Distribution of public health care spending: a comparative analysis of Sub-Saharan Africa, Asia, Latin America and high income countries

Abstract

Background: In many countries, the quest to ensure that the poor have access to quality health care and benefit from services and other  related interventions remains a priority. Globally, it has been shown that the poor hardly benefit from health interventions even  when they are provided for free. Government spending on health care has the potential to increase access for the poorest populations, in  addition to promoting income cross-subsidisation, particularly in settings where it is administratively difficult to implement cash  transfer in a large scale. Despite this recognition, the extent to which health spending benefits the poor remains unexplored in many  countries. Although health system financing debates have shifted from targeting to universality, it remains important to ensure that  deliberate efforts are directed towards ensuring that the poor benefit from universal health systems, particularly because they often have  high need for care as compared to the rich. This study reviews literature on the distribution of government health spending in  Africa, Asia, Latin America and the Caribbean and high income countries. It also demonstrates the extent to which patterns reflect health  financing systems in the different regions.

Methods: The data used in this paper are from an extensive electronic search of both published articles and grey literature from relevant  databases. Literature was searched from data bases such as PubMed, MEDLINE, EBSCOHOST and Web of Science as well as from  websites of international institutions such as the World Bank, the International Monetary Fund (IMF), Organisation of Economic  Cooperation and Development (OECD), the World Health 2 Organisation (WHO), the Latin America and Caribbean Countries (LAC), and  the PanAmerican Health Organisation (PAHO). Articles and reports relating to benefit incidence analysis on government spending and  benefits distribution were selected and reviewed.

Results: Both rich and poor countries recorded some levels of inequalities but differences existed where inequalities were concentrated.  The distribution of primary health care services was mainly pro-poor in all the four regions, although a few African countries showed a  pro-rich distribution in these services. In high income countries, the largest inequalities existed on utilisation of specialists, while in Africa  and Asia, hospital level services were mainly prorich. Interestingly, the distribution of outpatient services at the hospital level was more  prorich than inpatient services in most African and Asian countries. The pattern in the distribution of health care benefits in most cases  reflected the country’s financing arrangements.

Conclusions: These findings call for increased efforts towards convincing governments to allocate 50% of their resources to district  hospitals and primary health care services that are likely to benefit the poor. Some progress towards pro-poor distribution has been  recorded in the last decade, particularly for primary health care services in Africa. Significant efforts towards restructuring health  financing arrangements and re-orientating health systems towards preventive and promotive care are urgently needed if universal  coverage is to be achieved and sustained in LMICs