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Who pays for health care in Asia?

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Author Info

  • O'Donnell, Owen
  • van Doorslaer, Eddy
  • Rannan-Eliya, Ravi P.
  • Somanathan, Aparnaa
  • Adhikari, Shiva Raj
  • Akkazieva, Baktygul
  • Harbianto, Deni
  • Garg, Charu C.
  • Hanvoravongchai, Piya
  • Herrin, Alejandro N.
  • Huq, Mohammed N.
  • Ibragimova, Shamsia
  • Karan, Anup
  • Kwon, Soon-man
  • Leung, Gabriel M.
  • Lu, Jui-fen Rachel
  • Ohkusa, Yasushi
  • Pande, Badri Raj
  • Racelis, Rachel
  • Tin, Keith
  • Tisayaticom, Kanjana
  • Trisnantoro, Laksono
  • Wan, Quan
  • Yang, Bong-Min
  • Zhao, Yuxin

Abstract

We estimate the distributional incidence of health care financing in 13 Asian territories that account for 55% of the Asian population. In all territories, higher-income households contribute more to the financing of health care. The better-off contribute more as a proportion of ability to pay in most low- and lower-middle-income territories. Health care financing is slightly regressive in three high-income economies with universal social insurance. Direct taxation is the most progressive source of finance and is most so in poorer economies. In universal systems, social insurance is proportional to regressive. In high-income economies, the out-of-pocket (OOP) payments are proportional or regressive while in low-income economies the better-off spend relatively more OOP. But in most low-/middle-income countries, the better-off not only pay more, they also get more health care.

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Bibliographic Info

Article provided by Elsevier in its journal Journal of Health Economics.

Volume (Year): 27 (2008)
Issue (Month): 2 (March)
Pages: 460-475

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Handle: RePEc:eee:jhecon:v:27:y:2008:i:2:p:460-475

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Web page: http://www.elsevier.com/locate/inca/505560

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  1. van Doorslaer, Eddy & Wagstaff, Adam & van der Burg, Hattem & Christiansen, Terkel & Citoni, Guido & Di Biase, Rita & Gerdtham, Ulf-G. & Gerfin, Mike & Gross, Lorna & Hakinnen, Unto, 1999. "The redistributive effect of health care finance in twelve OECD countries," Journal of Health Economics, Elsevier, vol. 18(3), pages 291-313, June.
  2. Suits, Daniel B, 1977. "Measurement of Tax Progressivity," American Economic Review, American Economic Association, vol. 67(4), pages 747-52, September.
  3. Eddy van Doorslaer & Owen O'Donnell & Ravindra P. Rannan-Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Charu C. Garg & Deni Harbianto & Alejandro N. Herrin & Mohammed Nazmul Huq & Shamsia Ibragimo, 2007. "Catastrophic payments for health care in Asia," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1159-1184.
  4. Eddy van Doorslaer, 2007. "Paying Out-of-Pocket for Health Care in Asia: Catastrophic and Poverty Impact," Working Papers id:823, eSocialSciences.
  5. H. Naci Mocan & Erdal Tekin & Jeffrey S. Zax, 2000. "The Demand for Medical Care in Urban China," NBER Working Papers 7673, National Bureau of Economic Research, Inc.
  6. Paul J. Gertler & Luis Locay & Warren C. Sanderson, 1987. "Are User Fees Regressive? The Welfare Implications of Health Care Financing Proposals in Peru," NBER Working Papers 2299, National Bureau of Economic Research, Inc.
  7. van Doorslaer, Eddy & Wagstaff, Adam & van der Burg, Hattem & Christiansen, Terkel & De Graeve, Diana & Duchesne, Inge & Gerdtham, Ulf-G & Gerfin, Michael & Geurts, Jose & Gross, Lorna, 2000. "Equity in the delivery of health care in Europe and the US," Journal of Health Economics, Elsevier, vol. 19(5), pages 553-583, September.
  8. Kakwani, Nanok C, 1977. "Measurement of Tax Progressivity: An International Comparison," Economic Journal, Royal Economic Society, vol. 87(345), pages 71-80, March.
  9. Wagstaff, Adam & van Doorslaer, Eddy & van der Burg, Hattem & Calonge, Samuel & Christiansen, Terkel & Citoni, Guido & Gerdtham, Ulf-G & Gerfin, Mike & Gross, Lorna & Hakinnen, Unto, 1999. "Equity in the finance of health care: some further international comparisons1," Journal of Health Economics, Elsevier, vol. 18(3), pages 263-290, June.
  10. Lerman, Robert I. & Yitzhaki, Shlomo, 1989. "Improving the accuracy of estimates of Gini coefficients," Journal of Econometrics, Elsevier, vol. 42(1), pages 43-47, September.
  11. Aronson, J Richard & Johnson, Paul & Lambert, Peter J, 1994. "Redistributive Effects and Unequal Income Tax Treatment," Economic Journal, Royal Economic Society, vol. 104(423), pages 262-70, March.
  12. Pannarunothai, Supasit & Mills, Anne, 1997. "The poor pay more: Health-related inequality in Thailand," Social Science & Medicine, Elsevier, vol. 44(12), pages 1781-1790, June.
  13. Wagstaff, Adam & van Doorslaer, Eddy, 1992. "Equity in the finance of health care: Some international comparisons," Journal of Health Economics, Elsevier, vol. 11(4), pages 361-387, December.
  14. Owen O'Donnell & Eddy van Doorslaer & Ravi P. Rannan-Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Deni Harbianto & Charu C. Garg & Piya Hanvoravongchai & Mohammed N. Huq & Anup Karan & Gabriel M., 2007. "The Incidence of Public Spending on Healthcare: Comparative Evidence from Asia," World Bank Economic Review, World Bank Group, vol. 21(1), pages 93-123.
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Citations

