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How Does the Introduction of Health Insurance Change the Equity in the Health Care Provision in Bulgaria?

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  • Nora Markova
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    Abstract

    The study examines the effect of health care reform in Bulgaria in 1999 on the equity of health care financing. It explores the distribution of different types of health care financing by income. Furthermore, it separates the financial and social reasons for these differences, dividing them into economic and social inequalities. It suggests a method of distinguishing between financially based and "exclusion based" reasons for having progressive/regressive health care financing. Moreover, it looks at the social factors that shape health expenditure patterns and identifies those social characteristics that lead to exclusion from the health care system.

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    Bibliographic Info

    Paper provided by International Monetary Fund in its series IMF Working Papers with number 06/285.

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    Length: 39
    Date of creation: 01 Dec 2006
    Date of revision:
    Handle: RePEc:imf:imfwpa:06/285

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    Related research

    Keywords: Public finance; Income distribution; Poverty; Economic models; health care; health care financing; health care system; health care spending; pocket payments; health insurance; health care services; health care reform; health sector; health care provision; health policy; health economics; income groups; health care sector; health inequalities; health care expenditures; health care reforms; health care insurance; informal payments; health care expenditure; health expenditures; income variable; insurance system; health expenditure; health care utilization; delivery of health care; medical care; payments for health care; national health; inequalities in health care; health insurance system; provision of health care; health spending; inequity in health; medical insurance; health system; health care systems; financial protection; access to health care; financing of health care; health care facilities; health care delivery; health care policy; health care costs; health service; health care service utilization; payments for health services; health-care; pocket payments for health care; fee-for-service; health care resources; public spending; health insurance contributions; health care systems in transition; finance of health care; public health care; health sector reform; fee-for-service payment; health insurance taxation; financial impact; health system performance; care systems; national health insurance fund; health insurance fund; public health; public expenditure on health; risk adjustment; public expenditure; insurance contributions;

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    References

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    Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
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    1. 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.
    2. Doorslaer, Eddy van & Jones, Andrew M., 2003. "Inequalities in self-reported health: validation of a new approach to measurement," Journal of Health Economics, Elsevier, vol. 22(1), pages 61-87, January.
    3. Kakwani, Nanak C, 1977. "Applications of Lorenz Curves in Economic Analysis," Econometrica, Econometric Society, vol. 45(3), pages 719-27, April.
    4. Schokkaert, Erik & Van de Voorde, Carine, 2004. "Risk selection and the specification of the conventional risk adjustment formula," Journal of Health Economics, Elsevier, vol. 23(6), pages 1237-1259, November.
    5. 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.
    6. Eddy van Doorslaer & Andrew M. Jones, 2004. "Income-related inequality in health and health care in the European Union," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 605-608.
    7. Wagstaff, Adam & van Doorslaer, Eddy & Watanabe, Naoko, 2003. "On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam," Journal of Econometrics, Elsevier, vol. 112(1), pages 207-223, January.
    8. van Doorslaer, Eddy & Wagstaff, Adam, 1992. "Equity in the delivery of health care: some international comparisons," Journal of Health Economics, Elsevier, vol. 11(4), pages 389-411, December.
    9. Uitenbroek, Daan G. & Kerekovska, Albena & Festchieva, Nevijana, 1996. "Health lifestyle behaviour and socio-demographic characteristics. A study of Varna, Glasgow and Edinburgh," Social Science & Medicine, Elsevier, vol. 43(3), pages 367-377, August.
    10. Michael Marmot, 2001. "Income inequality, social environment, and inequalities in health," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 20(1), pages 156-159.
    11. Delcheva, Evgenia & Balabanova, Dina & McKee, Martin, 1997. "Under-the-counter payments for health care: Evidence from Bulgaria," Health Policy, Elsevier, vol. 42(2), pages 89-100, November.
    12. Minev, Duchomir & Dermendjieva, Bogdana & Mileva, Natasha, 1990. "The Bulgarian country profile: The dynamics of some inequalities in health," Social Science & Medicine, Elsevier, vol. 31(8), pages 837-846, January.
    13. Eddy van Doorslaer & Xander Koolman, 2004. "Explaining the differences in income-related health inequalities across European countries," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 609-628.
    14. Pavlova, Milena & Groot, Wim & van Merode, Godefridus, 2002. "Public attitudes towards patient payments in Bulgarian public health care sector: results of a household survey," Health Policy, Elsevier, vol. 59(1), pages 1-24, January.
    15. 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.
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    Cited by:
    1. Rama Joglekar, 2008. "Can Insurance Reduce Catastrophic Out-of-Pocket Health Expenditure?," Labor Economics Working Papers 22367, East Asian Bureau of Economic Research.

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