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. 2. Introduction - background.
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Eddy van Doorslaer
Erasmus School of Economics
& Erasmus Medical Centre
Merck Foundation Lecture
London School of Economics, 16 March 2007
21 AsiaPoor kids more likely to die before age five
22 AsiaBut poor kids and mothers less likely to receive health services
Important to realize:
D= Stochastic Dominance (more pro-poor) ; * = strict dominance ; ns = not signif 5%
Subsidy still narrows rich-poor gap, and poor may benefit more from same subsidy.
All three emphasize universality, minimize user charges, seek to exempt the poor and spend more.
And private sector offering attractive alternative seems to lead to better targeting and redistribution.
Reporting effects by income: are poor more likely to report same condition as very good?
Yes in India and China (some domains), not in Indonesia (Fig)
Does heterogeneity correction ‘resurrect’ the SE gradients?
Yes, for some domains, and some countries. Not for others.
In general, for any linear additive explanatory model such as :
where y is health, X is a vector of determinants, and eis a disturbance term, one can write (Wagstaff et al, 2003):
And in (time) differences:
Income and growth helps, but is not sufficient
Targeted protection of worst off also helps
Interestingly, a combination of (near) universal public provision, linited user charges and good geographic dispersion of services, coupled with an attractive private alternative sometimes leads to best protection.