Yu Chai Ping, Whynes David K, Sach Tracey H
Trent Research and Development Support Unit, School of Community Health Sciences, University of Nottingham, UK.
Int J Health Plann Manage. 2006 Jul-Sep;21(3):193-210. doi: 10.1002/hpm.845.
Throughout the world, policy makers are considering or implementing financing strategies that are likely to have a substantial impact on the equity of health financing. The assessment of the equity implication is clearly important, given the potential impact that alternative finance sources have on households. Households incur out-of-pocket payment directly from their budget, apart from their public or private insurance. Out-of-pocket payment is the primary concern, given their undesirable impact on households. Progressivity measures departures from proportionality in the relationship between out-of-pocket payment and ability to pay. It is the most frequently used yardstick to assess the equity of out-of-pocket payments in empirical studies. This paper provides an evaluation of such progressivity measures, undertaken using four approaches (proportion approach, tabulation approach, concentration curve and Kakwani's index), in order to reveal their usefulness and underlying notion. It is illustrated empirically with data on out-of-pocket payment for health care in Malaysia for 1998/ 1999, based on the nationally representative Household Expenditure Survey. Results indicate that out-of-pocket payments are mildly progressive, whilst the four approaches have their benefits and limitations in assessing equity implications. This analysis is of interest from a policy perspective, given Malaysia's heavy reliance on out-of-pocket payments to finance health care.
在全球范围内，政策制定者正在考虑或实施可能对卫生筹资公平性产生重大影响的筹资战略。鉴于不同融资来源对家庭可能产生的影响，对公平性影响的评估显然至关重要。除了公共或私人保险外，家庭需直接从其预算中支付自付费用。鉴于自付费用对家庭产生的不良影响，它是主要关注点。累进性衡量自付费用与支付能力之间关系偏离比例的程度。在实证研究中，它是评估自付费用公平性最常用的标准。本文对使用四种方法（比例法、列表法、集中曲线法和卡克瓦尼指数法）进行的此类累进性衡量进行评估，以揭示其有用性和基本概念。基于具有全国代表性的家庭支出调查，用1998/1999年马来西亚医疗保健自付费用数据进行了实证说明。结果表明，自付费用呈轻度累进性，而这四种方法在评估公平性影响方面各有优缺点。鉴于马来西亚严重依赖自付费用为医疗保健筹资，从政策角度来看，这一分析具有重要意义。
