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Horizontal equity in utilisation of care and fairness of health financing: a comparison of micro-health insurance and user fees in Rwanda

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  • Pia Schneider
  • Kara Hanson

    (London School of Hygiene and Tropical Medicine, London, UK)

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    Abstract

    This paper uses two methods to compare the impact of health care payments under insurance and user fees. Concentration indices for insured and uninsured groups are computed following the indirect standardisation method to evaluate horizontal inequity in utilisation of basic health care services. The minimum standard approach analyses the extent to which out-of-pocket health spending contributed to increased poverty. The analysis uses cross-sectional household survey data collected in Rwanda in 2000 in the context of the introduction of community-based health insurance. Results indicate that health spending had a small impact on the socio-economic situation of uninsured and insured households; however, this is at the expense of horizontal inequity in utilisation of care for user-fee paying individuals who reported significantly lower visit rates than the insured. Copyright © 2005 John Wiley & Sons, Ltd.

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    File URL: http://hdl.handle.net/10.1002/hec.1014
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    Bibliographic Info

    Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

    Volume (Year): 15 (2006)
    Issue (Month): 1 ()
    Pages: 19-31

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    Handle: RePEc:wly:hlthec:v:15:y:2006:i:1:p:19-31

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    Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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    1. Wagstaff, Adam & van Doorslaer, Eddy & Paci, Pierella, 1989. "Equity in the Finance and Delivery of Health Care: Some Tentative Cross-country Comparisons," Oxford Review of Economic Policy, Oxford University Press, vol. 5(1), pages 89-112, Spring.
    2. Bitran, Ricardo & Munoz, Juan & Aguad, Paulina & Navarrete, Mario & Ubilla, Gloria, 2000. "Equity in the financing of social security for health in Chile," Health Policy, Elsevier, vol. 50(3), pages 171-196, January.
    3. Waters, Hugh R., 2000. "Measuring equity in access to health care," Social Science & Medicine, Elsevier, vol. 51(4), pages 599-612, August.
    4. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-77, June.
    5. Adam Wagstaff & Eddy van Doorslaer, 2000. "Measuring and Testing for Inequity in the Delivery of Health Care," Journal of Human Resources, University of Wisconsin Press, vol. 35(4), pages 716-733.
    6. Winnie Yip & Peter Berman, 2001. "Targeted health insurance in a low income country and its impact on access and equity in access: Egypt's school health insurance," Health Economics, John Wiley & Sons, Ltd., vol. 10(3), pages 207-220.
    7. 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.
    8. Sergi Jiménez-Mart�n & José M. Labeaga & Maite Mart�nez-Granado, 2002. "Latent class versus two-part models in the demand for physician services across the European Union," Health Economics, John Wiley & Sons, Ltd., vol. 11(4), pages 301-321.
    9. Culyer, A. J. & Wagstaff, Adam, 1993. "Equity and equality in health and health care," Journal of Health Economics, Elsevier, vol. 12(4), pages 431-457, December.
    10. 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.
    11. Matthew Jowett & Anil Deolalikar & Peter Martinsson, 2004. "Health insurance and treatment seeking behaviour: evidence from a low-income country," Health Economics, John Wiley & Sons, Ltd., vol. 13(9), pages 845-857.
    12. 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.
    13. Hurley, Jeremiah, 2000. "An overview of the normative economics of the health sector," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 2, pages 55-118 Elsevier.
    14. Xander Koolman & Eddy van Doorslaer, 2004. "On the interpretation of a concentration index of inequality," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 649-656.
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    Cited by:
    1. Saksena, Priyanka & Antunes, Adélio Fernandes & Xu, Ke & Musango, Laurent & Carrin, Guy, 2011. "Mutual health insurance in Rwanda: Evidence on access to care and financial risk protection," Health Policy, Elsevier, vol. 99(3), pages 203-209, March.
    2. Rama Joglekar, 2008. "Can Insurance Reduce Catastrophic Out-of-Pocket Health Expenditure," Working Papers id:1647, eSocialSciences.
    3. Binagwaho, Agnes & Hartwig, Renate & Ingeri, Denyse & Makaka, Andrew, 2012. "Mutual health insurance and its contribution to improving child health in Rwanda," Passauer Diskussionspapiere, Volkswirtschaftliche Reihe V-66-12, University of Passau, Faculty of Business and Economics.
    4. Robyn, Paul Jacob & Fink, Günther & Sié, Ali & Sauerborn, Rainer, 2012. "Health insurance and health-seeking behavior: Evidence from a randomized community-based insurance rollout in rural Burkina Faso," Social Science & Medicine, Elsevier, vol. 75(4), pages 595-603.
    5. Dekker, Marleen & Wilms, Annegien, 2010. "Health Insurance and Other Risk-Coping Strategies in Uganda: The Case of Microcare Insurance Ltd," World Development, Elsevier, vol. 38(3), pages 369-378, March.
    6. Divya Parmar & Aurélia Souares & Manuela de Allegri & Germain Savadogo & Rainer Sauerborn, 2012. "Adverse selection in a community-based health insurance scheme in rural Africa: implications for introducing targeted subsidies," LSE Research Online Documents on Economics 46664, London School of Economics and Political Science, LSE Library.
    7. Witter, Sophie, 2012. "Health financing in fragile and post-conflict states: What do we know and what are the gaps?," Social Science & Medicine, Elsevier, vol. 75(12), pages 2370-2377.
    8. Fink, Günther & Robyn, Paul Jacob & Sié, Ali & Sauerborn, Rainer, 2013. "Does health insurance improve health?," Journal of Health Economics, Elsevier, vol. 32(6), pages 1043-1056.

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