ABSTRACT

This study estimates progressivity of out-of-pocket (OOP) health payments and their determinants using South African Income and Expenditure Surveys. Concentration is decomposed to examine the effect of household determinants on OOP inequality, shedding light on how progressivity/regressivity is related to changes in the concentration and elasticities of the determinants over time. Our results suggest that actual OOP health expenditures are concentrated among non-poor households, although less so now than in the recent past. When OOP health payments are viewed from the perspective of affordability, which instead focuses on the share of payments relative to capacity-to-pay, they are regressive; However, they have become less concentrated amongst poor households, although still regressive, recently. These results appear to be independent of the measure of socioeconomic status employed in the analysis. The results highlight large income and education-related disparities and also suggest continued gender and ethnic differences that deserve further attention in policymaking.

摘要

本研究使用南非收入和支出调查估算了自费 (OOP) 医疗支付的累进性及其决定因素。分解浓度以检查家庭决定因素对 OOP 不平等的影响，阐明渐进性/回归性如何与决定因素的浓度和弹性随时间的变化相关联。我们的结果表明，实际的 OOP 卫生支出集中在非贫困家庭中，尽管现在比最近少了。当从负担能力的角度看待 OOP 医疗支付时，它侧重于支付相对于支付能力的份额，它们是倒退的；然而，它们在贫困家庭中的集中度有所降低，尽管最近仍呈倒退趋势。这些结果似乎与分析中采用的社会经济地位衡量无关。结果突出了与收入和教育相关的巨大差距，并表明持续存在的性别和种族差异值得在决策中进一步关注。