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Progressivity in the financing of decentralized government health programs: a decomposition


  • Adam Wagstaff

    (The World Bank, Washington, DC, USA)

  • Magnus Lindelow

    (The World Bank, Washington, DC, USA)


In many countries health services and|or health insurance are delivered but also partly financed by subnational entities that vary in their fiscal or financial capacity, e.g. local governments and social health insurance schemes. The central government typically mandates a specific (or at least minimum) level of benefit or expenditure per intended beneficiary, and sets rules about enrollment and coverage. It also typically contributes to the cost of the program, partly because the resources of subnational entities may be insufficient, on average, to meet the expenditure requirements, but partly for equity reasons. These two problems are typically addressed through tax-transfer schemes. In practice, there is considerable institutional heterogeneity across countries in the mix of vertical and horizontal schemes, and the way each works. In this Note, we show how the progressivity of health outlays by subnational entities can be decomposed into contributions from vertical and horizontal schemes, and how each of these can be further decomposed into contributions from taxes and transfers. We suggest that, in addition to providing a foundation for future empirical work, the decomposition provides some insights into the reasons for different institutional choices, and into the way vertical and horizontal tax-transfer schemes operate in practice. Copyright © 2007 John Wiley & Sons, Ltd.

Suggested Citation

  • Adam Wagstaff & Magnus Lindelow, 2007. "Progressivity in the financing of decentralized government health programs: a decomposition," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1271-1275.
  • Handle: RePEc:wly:hlthec:v:16:y:2007:i:11:p:1271-1275
    DOI: 10.1002/hec.1212

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    References listed on IDEAS

    1. Kakwani, Nanok C, 1977. "Measurement of Tax Progressivity: An International Comparison," Economic Journal, Royal Economic Society, vol. 87(345), pages 71-80, March.
    2. Van de ven, Wynand P.M.M. & Ellis, Randall P., 2000. "Risk adjustment in competitive health plan markets," Handbook of Health Economics,in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 14, pages 755-845 Elsevier.
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    Cited by:

    1. Masayoshi Hayashi, 2011. "The effects of medical factors on transfer deficits in Public Assistance in Japan: a quantile regression analysis," International Journal of Health Economics and Management, Springer, vol. 11(4), pages 287-307, December.

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