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Cited by:
  1. Adam Wagstaff, 2010. "Social health insurance reexamined," Health Economics, John Wiley & Sons, Ltd., vol. 19(5), pages 503-517.
  2. Gabriel M. Leung & Keith Y. K. Tin & Owen O'Donnell, 2009. "Redistribution or horizontal equity in Hong Kong's mixed public-private health system: a policy conundrum," Health Economics, John Wiley & Sons, Ltd., vol. 18(1), pages 37-54.
  3. Adam Wagstaff & Marcel Bilger & Zurab Sajaia & Michael Lokshin, 2011. "Health Equity and Financial Protection : Streamlined Analysis with ADePT Software," World Bank Publications, The World Bank, number 2306, October.
  4. Awad Mataria & Firas Raad & Mohammad Abu-Zaineh & Cam Donaldson, 2010. "Catastrophic healthcare payments and impoverishment in the occupied Palestinian territory," Applied Health Economics and Health Policy, Springer, vol. 8(6), pages 393-405, November.
  5. Kumagai, Narimasa, 2010. "On Geographic Inequality in Japanese Regional Health Insurance," PIE/CIS Discussion Paper 465, Center for Intergenerational Studies, Institute of Economic Research, Hitotsubashi University.
  6. Rutger Daems & Edith Maes, 2014. "Global Pharmaceutical Management: Building a Fair Pricing Policy," Working Papers 2014/05, Maastricht School of Management.
  7. Wagstaff, Adam, 2005. "Health systems in East Asia : what can developing countries learn from Japan and the Asian tigers ?," Policy Research Working Paper Series 3790, The World Bank.
  8. Eddy van Doorslaer & Owen O'Donnell & Ravindra P. Rannan-Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Charu C. Garg & Deni Harbianto & Alejandro N. Herrin & Mohammed Nazmul Huq & Shamsia Ibragimo, 2007. "Catastrophic payments for health care in Asia," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1159-1184.
  9. Amedeo Spadaro & Lucia Mangiavacchi & Ignacio Moral-Arce & Marta Adiego-Estella & Angela Blanco-Moreno, 2013. "Evaluating the redistributive impact of public health expenditure using an insurance value approach," The European Journal of Health Economics, Springer, vol. 14(5), pages 775-787, October.
  10. Supon Limwattananon & Viroj Tangcharoensathien & Phusit Prakongsai, 2008. "Equity in Financing Healthcare: Impact of Universal Access to Healthcare in Thailand," Working Papers id:1577, eSocialSciences.
  11. Eddy van Doorslaer & Owen O’ Donnell, 2010. "Measurement and Explanation of Inequality in Health and Health Care in Low-Income Settings," Working Papers id:3177, eSocialSciences.
  12. Mohammad Hajizadeh & Hong Nghiem, 2011. "Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments?," International Journal of Health Care Finance and Economics, Springer, vol. 11(4), pages 267-285, December.
  13. Cavagnero, Eleonora & Bilger, Marcel, 2010. "Equity during an economic crisis: Financing of the Argentine health system," Journal of Health Economics, Elsevier, vol. 29(4), pages 479-488, July.

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