Health Equity and Financial Protection
196 pages
English

Health Equity and Financial Protection

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Two key policy goals in the health sector are equity and financial protection. New methods, data and powerful computers have led to a surge of interest in quantitative analysis that permits monitoring progress toward these objectives, and comparisons across countries. ADePT is a new computer program that streamlines and automates such work, ensuring that results are genuinely comparable and allowing them to be produced with a minimum of programming skills. This book provides a step-by-step guide to the use of ADePT for quantitative analysis of equity and financial protection in the health sector. It also gives the reader an accessible guide to the concepts and methods used by the software, as well as more detailed technical explanations.

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Publié par
Publié le 27 mai 2011
Nombre de lectures 28
EAN13 9780821387962
Langue English
Poids de l'ouvrage 2 Mo

Health Equity and Financial Protection Wagstaff, Bilger, Sajaia, and Lokshin
www.worldbank.org/adept STREAMLINED ANALYSIS WITH ADePT SOFTWARE
Two key policy goals in the health sector are equity and fi nancial protection. New methods, data, and powerful
computers have led to a surge of interest in quantitative analysis that permits the monitoring of progress toward these
goals, as well as comparisons across countries. ADePT is a new computer program that streamlines and automates
such work, ensuring that the results are genuinely comparable and allowing them to be produced with a minimum of
programming skills. Health Equity
This book provides a step-by-step guide to the use of ADePT for the quantitative analysis of equity and fi nancial
protection in the health sector. It also elucidates the concepts and methods used by the software and supplies more-
detailed, technical explanations. The book is geared to practitioners, researchers, students, and teachers who have some
knowledge of quantitative techniques and the manipulation of household data using such programs as SPSS or Stata.
“During the past 20 years, an increasingly standardized set of tools have been developed to analyze equity in health and Financial
outcomes and health fi nancing. Hitherto, the application of these analytical methods has remained the province of
health economists and statisticians. This book and the accompanying software democratize the conduct of such analyses,
offering an easily accessible guide to equity analysis in health without requiring sophisticated data analysis skills.” Adam Wagstaff
Sara Bennett, Associate Professor, Department of International Health, Bloomberg School of Public Health, Marcel Bilger
Johns Hopkins University, Baltimore, Maryland, United States
Zurab SajaiaProtection
“As the international health community becomes increasingly focused on monitoring the impact of universal coverage
Michael Lokshininitiatives, ADePT Health will help make the standard techniques more accessible to policy makers and analysts,
increase the comparability of health equity and fi nancial protection measures, and aid in generating the evidence
needed to support policy.”
Kara Hanson, Reader in Health System Economics, Health Policy Unit, London School of Hygiene and
Tropical Medicine, United Kingdom
“The ADePT software and manual make it possible for researchers without extensive statistical training to perform a
range of analyses that will provide an important evidence base for introducing universal coverage reforms and for
monitoring if these reforms are achieving their objectives. The ADePT initiative is an exciting and timely development
that will enable researchers in low- and middle-income (as well as high-income) countries to undertake health and
health system equity analyses that would previously have been lengthy and extremely resource intensive.”
Di McIntyre, Professor, School of Public Health and Family Medicine, University of Cape Town, South Africa
Streamlined Analysis with ADePT Software is a new series that provides academics, students, and policy practitioners
with a theoretical foundation, practical guidelines, and software tools for applied analysis in various areas of
economic research. ADePT Platform is a software package developed in the research department of the World Bank
(see www.worldbank.org/adept). The series examines such topics as sector performance and inequality in education,
the effectiveness of social transfers, labor market conditions, the effects of macroeconomic shocks on income
distribution and labor market outcomes, child anthropometrics, and gender inequalities.
ISBN 978-0-8213-8459-6
SKU 18459Health Equity and
Financial ProtectionSTREAMLINED ANALYSIS WITH ADePT SOFTWARE
Health Equity and
Financial Protection
Adam Wagstaff
Marcel Bilger
Zurab Sajaia
Michael Lokshin© 2011 The International Bank for Reconstruction and Development / The World Bank
1818 H Street, NW
Washington, DC 20433
Telephone: 202-473-1000
Internet: www.worldbank.org
All rights reserved
1 2 3 4 14 13 12 11
This volume is a product of the staff of the International Bank for Reconstruction and
Development / The World Bank. The findings, interpretations, and conclusions expressed in
this volume do not necessarily reflect the views of the Executive Directors of The World
Bank or the governments they represent.
The World Bank does not guarantee the accuracy of the data included in this work. The
boundaries, colors, denominations, and other information shown on any map in this work do
not imply any judgement on the part of The World Bank concerning the legal status of any
territory or the endorsement or acceptance of such boundaries.
Rights and Permissions
The material in this publication is copyrighted. Copying and/or transmitting portions or all
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to the Office of the Publisher, The World Bank, 1818 H Street NW, Washington, DC 20433,
USA; fax: 202-522-2422; e-mail: pubrights@worldbank.org.
ISBN: 978-0-8213-8459-6
eISBN: 978-0-8213-8796-2
DOI: 10.1596/978-0-8213-8459-6
Cover photo: © Shehzad Noorani /World Bank (woman and child); © iStockphoto.com/Olga
Altunina (background image)
Cover design: Kim Vilov
Library of Congress Cataloging-in-Publication Data has been requested.Contents
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xv
