Read full article: http://fhs.mcmaster.ca/main/news/news_2011/health_economists.html

Find out more about Prof Birch: http://heu-uct.org.za/about-heu/staff/professor-stephen-birch/

For more information, see: http://www.hst.org.za/publications/presentations-national-health-insurance-nhi-conference-2011

http://ssrn.com/abstract=1937721

Methods 

Two nationally representative cross-sectional households surveys conducted in 2003 and 2007 were the main sources of data. A comprehensive analysis of the entire health system is conducted including the public sector, private-not-for-profit and private-for-profit sectors. Standard benefit incidence analysis techniques were applied and adopted to allow application to private sector services.

Results

The results indicate that the three sectors recorded similar levels of pro-rich distribution in 2003, but in 2007, the private-not-for-profit sector was pro-poor, public sector benefits showed an equal distribution, while the private-for-profit sector remained pro-rich. Larger pro-rich disparities were recorded for inpatient compared to outpatient benefits at the hospital level, but primary health care services were pro-poor. Benefits were distributed on the basis of ability to pay and not on need for care.

Conclusions

The principles of universal coverage require that all should benefit from health care according to need. The Kenyan health sector is clearly inequitable and benefits are not distributed on the basis of need. Deliberate efforts should be directed to restructuring the Kenyan health system to address access barriers and ensure that all Kenyans benefit from health care when they need it.

http://www.biomedcentral.com/1471-2458/12/20/abstract

Objective: The objective of this article is to present an analysis of alcohol tax incidence for the first time in South Africa. This was done for each category of alcohol tax (wines, spirits, beer and traditional brew [sorghum beer]) and for alcohol tax as a whole. The paper also uses the results to point to the areas where a greater understanding of the issues surrounding alcohol abuse needs to be developed.

Methods: Data were drawn from the 2005/06 South African Income and Expenditure Survey. Reported expenditures on alcohol beverages were used to obtain the tax component paid by households. This was done under certain assumptions relating to alcohol content and the price per litre of alcohol. Per adult equivalent consumption expenditure was used as the measure of relative living standards and concentration curves and Kakwani indices to assess relative progressivity of alcohol taxes. Statistical dominance tests were also performed.

Results: Most sorghum beer and malt beer drinkers were in the poorer quintiles. The reverse was the case for wines and spirits. Overall, alcohol tax in South Africa was regressive (Kakwani index −0.353). The individual categories were found to be regressive. The most regressive tax was that on sorghum beer (Kakwani index −1.01); the least regressive was that on spirits (Kakwani index −0.09), although this was not statistically significant at conventional levels. These results were confirmed by the test of dominance.

Conclusion: In South Africa, there has been a renewed interest in addressing the problem of rising alcohol abuse, but the extent to which this will translate into meaningful policies is unclear. The use of an excise tax is increasingly being recognized by economists as a way to get around some of the negative effects of abusive alcohol consumption. However, this study indicates that alcohol taxes are regressive in South Africa.

http://adisonline.com/healtheconomics/Abstract/2012/10010/Alcohol_Policy_and_Taxation_in_South_Africa__An.6.aspx

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• Who pays for health care in Ghana? (by Di McIntyre & colleagues) -  Financial protection against the cost of unforeseen ill health has become a global concern as expressed in the 2005 World Health Assembly resolution (WHA58.33), which urges its member states to “plan the transition to universal coverage of their citizens”. An important element of financial risk protection is to distribute health care financing fairly in relation to ability to pay. The distribution of health care financing burden across socio-economic groups has been estimated for European countries, the USA and Asia. Until recently there was no such analysis in Africa and this paper seeks to contribute to filling this gap. It presents the first comprehensive analysis of the distribution of health care financing in relation to ability to pay in Ghana.

Socioeconomic-related health inequality in South Africa: evidence from General Household Surveys (by John Ataguba, Di McIntyre & colleagues) – Inequalities in health have received considerable attention from health scientists and economists. In South Africa, inequalities exist in socio-economic status (SES) and in access to basic social services and are exacerbated by inequalities in health. While health systems, together with the wider social determinants of health, are relevant in seeking to improve health status and health inequalities, those that need good quality health care too seldom get it. Studies on the burden of ill-health in South Africa have shown consistently that, relative to the wealthy, the poor suffer more from more disease and violence. However, these studies are based on selected disease conditions and only consider a single point in time. Trend analyses have yet to be produced. This paper specifically investigates socio-economic related health inequality in South Africa and seeks to understand how the burden of self-reported illness and disability is distributed and whether this has changed since the early 2000s.

This PHASA conference is focusing on reducing health inequities so it is fitting that REACH has been given a session where six REACH members will give the following presentations:

• Utilisation Incidence Analysis: A comparison between the use of and need for public health services in South Africa – Silal
• Statistics and stories: Mixing methods to research equity in access to South African healthcare – B Harris
• Modelling complex treatment pathways and access barriers across multiple levels – H Schneider
• Resistance and resilience: narratives of patients and providers in South Africa’s public healthcare system – V Govender
• Exploring dimensions of integration: evaluating HIV and TB services in rural and urban South Africa – V Scott
• Demography of ageing: Access to health and health seeking behaviour of elderly in the Democratic Republic of Congo – T Zihindula