Socioeconomic inequalities in informal payments for health care: An assessment of the ‘Robin Hood’ hypothesis in 33 African countries
In almost all African countries, informal payments are frequently made when accessing health care. Some literature suggests that the informal payment system could lead to quasi-redistribution among patients, with physicians playing a ‘Robin Hood’ role, subsidizing the poor at the expense of the rich. We empirically tested this assumption with data from the rounds 3 and 5 of the Afrobarometer surveys conducted in 18 and 33 African countries respectively, from 2005 to 2006 for round 3 and from 2011 to 2013 for round 5. In these surveys, nationally representative samples of people aged 18 years or more were randomly selected in each country, with sizes varying between 1048 and 2400 for round 3 and between 1190 and 2407 for round 5. We used the ‘normalized’ concentration index, the poor/rich gap and the odds ratio to assess the level of inequality in the payment of bribes to access care at the local public health facility and implemented two decomposition techniques to identify the contributors to the observed inequalities. We obtained that: i) the socioeconomic gradient in informal payments is in favor of the rich in almost all countries, indicating a rather regressive system; ii) this is mainly due to the socioeconomic disadvantage itself, to poor/rich differences in supply side factors like lack of medicines, absence of doctors and long waiting times, as well as regional disparities. Although essentially empirical, the paper highlights the need for African health systems to undergo substantial country-specific reforms in order to better protect the worse-off from financial risk when they seek care.
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Volume (Year): 151 (2016)
Issue (Month): C ()
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- Vian, Taryn & Grybosk, Kristina & Sinoimeri, Zamira & Hall, Rachel, 2006. "Informal payments in government health facilities in Albania: Results of a qualitative study," Social Science & Medicine, Elsevier, vol. 62(4), pages 877-887, February.
- Doorslaer, Eddy van & Wagstaff, Adam & Rutten, Frans (ed.), 1992. "Equity in the Finance and Delivery of Health Care: An International Perspective," OUP Catalogue, Oxford University Press, number 9780192622914.
- Fairlie, Robert W, 1999.
"The Absence of the African-American Owned Business: An Analysis of the Dynamics of Self-Employment,"
Journal of Labor Economics,
University of Chicago Press, vol. 17(1), pages 80-108, January.
- Fairlie, Robert, 2014. "The Absence of the African-American Owned Business: An Analysis of the Dynamics of Self-Employment," Santa Cruz Department of Economics, Working Paper Series qt49c4n0fg, Department of Economics, UC Santa Cruz.
- Mæstad, Ottar & Mwisongo, Aziza, 2011. "Informal payments and the quality of health care: Mechanisms revealed by Tanzanian health workers," Health Policy, Elsevier, vol. 99(2), pages 107-115, February.
- Nguyen, Ha T.H. & Hatt, Laurel & Islam, Mursaleena & Sloan, Nancy L. & Chowdhury, Jamil & Schmidt, Jean-Olivier & Hossain, Atia & Wang, Hong, 2012. "Encouraging maternal health service utilization: An evaluation of the Bangladesh voucher program," Social Science & Medicine, Elsevier, vol. 74(7), pages 989-996.
- Eddy van Doorslaer & Xander Koolman & Andrew M. Jones, 2004. "Explaining income-related inequalities in doctor utilisation in Europe," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 629-647.
- Mackenbach, Johan P. & Kunst, Anton E., 1997. "Measuring the magnitude of socio-economic inequalities in health: An overview of available measures illustrated with two examples from Europe," Social Science & Medicine, Elsevier, vol. 44(6), pages 757-771, March.
- Balabanova, Dina & McKee, Martin, 2002. "Understanding informal payments for health care: the example of Bulgaria," Health Policy, Elsevier, vol. 62(3), pages 243-273, December.
- 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.
- Wagstaff, Adam & Van Doorslaer, Eddy & Watanabe, Naoko, 2001. "On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam," Policy Research Working Paper Series 2714, The World Bank.
- Gaal, Peter & Evetovits, Tamas & McKee, Martin, 2006. "Informal payment for health care: Evidence from Hungary," Health Policy, Elsevier, vol. 77(1), pages 86-102, June.
- Belli, Paolo & Gotsadze, George & Shahriari, Helen, 2004. "Out-of-pocket and informal payments in health sector: evidence from Georgia," Health Policy, Elsevier, vol. 70(1), pages 109-123, October.
- Adam Wagstaff, 2005. "The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 429-432.
- Wagstaff, Adam, 2009. "Correcting the concentration index: A comment," Journal of Health Economics, Elsevier, vol. 28(2), pages 516-520, March.
- Hyacinthe Tchewonpi Kankeu & Sylvie Boyer & Raoul Fodjo Toukam & Mohammad Abu-Zaineh, 2016. "How do supply-side factors influence informal payments for healthcare? The case of HIV patients in Cameroon," International Journal of Health Planning and Management, Wiley Blackwell, vol. 31(1), pages 41-57, January.
- Kankeu Tchewonpi, Hyacinthe & Boyer, Sylvie & Fodjo Toukan, Raoul & Abu-Zaineh, Mohammad, 2014. "How do supply-side factors influence informal payments for healthcare? The case of HIV patients in Cameroon," MPRA Paper 58068, University Library of Munich, Germany.
- Hyacinthe T. Kankeu & Sylvie Boyer & Raoul A. Fodjo Toukam & Mohammad Abu-Zaineh, 2016. "How do supply-side factors influence informal payments for healthcare? The case of HIV patients in Cameroon," Post-Print hal-01446192, HAL.
- Cherecheş, Răzvan M. & Ungureanu, Marius I. & Sandu, Petru & Rus, Ioana A., 2013. "Defining informal payments in healthcare: A systematic review," Health Policy, Elsevier, vol. 110(2), pages 105-114.
- Mokhtari, Manouchehr & Ashtari, Mamak, 2012. "Reducing informal payments in the health care system: Evidence from a large patient satisfaction survey," Journal of Asian Economics, Elsevier, vol. 23(2), pages 189-200.
- Chen, Zhuo & Roy, Kakoli, 2009. "Calculating concentration index with repetitive values of indicators of economic welfare," Journal of Health Economics, Elsevier, vol. 28(1), pages 169-175, January.
- Kakwani, Nanak & Wagstaff, Adam & van Doorslaer, Eddy, 1997. "Socioeconomic inequalities in health: Measurement, computation, and statistical inference," Journal of Econometrics, Elsevier, vol. 77(1), pages 87-103, March.
- Szende, Agota & Culyer, Anthony Johr, 2006. "The inequity of informal payments for health care: The case of Hungary," Health Policy, Elsevier, vol. 75(3), pages 262-271, February. Full references (including those not matched with items on IDEAS)
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