Health systems in most OECD countries are highly redistributive in nature, with national programs or social insurance schemes guaranteeing that services are accessible to those who cannot afford to pay. Systems in developing countries are vastly different. Private markets often account for upward of 50% of total health expenditures, making equity a principal concern of health policy makers. This paper investigates equity aspects of health systems in a sample of developing countries, with particular focus on Ecuador and Morocco, to assess whether resources are being allocated in accordance with policy objectives.
A National Health Accounts methodology was used to estimate public and private expenditures for 1997 in both countries. Total expenditures as well as the flow of funds from their origin to the ultimate beneficiaries of health services were derived from a review of the public accounting system, interviews with financing agencies and providers, and estimates from the household survey on living conditions.
Preliminary results show tremendous disparity in the allocation of health funds. Social insurance schemes spend per contributor as much as 10-fold what the Ministry of Health spends per capita, but cover only a small fraction of the population. Regional differences are marked, with some provinces receiving per capita allocations that are 50% higher than the national average. Allocation of resources does not appear to match the health needs of the population nor stated policy priorities.
Learning Objectives: Greater understanding of health financing in developing countries.
Keywords: Financing, Developing Countries
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