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

Social Science & Medicine
Hyacinthe Tchewonpi Kankeu, Bruno Ventelou

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 disadvanta...Continue Reading

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Citations

Mar 16, 2018·The International Journal of Health Planning and Management·Adrian V HorodnicLiviu Oprea
Nov 21, 2017·PLoS Neglected Tropical Diseases·Valerie MakogeMaria Koelen
Feb 16, 2019·Health Economics·Roxanne J KovacsJohn Cairns
Feb 8, 2020·BMC Health Services Research·Ning LiuAlex Jingwei He
Jun 27, 2019·International Journal for Equity in Health·Evelyn KabiaEdwine Barasa
Jan 7, 2020·BMC Health Services Research·Arefeh PourtalebAli Akhavan Behbahani
Mar 25, 2019·Health Policy and Planning·Marta Schaaf, Stephanie M Topp
Jan 21, 2017·Tropical Medicine and Health·Valerie MakogeMaria Koelen
Feb 25, 2021·Healthcare Management Forum·Stephen Duckett
May 23, 2021·Health Policy and Planning·Peter BinyarukaMasuma Mamdani
Sep 25, 2021·Health Policy and Planning·Nazim Habibov, Alena Auchynnikava
Oct 19, 2021·Health Policy and Planning·Selina RajanDina Balabanova

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