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Health equity in Lebanon: a microeconomic analysis.

Salti N, Chaaban J, Raad F - Int J Equity Health (2010)

Bottom Line: Spending on health is found to be "normal" and income-elastic.Poverty is associated with lower insurance coverage for both private and public insurance.They have lower rates of insurance coverage, causing them to spend a larger proportion of their expenditures on health, and further confirming our results on the vulnerability of the bottom quintiles.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Economics, American University of Beirut, PO Box 110236, Riad el Solh, Beirut, 11072020, Lebanon. nisreen.salti@aub.edu.lb.

ABSTRACT

Background: The health sector in Lebanon suffers from high levels of spending and is acknowledged to be a source of fiscal waste. Lebanon initiated a series of health sector reforms which aim at containing the fiscal waste caused by high and inefficient public health expenditures. Yet these reforms do not address the issues of health equity in use and coverage of healthcare services, which appear to be acute. This paper takes a closer look at the micro-level inequities in the use of healthcare, in access, in ability to pay, and in some health outcomes.

Methods: We use data from the 2004/2005 Multi Purpose Survey of Households in Lebanon to conduct health equity analysis, including equity in need, access and outcomes. We briefly describe the data and explain some of its limitations. We examine, in turn, and using standardization techniques, the equity in health care utilization, the impact of catastrophic health payments on household wellbeing, the effect of health payment on household impoverishment, the equity implications of existing health financing methods, and health characteristics by geographical region.

Results: We find that the incidence of disability decreases steadily across expenditure quintiles, whereas the incidence of chronic disease shows the opposite pattern, which may be an indication of better diagnostics for higher quintiles. The presence of any health-related expenditure is regressive while the magnitude of out-of-pocket expenditures on health is progressive. Spending on health is found to be "normal" and income-elastic. Catastrophic health payments are likelier among disadvantaged groups (in terms of income, geography and gender). However, the cash amounts of catastrophic payments are progressive. Poverty is associated with lower insurance coverage for both private and public insurance. While the insured seem to spend an average of almost LL93,000 ($62) on health a year in excess of the uninsured, they devote a smaller proportion of their expenditures to health.

Conclusions: The lowest quintiles of expenditures per adult have less of an ability to pay out-of-pocket for healthcare, and yet incur healthcare expenditures more often than the wealthy. They have lower rates of insurance coverage, causing them to spend a larger proportion of their expenditures on health, and further confirming our results on the vulnerability of the bottom quintiles.

No MeSH data available.


Related in: MedlinePlus

Insurance type by hospitalization class. Source: Authors' estimates using 2004/2005 Household Survey
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Figure 10: Insurance type by hospitalization class. Source: Authors' estimates using 2004/2005 Household Survey

Mentions: These results, however, should be seen in contrast with the quality of services provided by either class of plan. Public insurance accounts for the overwhelming majority of second and third class hospitalization service, whereas private insurance accounts for more first class hospitalization plans, by a relatively thin margin of 10% (Figure 10). The quality of care is obviously strongly related to hospitalization class however we have no real measure of the magnitude of the difference in the quality of service across classes.


Health equity in Lebanon: a microeconomic analysis.

Salti N, Chaaban J, Raad F - Int J Equity Health (2010)

Insurance type by hospitalization class. Source: Authors' estimates using 2004/2005 Household Survey
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2864280&req=5

Figure 10: Insurance type by hospitalization class. Source: Authors' estimates using 2004/2005 Household Survey
Mentions: These results, however, should be seen in contrast with the quality of services provided by either class of plan. Public insurance accounts for the overwhelming majority of second and third class hospitalization service, whereas private insurance accounts for more first class hospitalization plans, by a relatively thin margin of 10% (Figure 10). The quality of care is obviously strongly related to hospitalization class however we have no real measure of the magnitude of the difference in the quality of service across classes.

Bottom Line: Spending on health is found to be "normal" and income-elastic.Poverty is associated with lower insurance coverage for both private and public insurance.They have lower rates of insurance coverage, causing them to spend a larger proportion of their expenditures on health, and further confirming our results on the vulnerability of the bottom quintiles.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Economics, American University of Beirut, PO Box 110236, Riad el Solh, Beirut, 11072020, Lebanon. nisreen.salti@aub.edu.lb.

ABSTRACT

Background: The health sector in Lebanon suffers from high levels of spending and is acknowledged to be a source of fiscal waste. Lebanon initiated a series of health sector reforms which aim at containing the fiscal waste caused by high and inefficient public health expenditures. Yet these reforms do not address the issues of health equity in use and coverage of healthcare services, which appear to be acute. This paper takes a closer look at the micro-level inequities in the use of healthcare, in access, in ability to pay, and in some health outcomes.

Methods: We use data from the 2004/2005 Multi Purpose Survey of Households in Lebanon to conduct health equity analysis, including equity in need, access and outcomes. We briefly describe the data and explain some of its limitations. We examine, in turn, and using standardization techniques, the equity in health care utilization, the impact of catastrophic health payments on household wellbeing, the effect of health payment on household impoverishment, the equity implications of existing health financing methods, and health characteristics by geographical region.

Results: We find that the incidence of disability decreases steadily across expenditure quintiles, whereas the incidence of chronic disease shows the opposite pattern, which may be an indication of better diagnostics for higher quintiles. The presence of any health-related expenditure is regressive while the magnitude of out-of-pocket expenditures on health is progressive. Spending on health is found to be "normal" and income-elastic. Catastrophic health payments are likelier among disadvantaged groups (in terms of income, geography and gender). However, the cash amounts of catastrophic payments are progressive. Poverty is associated with lower insurance coverage for both private and public insurance. While the insured seem to spend an average of almost LL93,000 ($62) on health a year in excess of the uninsured, they devote a smaller proportion of their expenditures to health.

Conclusions: The lowest quintiles of expenditures per adult have less of an ability to pay out-of-pocket for healthcare, and yet incur healthcare expenditures more often than the wealthy. They have lower rates of insurance coverage, causing them to spend a larger proportion of their expenditures on health, and further confirming our results on the vulnerability of the bottom quintiles.

No MeSH data available.


Related in: MedlinePlus