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xvii
Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xix
Chapter 1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
PART I: Health Outcomes, Utilization, and Benefit
Incidence Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Chapter 2
What the ADePT Health Outcomes Module Does . . . . . . . . . . . . . . . . .5
Measuring Inequality in and Utilization . . . . . . . . . . . . . . . . . . . . .5
Basic Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Standardization for Demographic Factors* . . . . . . . . . . . . . . . . . . . . . . . . .7
Accounting for Inequality Aversion* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Trading Off the Average against Inequality* . . . . . . . . . . . . . . . . . . . . . . . .8
Explaining Inequalities and Measuring Inequity* . . . . . . . . . . . . . . . . . . . . . .8
vContents
Benefit Incidence Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Basic BIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
BIA under Alternative Assumptions* . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Chapter 3
Data Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Household Identifier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Living Standards Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Direct Approaches to Measuring Living Standards . . . . . . . . . . . . . . . . . .16
Indirect to Living . . . . . . . . . . . . . . . .17
Health Outcome Variables 17
Child Survival . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Anthropometric Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
Other Measures of Adult Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
Health Utilization Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Variables for Basic Tabulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Weights and Survey Settings 21
Determinants of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21of Utilization 22
Information on for Benefit Incidence Analysis . . . . . . . . . . . . . .22
Fees Paid to Public Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
NHA Aggregate Data on Subsidies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Chapter 4
Example Data Set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Household Identification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
Living Standards Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
Health Outcome Variables 28Utilization V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
Variables for Basic Tabulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
Weights and Survey Settings 29
Determinants of Health 29of Utilization 29
Utilization Variables for Benefit Incidence Analysis . . . . . . . . . . . . . . . . . . .30
viContents
Fees Paid to Public Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
NHA Aggregate Data on Subsidies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
Chapter 5
How to Generate the Tables and Graphs . . . . . . . . . . . . . . . . . . . . . . .33
Main Tab 34
Determinants of Health or Utilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36
Benefit Incidence Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
Chapter 6
Interpreting the Tables and Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
Original Data Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
Interpreting the Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42
Basic Tabulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
Concepts 43
Interpreting the Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
Inequalities in Health Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
Concepts 45
Interpreting the Results 46
Concentration of Health Utilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Interpreting the Results 48
Explaining Inequalities in Health 49
Concepts 49
Interpreting the Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52
Decomposition of the Concentration Index . . . . . . . . . . . . . . . . . . . . . . . . . .54
Concepts 54
Interpreting the Results 55
Inequalities in Utilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
Interpreting the Results 55
Explaining Inequalities in Utilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
Concepts 57
Interpreting the Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
viiContents
Use of Public Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59
Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59
Interpreting the Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59
Payments to Public Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60
Concepts 60
Interpreting the Results 61
Health Care Subsidies: Cost Assumptions . . . . . . . . . . . . . . . . . . . . . . . . . . .62
Concepts 62
Interpreting the Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64
Concentration of Public Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . .66
Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66
Interpreting the Results 66
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69
Chapter 7
Technical Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71
Measuring Inequalities in Outcomes and Utilization . . . . . . . . . . . . . . . . . . .71
Note 1: The Concentration Curve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71
Note 2: The Index72
Note 3: Sensitivity of the Concentration Index to the Living
Standards Measure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75
Note 4: Extended Concentration Index . . . . . . . . . . . . . . . . . . . . . . . . . . .77
Note 5: Achievement Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78
Explaining Inequalities and Measuring Inequity . . . . . . . . . . . . . . . . . . . . . . .79
Note 6: Demographic Standardization of Health
and Utilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79
Note 7: Decomposition of the Concentration Index . . . . . . . . . . . . . . . . .82
Note 8: Distinguishing between Inequality and Inequity . . . . . . . . . . . . . .83
Benefit Incidence Analysis (BIA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84
Note 9: Public Health Subsidy in Standard BIA . . . . . . . . . . . . . . . . . . . .84
Note 10: Public Health Subsidy with Proportional
Cost Assumption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86
Note 11: Public Health Subsidy with Linear
Cost Assumption87
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89
viii