The Impact of Resource Allocation and Purchasing Reforms on Equity

The Impact of Resource Allocation and Purchasing Reforms on Equity

This paper introduces a conceptual framework to investigate the equity consequences of resource allocation, strategic purchasing and payment system reforms (RAP) in health, and reviews the empirical literature that has analyzed the impact of these...

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Bibliographic Details
Main Author: Belli, Paolo Carlo
Format: Working Paper
Language:English
en_US
Published: World Bank, Washington, DC 2013
Subjects:
ACCESS TO HEALTH SERVICES
ADULT MORTALITY
BURDEN OF DISEASE
CHILD CARE
CHILD HEALTH
CHILD HEALTH SERVICES
COMMUNICABLE DISEASES
DEATHS
DETERMINANTS OF HEALTH
DIARRHEA
DISABILITY
ECONOMIC DEVELOPMENT
EMPLOYMENT
EQUITY IN HEALTH
EXTERNALITY
EXTREME POVERTY
FERTILITY
FERTILITY RATES
HEALTH CARE
HEALTH CARE FACILITIES
HEALTH CARE FINANCING
HEALTH CARE SERVICES
HEALTH CARE UTILIZATION
HEALTH ECONOMICS
HEALTH EXPENDITURE
HEALTH IMPACT
HEALTH INTERVENTIONS
HEALTH OUTCOMES
HEALTH POLICY
HEALTH REFORM
HEALTH REFORMS
HEALTH SECTOR
HEALTH SERVICES
HEALTH STATUS
HEALTH SURVEYS
HEALTH SYSTEM
HEALTH SYSTEMS
HOSPITAL CARE
HUMAN DEVELOPMENT
HUMAN RESOURCES
HUMAN RIGHTS
IMMUNIZATION
IMMUNIZATION RATES
IMMUNIZATION SERVICES
INCIDENCE ANALYSIS
INCOME
INFANT MORTALITY
INFANT MORTALITY RATE
INFANT MORTALITY RATES
INFECTION
INPATIENT CARE
INTERVENTION
ISOLATION
LESSONS LEARNED
LIFE EXPECTANCY
LIVE BIRTHS
MALNUTRITION
MATERNAL AND CHILD HEALTH
MEDICAL EQUIPMENT
MORBIDITY
MORTALITY
MOTIVATION
NUTRITION
OUTPATIENT CARE
PATIENTS
PRIMARY CARE
PRIMARY HEALTH CARE
PRIVATE SECTOR
PROMOTING HEALTH
PUBLIC HEALTH
PUBLIC HEALTH INSURANCE
PUBLIC HEALTH SYSTEMS
PUBLIC SECTOR
RESPIRATORY INFECTIONS
SERVICE DELIVERY
SOCIAL CAPITAL
UNDER 5 MORTALITY
URBAN POPULATIONS
Online Access:http://documents.worldbank.org/curated/en/2004/09/5635378/impact-resource-allocation-purchasing-reforms-equity
http://hdl.handle.net/10986/13739
Description
Summary:This paper introduces a conceptual framework to investigate the equity consequences of resource allocation, strategic purchasing and payment system reforms (RAP) in health, and reviews the empirical literature that has analyzed the impact of these reforms on equity. In the first part, the paper reviews the existing evidence on the distribution of health and health care utilization across socio-economic groups in developing countries. Such evidence shows a striking consistency in the association between poverty and poor health, and that the distribution of health benefits across socio-economic groups is highly unequal, favoring the wealthier segments of the population. At the same time it shows that the issue of quality of services is as important as the issue of their accessibility. Then the paper addresses the meaning of equity in health care: we argue that the concept of equity and that of an equitable distribution of resources in health are not as straightforward as they appear. In the second part, the paper reviews the core elements of RAP reforms, and it presents a survey of the empirical literature that has investigated the impact of RAP reforms from an equity perspective. We argue that some RAP reform components, such as the new resource allocation mechanisms, bear a strong pro-poor potential, but that other components can lead to the emergence of trade-offs between conflicting objectives, such as efficiency and equity. For instance, the new purchasing contracts and payment systems devised to enhance efficiency can create adverse equity effects. Conceptually, these trade-offs are significant and operating at several levels.

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