PMID: 11921309Mar 29, 2002Paper

Reflections on and alternatives to WHO's fairness of financial contribution index

Health Economics
Adam Wagstaff

Abstract

In its 2000 World Health Report (WHR), the World Health Organization argues that a key dimension of a health system's performance is the fairness of its financing system. This paper provides a critical assessment of the index of fairness of financial contribution (FFC) proposed in the WHR. It shows that the index cannot discriminate between health financing systems that are regressive and those that are progressive, and cannot discriminate between horizontal inequity on the one hand, and progressivity and regressivity on the other. The paper compares the WHO index to an alternative and more illuminating approach developed in the income redistribution literature in the early 1990s and used in the late 1990s to study the fairness of various OECD countries' health financing systems. It ends with an illustrative empirical comparison of the two approaches using data on out-of-pocket payments for health services in Vietnam for two years - 1993 and 1998. This analysis is of some interest in its own right, given the large share of health spending from out-of-pocket payments in Vietnam, and the changes in fees and drug prices over the 1990s.

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Citations

Jan 20, 2007·Journal of Medical Systems·Felix MasiyeDavid Okello
Jun 11, 2008·International Journal for Equity in Health·Chai Ping YuTracey H Sach
May 28, 2013·Health Policy and Planning·Mohammad Abu-ZainehJean-Paul Moatti
Nov 17, 2009·Journal of Health Economics·Mohammad Abu-ZainehJean-Paul Moatti
Mar 4, 2008·Social Science & Medicine·Mohammad Abu-ZainehJean-Paul Moatti
Mar 26, 2004·Tropical Medicine & International Health : TM & IH·Wim Van DammeBruno Meessen
May 9, 2006·Health Policy·Kakoli Roy, David Hill Howard
Oct 30, 2003·International Journal of Health Services : Planning, Administration, Evaluation·Richard Horton
May 22, 2003·Health Affairs·Jui-Fen Rachel Lu, William C Hsiao
Jan 19, 2018·Health Policy and Planning·John E AtagubaVirginia Wiseman
Sep 15, 2005·Health Economics·Elias MossialosKonstantina Davaki
May 12, 2017·Revista de saúde pública·Alicia Lorena Núñez Mondaca, Chunhuei Chi
Sep 14, 2018·International Journal for Equity in Health·Virginia WisemanWalaiporn Patcharanarumol
Jun 19, 2019·International Journal for Equity in Health·Faride Sadat JalaliRamin Ravangard
Nov 1, 2008·Development and Change·Meri Koivusalo, Maureen Mackintosh
Mar 20, 2020·International Journal of Environmental Research and Public Health·Hao DongPierre Failler
May 19, 2021·BMC Research Notes·Ali DarvishiVahid Yazdi-Feyzabadi

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