Universal health coverage and the poor: to what extent are health financing policies making a difference? Evidence from a benefit incidence analysis in Zambia

Martin Rudasingwa, Manuela de Allegri, Chrispin Mphuka, Collins Chansa, Edmund Yeboah, Emmanuel Bonnet, Valéry Ridde () and Bona Mukosha Chitah
Additional contact information
Martin Rudasingwa: Universität Heidelberg [Heidelberg] = Heidelberg University
Manuela de Allegri: Universität Heidelberg [Heidelberg] = Heidelberg University
Chrispin Mphuka: UNZA - University of Zambia [Lusaka]
Collins Chansa: Universität Heidelberg [Heidelberg] = Heidelberg University
Edmund Yeboah: Universität Heidelberg [Heidelberg] = Heidelberg University
Emmanuel Bonnet: PRODIG (UMR_8586 / UMR_D_215 / UM_115) - Pôle de recherche pour l'organisation et la diffusion de l'information géographique - UP1 - Université Paris 1 Panthéon-Sorbonne - IRD - Institut de Recherche pour le Développement - AgroParisTech - SU - Sorbonne Université - CNRS - Centre National de la Recherche Scientifique - UPCité - Université Paris Cité
Valéry Ridde: CEPED - UMR_D 196 - Centre population et développement - IRD - Institut de Recherche pour le Développement - UPCité - Université Paris Cité
Bona Mukosha Chitah: UNZA - University of Zambia [Lusaka]

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Abstract: Background: Zambia has invested in several healthcare financing reforms aimed at achieving universal access to health services. Several evaluations have investigated the effects of these reforms on the utilization of health services. However, only one study has assessed the distributional incidence of health spending across different socioeconomic groups, but without differentiating between public and overall health spending and between curative and maternal health services. Our study aims to fill this gap by undertaking a quasi-longitudinal benefit incidence analysis of public and overall health spending between 2006 and 2014. Methods: We conducted a Benefit Incidence Analysis (BIA) to measure the socioeconomic inequality of public and overall health spending on curative services and institutional delivery across different health facility typologies at three time points. We combined data from household surveys and National Health Accounts. Results: Results showed that public (concentration index of − 0.003; SE 0.027 in 2006 and − 0.207; SE 0.011 in 2014) and overall (0.050; SE 0.033 in 2006 and − 0.169; SE 0.011 in 2014) health spending on curative services tended to benefit the poorer segments of the population while public (0.241; SE 0.018 in 2007 and 0.120; SE 0.007 in 2014) and overall health spending (0.051; SE 0.022 in 2007 and 0.116; SE 0.007 in 2014) on institutional delivery tended to benefit the least-poor. Higher inequalities were observed at higher care levels for both curative and institutional delivery services. Conclusion: Our findings suggest that the implementation of UHC policies in Zambia led to a reduction in socioeconomic inequality in health spending, particularly at health centres and for curative care. Further action is needed to address existing barriers for the poor to benefit from health spending on curative services and at higher levels of care.

Keywords: UHC; Health financing; Benefit incidence analysis; Health benefits; Zambia (search for similar items in EconPapers)
Date: 2022
Note: View the original document on HAL open archive server: https://hal.science/hal-03824643v1
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Published in BMC Public Health, 2022, 22 (1), pp.1546. ⟨10.1186/s12889-022-13923-1⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-03824643

DOI: 10.1186/s12889-022-13923-1

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