Reflections on and alternatives to WHO's fairness of financial contribution index.
- Authors
Wagstaff, Adam
- Abstract
In its 2000 World Health Report (WHR), the World Health Organization argues that a key dimension of a health system's performance is the fairness of its financing system. This paper provides a critical assessment of the index of fairness of financial contribution (FFC) proposed in the WHR. It shows that the index cannot discriminate between health financing systems that are regressive and those that are progressive, and cannot discriminate between horizontal inequity on the one hand, and progressivity and regressivity on the other. The paper compares the WHO index to an alternative and more illuminating approach developed in the income redistribution literature in the early 1990s and used in the late 1990s to study the fairness of various OECD countries' health financing systems. It ends with an illustrative empirical comparison of the two approaches using data on out-of-pocket payments for health services in Vietnam for two years - 1993 and 1998. This analysis is of some interest in its own right, given the large share of health spending from out-of-pocket payments in Vietnam, and the changes in fees and drug prices over the 1990s.
- Subjects
VIETNAM; WORLD Health Organization; PUBLIC health; MEDICAL care costs; INCOME redistribution; DRUGS; MEDICAL care cost statistics; ABSTRACTING &; indexing services; COMPARATIVE studies; ECONOMICS; FAMILIES; HEALTH services accessibility; INCOME; MASS media; RESEARCH methodology; MEDICAL care research; MEDICAL cooperation; RESEARCH; SOCIAL justice; WORLD health; SOCIOECONOMIC factors; EVALUATION research; STATISTICAL models
- Publication
Health Economics, 2002, Vol 11, Issue 2, p103
- ISSN
1057-9230
- Publication type
journal article
- DOI
10.1002/hec.685