IDEAS home Printed from
MyIDEAS: Log in (now much improved!) to save this article

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

Listed author(s):
  • 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.

If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.

File URL:
File Function: Link to full text; subscription required
Download Restriction: no

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

Volume (Year): 16 (2007)
Issue (Month): 11 ()
Pages: 1271-1275

in new window

Handle: RePEc:wly:hlthec:v:16:y:2007:i:11:p:1271-1275
DOI: 10.1002/hec.1212
Contact details of provider: Web page:

References listed on IDEAS
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.:

in new window

  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.
Full references (including those not matched with items on IDEAS)

This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

When requesting a correction, please mention this item's handle: RePEc:wly:hlthec:v:16:y:2007:i:11:p:1271-1275. See general information about how to correct material in RePEc.

For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Wiley-Blackwell Digital Licensing)

or (Christopher F. Baum)

If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

If references are entirely missing, you can add them using this form.

If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.

If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.

Please note that corrections may take a couple of weeks to filter through the various RePEc services.

This information is provided to you by IDEAS at the Research Division of the Federal Reserve Bank of St. Louis using RePEc data.