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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

Catastrophic vs. non-catastrophic payments by Mohafaza (province). Source: Authors' estimates using 2004/2005 Household Survey
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Figure 5: Catastrophic vs. non-catastrophic payments by Mohafaza (province). Source: Authors' estimates using 2004/2005 Household Survey

Mentions: We compare the geographical breakdown of households making catastrophic healthcare payments to that of households whose expenditure on healthcare does not exceed 25% of their overall household expenditures (Figure 5): the sharpest difference in the distribution is in the mohafaza of Nabatieh which accounts for around 9% of households whose healthcare payments fall below 25% of total household expenditures but close to 35% of households incurring catastrophic healthcare. The mohafaza of the South also shows sharp contrast: around 13% of households with non-catastrophic payments and close to 18% of households straddled with healthcare payments. Other remarkable differences that deserve note are that about 35% of households who spend less than a quarter of their income on healthcare are in Mount Lebanon. Similarly, the otherwise quite poor mohafaza of the North houses 17% of households whose payments are non-catastrophic but just 6% of households making catastrophic health payments. These results show an overlap between the districts that exhibit the starkest contrast in catastrophic healthcare payments and the incidence of repeated episodes of political violence (mainly in the governorates of Nabatieh and South Lebanon, in the southern part of the country) and their legacy of liabilities in terms of lifetime disabilities and risks in terms of unexploded mines and munitions.


Health equity in Lebanon: a microeconomic analysis.

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

Catastrophic vs. non-catastrophic payments by Mohafaza (province). 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 5: Catastrophic vs. non-catastrophic payments by Mohafaza (province). Source: Authors' estimates using 2004/2005 Household Survey
Mentions: We compare the geographical breakdown of households making catastrophic healthcare payments to that of households whose expenditure on healthcare does not exceed 25% of their overall household expenditures (Figure 5): the sharpest difference in the distribution is in the mohafaza of Nabatieh which accounts for around 9% of households whose healthcare payments fall below 25% of total household expenditures but close to 35% of households incurring catastrophic healthcare. The mohafaza of the South also shows sharp contrast: around 13% of households with non-catastrophic payments and close to 18% of households straddled with healthcare payments. Other remarkable differences that deserve note are that about 35% of households who spend less than a quarter of their income on healthcare are in Mount Lebanon. Similarly, the otherwise quite poor mohafaza of the North houses 17% of households whose payments are non-catastrophic but just 6% of households making catastrophic health payments. These results show an overlap between the districts that exhibit the starkest contrast in catastrophic healthcare payments and the incidence of repeated episodes of political violence (mainly in the governorates of Nabatieh and South Lebanon, in the southern part of the country) and their legacy of liabilities in terms of lifetime disabilities and risks in terms of unexploded mines and munitions.

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