Development Research Group, The World Bank, Washington, DC 20433, USA.
Health Econ. 2012 Apr;21(4):351-66. doi: 10.1002/hec.1727. Epub 2011 Mar 10.
Authors of benefit-incidence analyses (BIA) have to impute subsidies using assumptions about the relationship between unobserved subsidies 'captured' by the household and what can be observed at the household and aggregate levels. This paper shows that one of the two assumptions used in BIA studies to date will necessarily produce a more pro-rich (or less pro-poor) picture of government health spending than the other, depending on whether utilization is more pro-rich or pro-poor than fees paid to public providers. Both assumptions have their disadvantages, and the paper suggests a couple of alternatives that explicitly link fees paid to the costliness of care. It shows that in the most likely case where fees are distributed in a more pro-rich fashion than utilization, the two traditional assumptions will produce less pro-rich distributions of subsidies than the two new alternatives. Also considered are three complications that arise in BIA studies, including factoring in social health insurance. The paper's theoretical results are illustrated with an empirical BIA for Vietnam.
利益-发生率分析（BIA）的作者必须使用关于家庭中未观察到的补贴与家庭和总体层面可观察到的补贴之间关系的假设来推断补贴。本文表明，迄今为止 BIA 研究中使用的两个假设之一将根据利用比向公共提供者支付的费用更有利于富人（或更有利于穷人）还是更有利于穷人，必然会产生比另一个更有利于富人（或更有利于穷人）的政府卫生支出图景。这两个假设都有其缺点，本文提出了一些替代方案，这些方案明确将支付的费用与护理费用的昂贵程度联系起来。结果表明，在最有可能的情况下，费用的分配比利用率更有利于富人，那么两种传统的假设将产生比两种新的替代方案更少的有利于富人的补贴分配。还考虑了 BIA 研究中出现的三个复杂情况，包括社会保险的因素。本文的理论结果通过对越南的实证 BIA 进行了说明。
