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Socioeconomic inequalities in informal payments for health care: An assessment of the ‘Robin Hood’ hypothesis in 33 African countries

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  • Hyacinthe T. Kankeu

    (GREQAM - Groupement de Recherche en Économie Quantitative d'Aix-Marseille - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique)

  • Bruno Ventelou

    () (GREQAM - Groupement de Recherche en Économie Quantitative d'Aix-Marseille - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique, SESSTIM - U912 INSERM - Aix Marseille Univ - IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale - IRD - Institut de Recherche pour le Développement - INSERM - Institut National de la Santé et de la Recherche Médicale - AMU - Aix Marseille Université)

Abstract

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.

Suggested Citation

  • Hyacinthe T. Kankeu & Bruno Ventelou, 2016. "Socioeconomic inequalities in informal payments for health care: An assessment of the ‘Robin Hood’ hypothesis in 33 African countries," Post-Print hal-01447857, HAL.
  • Handle: RePEc:hal:journl:hal-01447857
    DOI: 10.1016/j.socscimed.2016.01.015
    Note: View the original document on HAL open archive server: https://hal-amu.archives-ouvertes.fr/hal-01447857
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    Cited by:

    1. Mulenga, Arnold & Ataguba, John Ele-Ojo, 2017. "Assessing income redistributive effect of health financing in Zambia," Social Science & Medicine, Elsevier, vol. 189(C), pages 1-10.
    2. Ivlevs, Artjoms & Hinks, Timothy, 2018. "Former Communist party membership and bribery in the post-socialist countries," Journal of Comparative Economics, Elsevier, vol. 46(4), pages 1411-1424.
    3. Astghik Mavisakalyan & Vladimir Otrachshenko & Olga Popova, 2019. "Can bribery buy health? Evidence from post-communist countries," Bankwest Curtin Economics Centre Working Paper series WP1905, Bankwest Curtin Economics Centre (BCEC), Curtin Business School.
    4. Williams, Colin C. & Horodnic, Adrian V., 2017. "Rethinking informal payments by patients in Europe: An institutional approach," Health Policy, Elsevier, vol. 121(10), pages 1053-1062.

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