Equity in financing and use of health care in Ghana, South Africa, and Tanzania : implications for paths to universal coverage

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dc.contributor.authorMills, Anne
dc.contributor.authorAtaguba, John
dc.contributor.authorAkazili, James
dc.contributor.authorBorghi, Jo
dc.contributor.authorGarshong, Bertha
dc.date.accessioned2015-03-05T16:39:47Z
dc.date.available2015-03-05T16:39:47Z
dc.date.issued2012
dc.description.abstractBackground Universal coverage of health care is now receiving substantial worldwide and national attention, but debate continues on the best mix of financing mechanisms, especially to protect people outside the formal employment sector. Crucial issues are the equity implications of different financing mechanisms, and patterns of service use. We report a whole-system analysis—integrating both public and private sectors—of the equity of health-system financing and service use in Ghana, South Africa, and Tanzania. Methods We used primary and secondary data to calculate the progressivity of each health-care financing mechanism, catastrophic spending on health care, and the distribution of health-care benefits. We collected qualitative data to inform interpretation. Findings Overall health-care financing was progressive in all three countries, as were direct taxes. Indirect taxes were regressive in South Africa but progressive in Ghana and Tanzania. Out-of-pocket payments were regressive in all three countries. Health-insurance contributions by those outside the formal sector were regressive in both Ghana and Tanzania. The overall distribution of service benefits in all three countries favoured richer people, although the burden of illness was greater for lower-income groups. Access to needed, appropriate services was the biggest challenge to universal coverage in all three countries. Interpretation Analyses of the equity of financing and service use provide guidance on which financing mechanisms to expand, and especially raise questions over the appropriate financing mechanism for the health care of people outside the formal sector. Physical and financial barriers to service access must be addressed if universal coverage is to become a reality.en
dc.format.mimetypeapplication/pdf
dc.identifier.citationMills, A., Ataguba, J.E., Akazili, J., Borghi, J., Garshong, B., Makawia, S., et al. (2012). Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage. The Lancet, 380(9837), 126-133. doi:10.1016/S0140-6736(12)60357-2en
dc.identifier.urihttp://hdl.handle.net/10625/53817
dc.language.isoen
dc.publisherScienceDirecten
dc.subjectGHANAen
dc.subjectSOUTH AFRICAen
dc.subjectTANZANIAen
dc.subjectHEALTH FINANCINGen
dc.subjectHEALTH SYSTEMen
dc.subjectHEALTH EQUITYen
dc.subjectPROGRESSIVE TAXATIONen
dc.titleEquity in financing and use of health care in Ghana, South Africa, and Tanzania : implications for paths to universal coverageen
dc.typeJournal Article (peer-reviewed)en
idrc.dspace.accessIDRC Onlyen
idrc.noaccessDue to copyright restrictions the full text of this research output is not available in the IDRC Digital Library or by request from the IDRC Library. / Compte tenu des restrictions relatives au droit d'auteur, le texte intégral de cet extrant de recherche n'est pas accessible dans la Bibliothèque numérique du CRDI, et il n'est pas possible d'en faire la demande à la Bibliothéque du CRDI.en
idrc.project.componentnumber106439002
idrc.project.number106439
idrc.project.titleEquity in Health and Health Financing: Building and Strengthening Developing Country Networksen
idrc.recordsserver.bcsnumberIC01-4451-43
idrc.rims.adhocgroupIDRC SUPPORTEDen

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